Objective: In this study we examine non-motor symptom (NMS) fluctuations reported by People with Parkinson’s (PWP) pursuing Deep Brain Stimulation (DBS) surgery using the MDS Non-Motor Fluctuations Scale (NoMoFa).

Background: With progressive nigrostriatal degeneration in Parkinson’s disease (PD), response to dopamine therapy becomes less reliable and fluctuations in motor function, increased “off” time, and dyskinesia often emerge. NMS may also develop and fluctuate with medication status. While DBS surgery has demonstrated effectiveness in reducing motor fluctuations, impact on NMS fluctuations remains unclear.

Method: All PwP considering DBS undergo comprehensive clinical neuropsychological evaluation to assess eligibility. The NoMoFa is completed independently by the patient. Responses are discussed with the patient and presented in subsequent interdisciplinary team meetings. In this retrospective chart review, item-level responses from the NoMoFa in a sample of 40 DBS candidates are analyzed with respect to presence, severity, and fluctuations (i.e., worse during medication “on” time, “off” time, or static). Relationships between NMS fluctuations and other clinical variables are also explored.

Results: To date, 26 PwP have completed pre-DBS NoMoFa, and clinical utility for understanding NMS phenomenology and motivations for surgery have been appreciated. Preliminary results indicate mild to moderate “off” NMS are common in PD patients seeking DBS, particularly for energy/fatigue and cognition, and account for about 31% of total NMS severity, 95% CI: [21,41]. Worse NMS during “on” times are rarely reported. NMS static across medication states correlate with “on” UPDRS Part 3 ratings (r=646); however, “off” NMS do not appear related to Part 3 ratings during “on” or “off” exams.

Conclusion: The NoMoFa offers clinical utility for assessing NMS in PwP considering DBS surgery. Preliminary results indicate that NMS are commonly reported, and medication “off” time may account for one-third of subjective NMS severity. Lack of association between “off” NMS and “off” motor functioning suggest NMS fluctuations directly reflect neurochemical imbalance rather than secondary reaction to motor fluctuations. Current results will be confirmed in the final sample, and future studies will examine impact of DBS and post-surgical medication reduction on NMS, with particular attention to those previously rated as worse during “off” time.

« Back to 2022 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/non-motor-fluctuations-in-people-with-parkinsons-considering-deep-brain-stimulation-surgery/