Objective: To evaluate postoperative quality of life (QoL) depending on the occurrence of dyskinesia during standardized levodopa test in patients with Parkinson’s Disease (PD) undergoing bilateral subthalamic Deep Brain Stimulation (STN-DBS).

Background: As previous studies have shown, STN-DBS significantly improves QoL in PD. According to the fact that presence of dyskinesia often hampers the efficacy of DBS, we investigated whether the presence of dyskinesia prior to surgery has an effect on postoperative QoL. [1], [2]

Method: A total of 88 patients with PD and STN-DBS were retrospectively included. Based on the occurrence of levodopa-induced dyskinesia during the video-taped, standardized, preoperative levodopa test, the patient cohort was divided in two cohorts (n_dyskinesia = 44, n_nodyskinesia = 44). Propensity score considering age, gender, weight and levodopa equivalent daily dose (LEDD) as covariates was applied for matching the groups. Severity of dyskinesia was assessed by means of the Marconi dyskinesia scale [3]. Additionally, QoL was assessed with the Parkinson’s Disease Questionnaire-39 (PDQ-39) at baseline and at follow up 6 months after surgery as per clinical routine.

Results: The dyskinesia group had significantly longer disease duration (p = 0.010). There were no significant differences in dopaminergic medication burden, charge per pulse, and motor scores between groups (all p-values > 0.05). Patients with levodopa-induced dyskinesia showed poorer QoL (mean 25.31 ± 15.56 pt) in comparison to patients without dyskinesia (mean 17.98 ± 13.8 pt, p = 0.020) at follow up [Figure 1 A]. Analysis of PDQ-39 domains yielded differences especially for “activities of daily living” (p = 0.015), “cognition” (p = 0.031), and “stigma” (p = 0.012). Notably, postoperative improvement in PDQ-39 was observed only in the group of patients without dyskinesia in the preoperative levodopa test [Figure 1 C, p < 0.001], but not in the group of patients with occurrence of dyskinesia [Figure 1 B, p = 0.105].

Conclusion: Improvement in QoL after STN-DBS in PD was only observed in the group of patients without dyskinesia in the preoperative levodopa challenge test, which might emphasize the importance of considering STN-DBS in PD before severe motor complications arise.

References: [1] W. M. M. Schuepbach et al., ‘Neurostimulation for Parkinson’s Disease with Early Motor Complications’, N. Engl. J. Med., vol. 368, no. 7, pp. 610–622, Feb. 2013, doi: 10.1056/NEJMoa1205158.
[2] H. Toda, H. Saiki, N. Nishida, and K. Iwasaki, ‘Update on Deep Brain Stimulation for Dyskinesia and Dystonia: A Literature Review’, Neurol. Med. Chir. (Tokyo), vol. 56, no. 5, pp. 236–248, 2016, doi: 10.2176/nmc.ra.2016-0002.
[3] R. Marconi, D. Lefebvre-Caparros, A.-M. Bonnet, M. Vidailhet, B. Dubois, and Y. Agid, ‘Levodopa-induced dyskinesias in Parkinson’s disease phenomenology and pathophysiology’, Mov. Disord., vol. 9, no. 1, pp. 2–12, 1994, doi: 10.1002/mds.870090103.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/preoperative-dyskinesia-impacts-postoperative-quality-of-life-in-pd-patients-with-subthalamic-deep-brain-stimulation/