Objective: We aimed to monitor long-term motor, non-motor, and quality of life outcomes in PD patients with STN and GPi DBS.

Background: Both STN and GPi DBS provide comparable motor symptom efficacy in PD, based on evaluations up to 3 years post-implantation. However, clinical indications may exist for favoring one target over the other. Compared to their GPi DBS counterparts, STN DBS reduce to a greater extent their medication burden, but they exhibit more frequent speech difficulties, cognitive depreciation; and depression. Whether such differences by target resolve, persist, or deepen over time is unclear, as is the long-term impact of DBS on many motor and non-motor symptoms.

Method: We recruited a convenience cohort of 40 PD patients at least 2 years post-DBS surgery. Subjects agreed to an on-medication visit comprised of a video-recorded MDS-UPDRS III, Montreal Cognitive Assessment (MoCA), Beck Depression Inventory II (BDI II), and Parkinson’s Disease Questionnaire-39 (PDQ-39). Four movement disorders trained neurologists served as blinded raters; 2 raters viewed each video: one scored with the MDS-UPDRS III and the other with the UPDRS III. All patients also had pre-operative video-recorded UPDRS Part III (UPDRS III), which were re-rated by the same neurologist assigned to that subject’s current UPDRS III video. Rigidity was not scored on video-rated examinations.

Results: 40 patients enrolled: 27 STN and 13 GPi DBS patients, for a cumulative follow-up time of 2,407 person-months. Disease duration at surgery (STN 9.9 yrs, GPi 9.2 yrs), pre-DBS LEDD (STN 1416, GPi 1423), UPDRS III Off/On (STN 41.2/19.0, GPi 41.2/22.2), and age at study visit (STN 66.1 yrs, GPi 65.0 yrs) were similar between groups; time since DBS surgery differed (STN 65.3 mos, GPi 49.5 mos). Mean video-rated on-medication UPDRS III (STN 23.4, 24.8) and MDS-UPDRS III (STN 27.4, GPi 33.5) scores were comparable and did not diverge when stratified by years post-surgery. STN patients had significantly lower LEDD (STN 813, GPi 1300). MoCA (STN 23.0, GPi 21.0) and BDI II (STN 16.1, GPi 19.2) were similar. PDQ39 summary index reflected higher quality of life in STN (29.1) than GPi (40.2) patients. No significant correlation existed between UPDRS III change and months post-surgery.

Conclusion: Ongoing efforts are necessary to establish longitudinal impact of DBS on symptoms and quality of life.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-motor-and-non-motor-outcomes-in-parkinsons-disease-following-deep-brain-stimulation/