Influencing factors of effect of subthalamic nucleus deep brain stimulation on Parkinson's disease

Abstract

Objective To evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on Parkinson's disease and analyze predictive factors of the operational outcomes. Methods A total of 228 patients with Parkinson's disease (PD) who underwent STN-DBS at Department of Neurosurgery, Brain Health Center, Affiliated Hospital of Logistics College of Chinese People's Armed Police Force from January 2007 to June 2015 were enrolled into this retrospective study. The scores of Unified Parkinson's Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE) before and 6, 12 and 24 months after STN-DBS were retrospectively analyzed. All patients were classified into 2 groups based on the activities of daily living at 24 months after DBS. The good prognostic group (122 cases) showed a Schwab and England (S&E) scale score of more than 70 during the off-period, and the poor prognostic group (106 cases) showed a score of no more than 70 during the off-period. The preoperative state in the 2 groups was compared and multiple logistic regression analysis was used to analyze the factors affecting the prognosis of DBS. Results The UPDRS II, UPDRS III and S&E scores decreased significantly after 24 months (all P 0.05). There were significant differences in PD onset age, Hoehn-Yahr scale, age at surgery, preoperative UPDRS II, MMSE and S&E scores between the 2 groups. Multiple logistic regression analysis showed that the independent factors of daily activities after STN-DBS included the age at surgery (OR=1.200, 95% CI: 1.079-1.334, P<0.01), MMSE scores (OR=0.598, 95% CI: 0.423-0.846, P<0.01) and preoperative S&E scale scores during the off-period (OR=0.959, 95% CI: 0.921-0.998, P<0.05). Conclusions STN-DBS could improve the clinical symptoms of patients with PD. Age at surgery, MMSE scores and preoperative S&E scale scores during the off-period appear to be the independent factors of prognosis. The onset age of PD, Hoehn-Yahr scale, preoperative UPDRS II scores and S&E scale scores during the on-period may also predict the therapeutic effect of STN-DBS. Key words: Subthalamic nucleus; Deep brain stimulation; Parkinson disease; Prognosis; Root cause analysis