Session Information
Date: Saturday, October 6, 2018
Session Title: Surgical Therapy: Parkinson's Disease
Session Time: 1:45pm-3:15pm
Location: Hall 3FG
Objective: To investigate nonmotor effects of bilateral subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) in Parkinson’s disease (PD).
Background: Bilateral STN-DBS as well as bilateral GPi-DBS improves quality of life and motor symptoms in PD. Beneficial non-motor effects have been reported for STN-DBS, whereas few studies have investigated a wide range of NMS in patients with PD undergoing GPi-DBS. Therefore, we conducted a comparative investigation of non-motor effects for these two DBS targets. We hypothesized that (1) GPi-DBS has beneficial effects on NMS and (2) STN-DBS and GPi-DBS have distinct non-motor effect profiles.
Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n=40) or GPi-DBS (n=20), we examined PDQuestionnaire (PDQ), Nonmotor Symptom Scale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Intra-group changes from baseline to follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Differences between STN-DBS and GPi-DBS were explored with Mann-Whitney-U or unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.
Results: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly from baseline to follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV improvement. While NMSS total score outcomes were similar, explorative NMSS domain analyses resulted in distinct profiles. Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS improved the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.
Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD patients. This study highlights the importance of comprehensive assessments of NMS to tailor the choice of DBS target to patients’ individual motor and nonmotor profiles.
To cite this abstract in AMA style:
H. Dafsari, M. dosSantos Ghilardi, V. Visser-Vandewalle, A. Rizos, K. Ashkan, M. Silverdale, J. Evans, R. Martinez, R. Cury, M. Barbe, G. Fink, A. Antonini, K. Ray-Chaudhuri, P. Martinez-Martin, E. Fonoff, L. Timmermann. Beneficial nonmotor effects of subthalamic and pallidal DBS in Parkinson’s disease [abstract]. Mov Disord. 2018; 33 (suppl 2). https://www.mdsabstracts.org/abstract/beneficial-nonmotor-effects-of-subthalamic-and-pallidal-dbs-in-parkinsons-disease/. Accessed October 15, 2024.« Back to 2018 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/beneficial-nonmotor-effects-of-subthalamic-and-pallidal-dbs-in-parkinsons-disease/