Objective: To compare the cognitive and quality of life (QoL) outcomes of GPi-DBS and GPi-RF, investigating whether lesion-based approaches pose a greater cognitive burden over time.

Background: The resurgence of lesion-based therapies for Parkinson’s disease (PD) has raised questions about their long-term effects on cognition. While deep brain stimulation (DBS) of the GPi remains a gold standard, pallidotomy (GPi-RF) is being reconsidered especially for patients without access to DBS. However, it remains unclear whether lesioning strategies, carry a higher risk of cognitive decline compared to neuromodulation at the same target.

Method: A consecutive series of 102 PD patients treated with GPi-DBS (n=46) or GPi-RF (n=56) between 2017 and 2022 was conducted. Inclusion criteria followed contemporary selection protocols, considering disease duration, motor response to levodopa, baseline cognition (MoCA ≥ 24), and absence de major psychiatric comorbidities. Cognitive performance was assessed via MoCA and PDQ-39 cognition domain, while QoL was evaluated using PDQ-39. Follow-ups occurred at 1, 3, and 18 months postoperatively. UPDRS scores and levodopa equivalent daily dose (LEDD) were analyzed.

Results: Cognition (MoCA & PDQ-39 Cognition Domain):

No significant long-term cognitive decline was observed in either group.

GPi-RF patients experienced transient memory reductions at 1 month, which resolved by 3 months.

Quality of Life (PDQ-39):

GPi-DBS improved mobility more significantly (PDQ-39 mobility: 48.9 → 31.6).

GPi-RF provided greater relief in discomfort and ADL dependence (bodily discomfort: 49.9 → 29.8; ADLs: 47.1 → 25.2).

Both groups showed significant improvements in emotional well-being and cognitive QoL domains.

LEDD Progression:

GPi-DBS patients showed a progressive LEDD increase at 18 months, consistent with long-term PD management in GPi-operated patients, with both GPi-DBS and GPi-RF requiring adjustments.

Conclusion: Both GPi-DBS and GPi-RF significantly improved quality of life, with DBS leading to greater mobility benefits and RF providing superior relief in pain and activities of daily living (ADL). Cognitive stability was maintained in both groups, with no significant decline, reinforcing the safety of lesion-based approaches in PD treatment. These findings suggest that lesioning remains a viable alternative for selected patients.

DBS vs.RF: Cognition and Quality of Life

References: Combs HL, Folley BS, Berry DT, et al. Cognition and Depression Following Deep Brain Stimulation of the Subthalamic Nucleus and Globus Pallidus Pars Internus in Parkinson’s Disease: A Meta-Analysis. Neuropsychol Rev. 2015 . doi: 10.1007/s11065-015-9302-0.
Bucur M, Papagno C. Deep Brain Stimulation in Parkinson Disease: A Meta-analysis of the Long-term Neuropsychological Outcomes. Neuropsychol Rev. 2023 . doi: 10.1007/s11065-022-09540-9.
Martínez-Martín P, Valldeoriola F, Molinuevo JL, et al. Pallidotomy and quality of life in patients with Parkinson’s disease: an early study. Mov Disord. 2000 doi: 10.1002/1531-8257(200001)15:1<65::aid-mds1011>3.0.co;2-y.
Baron MS, Vitek JL, Bakay RA, et al. Treatment of advanced Parkinson’s disease by unilateral posterior GPi pallidotomy: 4-year results of a pilot study. Mov Disord. 2000 doi: 10.1002/1531-8257(200003)15:2<230::aid-mds1005>3.0.co;2-u.

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