Objective: Examine the effects of GPi or STN DBS on caregiver burden for Parkinson’s Disease

Background: Deep Brain Stimulation (DBS) is a common treatment used to improve quality of life (QOL) in Parkinson’s Disease (PD). Given the disabling nature of PD, caregiver burden is an important consideration for optimal treatment outcomes. Though some studies have shown improved caregiver burden post DBS, little is known about potential differences between the two most common DBS targets: subthalamic nucleus (STN) and globus pallidus interna (GPi). This study aims to assess caregiver burden and associated factors after DBS implantation at STN or GPi for PD.

Method: Cognitive and behavioral data was analyzed for 45 PD patients (29 male) who underwent bilateral DBS implantation at STN (n = 22) or GPI (n=23) and whose caregivers completed the Parkinson’s Disease Questionnaire for Caregivers (PDQ-C) before and approximately 6 – 18 months after surgery. For each target, 4 t-tests analyzed for change before to after surgery in total PDQ-C and sub-scores: stress, social/personal activities, anxiety/depression, and self-care. For all significantly changed scores, 9 multivariate regressions analyzed for potential predictors among patient factors such as QoL (PDQ-39), impulsivity (QUIP-RS), cognition (MMSE), mood (BDI-II), and frontal dysfunction (FrSBe subscores). The statistically significant test used to measure secondary outcomes in GPI was changes in social and personal activities for caregivers. The statistically significant test used to measure secondary outcomes in STN was changes to caregiver stress levels.

Results: Caregivers reported significant increase in social and personal activities after GPi DBS (-6.341 ± 16.977, p = 0.0435), which was associated with decreased QUIP-RS and FrSBe disinhibition scores. After STN DBS, caregivers reported significantly increased stress (10.644 ± 18.609, p = 0.004), which was associated with increased QUIP-RS and decreased FrSBe disinhibition scores.

Conclusion: Results suggest that social aspects of caregiver burden may improve among those caring for PD patients after GPi DBS, which may relate to improved impulse control in patients. Conversely, increased caregiver stress may be seen after STN DBS, which may relate to worsened impulse control in patients. Findings highlight the importance of better understanding the implications of PD DBS target differences in caregiver burden for improved treatment outcomes.

References: 1. Jost ST, Aloui S, Evans J, et al. Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years: A Nonrandomized Controlled Trial. JAMA Network Open. 2024;7(1):e2352177. doi:10.1001/jamanetworkopen.2023.52177
2. Soileau MJ, Persad C, Taylor J, Patil PG, Chou KL. Caregiver burden in patients with Parkinson disease undergoing deep brain stimulation: an exploratory analysis. J Parkinsons Dis. 2014;4(3):517-21. doi: 10.3233/JPD-140380. PMID: 24903924.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/caregiver-burden-after-dbs-at-gpi-or-stn-for-parkinsons-disease/