Objective: In Parkinson disease (PD) despite the high impact of nonmotor symptoms (NMSs) on patient autonomy and quality of life, evaluation of nonmotor fluctuations (NMF) is not part of the presurgical evaluation for deep brain stimulation (DBS). Our aim was to evaluate the severity of the non motor symptoms in OFF and ON state compared to the motor scores obtained in the same conditions.

Background: Subthalamic deep brain stimulation (STN DBS) is an established treatment for the motor symptoms in patients with advanced PD. In addition to improvements in motor symptoms, many studies have reported changes in various nonmotor symptoms (NMSs) after STN DBS in patients with PD. Although it is clear that NMSs are not target symptoms for STN DBS, NMSs have a strong influence on the quality of life of patients with PD, and clinicians should thus be aware of these NMSs when deciding whether to perform surgery and should pay attention to changes in these symptoms after STN DBS to ensure the optimal care for patients.

Methods: Data from three expert centers (Marseille, Toulouse, and Strasbourg) from 77 PD surgical candidates were collected. NMF were assessed using a visual analogue scale. The scale was made up of the 11 most frequent fluctuations that we have detected in previous studies (Witjas et al, 2002; Azulay et al, 2013). Each of the items being from 0 to 10. 77 patients (58 men; 19 women) were included. The mean age was 63 + 6 years. The scale was obtained in OFF and ON state during the presurgical evaluation as the UPDRS III, the QUIP and the PDQ 39.

Results: The mean score of the NMF in OFF state was 36.8/110 and improved by 49% after levodopa intake (19/110). The UPDRS III in the same population improved by 68 % (from 31 to 10). No correlation was found between the non motor and the motor score in off state and between the OFF non motor score and the PDQ 39 or with the QUIP. The degree of dopasensitivity of the motor and the non motor score were not correlated. The most disabling NMF were fatigue and restless legs syndrome. In half of the cases, the patients stated that NMF involved a greater degree of disability than MF.

Conclusions: NMF were present in all the patients in OFF state and improved dramatically after levodopa intake but less than the motor score. No correlation was found between the severity of the motor and the non motor score in OFF state and between the NMF score in OFF state and the Quality of life or the presence of impulse control disorders. The study will be continued on a larger population of patients, and we will evaluate the effect of STN-DBS on the NMS.

References: Eusebio A, Witjas T, Cohen J, Fluchère F, Jouve E, Régis J, Azulay JP. Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2013;84(8):868-74. Azulay JP, Witjas T, Eusebio A. Effect of subthalamic deep brain stimulation on non-motor fluctuations in Parkinson’s disease. J Neural Transm. 2013 ;120(4):655-7. Witjas T, Kaphan E, Régis J, Jouve E, Chérif AA, Péragut JC, Azulay JP. Effects of chronic subthalamic stimulation on nonmotor fluctuations in Parkinson’s disease. Mov Disord. 2007;22(12):1729-34.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluation-of-non-motor-fluctuations-in-parkinson-disease-by-a-visual-analogue-scale-in-surgical-candidates/