Objective: To characterize the handicap after 4.8 years of DBS-STN and to compare with pre-surgery data.
Background: The London Handicap Scale (LHS) provide an overall measure of patients’ health status and self-perceived functioning. It was previously studied in a wide sample of Parkinson’s disease (PD) patients and proved to be sensitive do identify the handicap determinants according to disease severity.
Method: 33 PD patients submitted to DBS-STN were evaluated after a mean of 4.8 years of surgery in 4 conditions (stimOFF/medOFF, stimON/medOFF, stimOFF/medON, stimON/medON), using MDS-UPDRS, HY and S&E. Nonmotor symptoms (NMSS, NPI, MMSE, GDS), QoL (PDQ-8, EQ-5D) and handicap (LHS: maximum handicap=0 and minimum handicap=1) were also evaluated. Pre-surgery data were collected.
Results: After 4.8 years of DBS-STN, mean age was 64.3 (±9.9) years, 78.8% were gait independent. Median MDS-UPDRS was 58 [43-74] and the S&E was 90 [70-90] (patients evaluated in stimON/medON ). The mean LHS score was 0.707 (±0.207) and the most affected domains were Occupation, Mobility and Social Integration. Functional independence (S&E)(r=0.562), gait assistance (r=-0.600) and depression (GDS)(r=-0.491)(all p<0.05) were the independent handicap predictors (adjusted R2=0.600; p=0.010).
Pre-surgical data was available in 18 patients. Handicap significantly improved after DBS [∆LHS 0.213(±0.185); p=0.002)]. The improvement correlated with age at disease onset, age and UPDRS-II (med on) at DBS (r=-0.598, r=-0.473 and r=-0.556 respectively; p<0.05). Age and UPDRS-II at DBS were independent predictors of ∆LHS (adjusted R2=0.552; p=0.025).
Conclusion: PD patients submitted to DBS-STN were mildly handicapped 5 years after surgery, which was determined by functional and gait independency, and depression. The affected subdomains were Occupation, Mobility and Social integration.
Handicap improvement continued after 5 years of surgery, and its main determinants were age at DBS and motor experiences of daily living on medication before surgery. LHS seems to be an instrument sensitive to change in health status of these patients.
To cite this abstract in AMA style:
D. Silva, M. Fabbri, L. Guedes, A. Caldas, P. Lobo, B. Cattoni, H. Carvalho, A. Ferreira, M. Rosa, J. Ferreira, M. Coelho. Improvement in the handicap is maintained after 5 years of deep brain stimulation in Parkinson’s disease [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/improvement-in-the-handicap-is-maintained-after-5-years-of-deep-brain-stimulation-in-parkinsons-disease/. Accessed June 15, 2025.« Back to MDS Virtual Congress 2020
MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-in-the-handicap-is-maintained-after-5-years-of-deep-brain-stimulation-in-parkinsons-disease/