Objective: This study aims to determine the impact of surgical procedures on quality of life in patients with PD using the PDQ-39 questionnaire.

Background: Parkinson’s disease (PD) is the second most common neurodegenerative disorder, significantly affecting quality of life through motor and non-motor symptoms. Although initial pharmacological treatment provides symptomatic benefit, its efficacy declines over time, mainly due to dyskinesias and motor fluctuations. In this context, functional neurosurgery, including ablative procedures and deep brain stimulation (DBS), constitutes a therapeutic alternative.

Method: A retrospective observational study was conducted, including patients who underwent surgery at our institution between 2019 and 2022. The following inclusion criteria were established: patients diagnosed with PD who had been assessed with the PDQ-39 questionnaire before and after surgery. Postoperative assessment had not been previously standardized; therefore, follow-up time ranged from 2 to 5 years.

Results: Of the 108 patients evaluated, only 39 met the inclusion criteria. The mean age was 56 ± 9.2 years, and the mean disease duration was 10.3 ± 5.4 years. Twenty-two ablative surgeries (18 were performed unilaterally and 4 bilaterally) and 17 DBS procedures were performed. Twenty-one procedures were performed in the subthalamic nucleus(STN), 6 in the internal globus pallidus(GPI), 9 in the ventral intermediate nucleus of the thalamus (VIM), and in 3 patients, combined targets were used. The STN shows moderate improvement in motor domains, GPI marked improvement mainly in functional domains, being statistically significant on Emotional Wellbeing (p: 0.023) fig.1. The greatest improvement was observed in the social stigma domain (43% p= 0.0017), followed by activities of daily living (18% p= 0.034) fig.2. DBS had a greater impact on mobility than ablative surgery (26 % vs 15% p= 0.014) fig.3. In contrast, cognition and communication worsened, particularly after bilateral DBS. Preoperative psychoprophylaxis was associated with better outcomes in emotional and social domains.

Conclusion: Functional surgery improves the overall quality of life of patients with PD. It significantly improves social stigma and activities of daily living. Pre-surgical psychoprophylaxis appears to be an important factor associated with better surgical outcomes. However, we believe that a double-blind study would reinforce these findings.

Postoperative improvement by target.

Pre vs Post PDQ-39 domain score.

Average postoperative improvement by treatment.

References: Damianova M, Gancheva D, Gabrovski K, Karazapryanov P, Milenova Y, Popivanov ID, Minkin K. Is PDQ-39 a reliable measure of quality of life of patients at advanced stages of Parkinson’s disease considered for Deep Brain Stimulation. Heliyon. 2024;10(10):e31325. doi: 10.1016/j.heliyon.2024.e31325. PMID: 38813175; PMCID: PMC11133834.

Jiang JL, Lo SF, Tsai ST, Chen SY. A systematic review of the impact of subthalamic nucleus stimulation on the quality of life of patients with Parkinson’s disease. Tzu Chi Med J. 2014;26:5–20

Fasano A, Romito LM, Daniele A, Piano C, Zinno M, Bentivoglio AR, Albanese A. Motor and cognitive outcome in patients with Parkinson’s disease 8 years after subthalamic implants. Brain. 2010 Sep;133(9):2664-76. doi:10.1093/brain/awq221. PMID: 20802207.

Parkinson’s Disease Quality of Life Questionnaire (PDQ-39)

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MDS Abstracts - https://www.mdsabstracts.org/abstract/functional-neurosurgery-in-parkinsons-disease-effects-on-quality-of-life/