Objective: To evaluate the impact of deep brain stimulation (DBS) on quality of life (QoL) in patients with Parkinson’s disease (PD) by comparing PDQ-8 longitudinal trajectories and the probability of clinical improvement versus a matched control cohort.

Background: PD is a neurodegenerative disorder characterized by motor and non-motor impairment that significantly affects patients’ QoL throughout the course of the disease. DBS is an effective therapeutic strategy for the management of motor symptoms. However, improvements in QoL may diminish over time or vary among patients. To distinguish its effect from that of conventional medical therapy, longitudinal studies with comparable groups are required.

Method: A retrospective longitudinal comparative study was conducted, including patients treated with DBS and a matched control cohort. Selection bias was mitigated using 1:1 Propensity Score Matching, adjusting for sex, age at evaluation, levodopa equivalent daily dose (LEDD), UPDRS-I, and MoCA scores. QoL trajectories were analyzed using a linear mixed-effects model for PDQ-8 index, while the probability of achieving a clinically meaningful improvement (MCID), defined as a reduction of ≥5 points, was assessed via a GEE logistic model.

Results: 86 participants (43 DBS and 43 matched controls) with 2 visits each were included. In the linear mixed-effects model, the group-by-time interaction was significant, showing a greater reduction in PDQ-8 scores in the DBS group compared with controls over follow-up (β=-10.09, 95% CI -17.73 to -2.45; p=0.01). This finding remained consistent after adjustment for baseline age, disease duration, LEDD, UPDRS-III, and MoCA. In the secondary analysis, DBS was associated with a higher likelihood of achieving a MCID in PDQ-8, with an odds ratio of 19.88 (95% CI 3.60-109.79; p=0.001) in the GEE logistic model. Higher baseline PDQ-8 was also independently associated with achieving MCID (OR 1.10, 95% CI 1.05-1.15; p<0.001).

Conclusion: In this matched longitudinal cohort, DBS was associated with a better evolution of QoL compared with conventional treatment. Patients with DBS showed a greater reduction in PDQ-8 scores and a higher probability of achieving a MCID. This suggests that the effect of DBS extends beyond motor control and translates into clinically relevant, long-term benefits for the patient.

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References: 1. Jiang JL, Chen SY, Tsai ST, Ma YC, Wang JH. Long-Term Effects of Subthalamic Stimulation on Motor Symptoms and Quality of Life in Patients with Parkinson’s Disease. Healthcare. 2023 Mar 22;11(6):920. doi:10.3390/healthcare11060920.
2. Ferrea E, Negahbani F, Cebi I, Weiss D, Gharabaghi A. Machine learning explains response variability of deep brain stimulation on Parkinson’s disease quality of life. NPJ Digit Med. 2024 Oct 2;7(1):269. doi:10.1038/s41746-024-01253-y.
3. Jost ST, Aloui S, Evans J, Ashkan K, Sauerbier A, Rizos A, et al. Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years: A Nonrandomized Controlled Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2352177. doi:10.1001/jamanetworkopen.2023.52177.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-deep-brain-stimulation-on-quality-of-life-in-parkinsons-disease-a-longitudinal-analysis-of-clinical-improvement-and-response-probability-using-mixed-effects-models-and-gee/