Objective: Comparative outcomes between deep brain stimulation (DBS) targets in Early-onset Parkinson’s Disease (EOPD) patients are lacking. This study leverages the University of Florida’s (UF) high-volume DBS center to assess longitudinal motor outcomes in EOPD patients treated with subthalamic nucleus (STN) versus globus pallidus interna (GPi) DBS.

Background: EOPD patients often experience premature motor complications that necessitate DBS. The primary DBS targets to reduce medication use and mitigate motor symptoms and fluctuations are the STN and GPi.

Method: A retrospective chart review was conducted on adult patients diagnosed with EOPD (PD diagnosis <50 years of age) treated with STN or GPi DBS between 1999 and 2023 at UF. Demographic, clinical, medication, and lead localization data were collected. Baseline, 6-month, 1-, 3-, and 5-year Unified Parkinson’s Disease Rating Scale (UPDRS) scores were compared to evaluate motor outcomes between cohorts.

Results: 405 patients were included in this analysis. 250 (61.3%) patients received GPi DBS and 154 (37.7%) received STN DBS (Table 1). All patients experienced a significant decrease in the mean (SD) number of unique PD medications from the time of DBS to the most recent visit (3.6 (2.7) vs.1.3 (1.0), p<0.0001). GPi DBS showed an initial decrease in ON UPDRS Part 3 scores from baseline to 1 year (26.5 (11.8) vs. 20.9 (9.1), p=0.0024, Fig 1B), but scores increased from 1 to 5 years (20.9 (9.1) vs. 24.7 (10.3), p=0.0491). No significant differences in ON UPDRS Part 3 scores were seen in STN DBS from baseline to 5 years (26.0 (11.5) vs. 23.2 (10.2), p=0.2030, Fig 1C). GPi DBS significantly improved ON UPDRS Part 4 scores from baseline to 5 years (8.3 (3.2) vs. 4.2 (2.3), p<0.0001, Fig 2B). STN DBS did not significantly impact ON UPDRS Part 4 scores from baseline to 5 years (6.2 (4.2) vs. 5.0 (3.0), p=0.3280, Fig 2C).  Patients with unilateral STN stimulation showed significantly greater improvements in ON UPDRS part 3 scores as compared to unilateral GPi stimulation at 6 months (p<0.001) with no effect of time (p=0.3000, Fig 3).

Conclusion: STN and GPi DBS offer distinct benefits in EOPD with similar initial efficacy on ON UPDRS motor scores. STN DBS provides longer-term motor benefits while GPi DBS sustains UPDRS Part 4 improvements, similar to published data. Our findings reinforce the need for individualized DBS treatment in EOPD.

Table 1

Figure 1

Figure 2

Figure 3

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MDS Abstracts - https://www.mdsabstracts.org/abstract/motor-outcomes-following-subthalamic-nucleus-or-globus-pallidus-interna-deep-brain-stimulation-in-early-onset-parkinsons-disease/