Abstract
Deep brain stimulation (DBS) for Parkinson’s disease (PD) improves quality of life (QoL), but longitudinal follow-up data are scarce. We sought to quantify long-term benefits of subthalamic nucleus (STN) vs globus pallidus internus (GPi), and unilateral vs staged bilateral PD-DBS on postoperative QoL. This is a retrospective, longitudinal, non-randomized study using the PD QoL questionnaire (PDQ)-39 in patients with STN- or GPi-DBS, and with unilateral (N = 191) or staged bilateral (an additional contralateral lead implant) surgery (N = 127 and 156 for the first and second lead, respectively). Changes in PDQ-39 summary index (PDQ-39SI) and subscores throughout 60 months of follow-up were used as the primary analysis. We applied mixed models that included levodopa and covariates that differed at baseline across groups. For unilateral implantation, we observed an initial improvement in PDQ-39SI of 15.55 ± 3.29% (µ ± SE) across both brain targets at 4 months postoperatively. Unilateral STN patients demonstrated greater improvement in PDQ-39SI than GPi patients at 4 and 18 months postoperatively. Analysis of patients with staged bilateral leads revealed an initial 25.34 ± 2.74% (µ ± SE) improvement in PDQ-39SI at 4 months after the first lead with further improvement until 18 months, with no difference across targets. Scores did not improve after the second lead with gradual worsening starting at 18 months postoperatively. STN-DBS provided greater short-term QoL improvement than GPi-DBS for unilateral surgery. For staged bilateral DBS, overall QoL improvement was explained primarily by the first lead. Decision-making for patients considering DBS should include a discussion surrounding the potential risks and benefits from a second DBS lead.
Highlights
Quality of life (QoL) is one of the most important outcome measures in healthcare[1,2]
60 globus pallidus internus (GPi) and 67 subthalamic nucleus (STN) patients were included for the first lead, and 72 GPi and 84 STN patients were included for the second lead
Unilateral STN patients had a higher tremor score compared to GPi patients (p < 0.01), and unilateral GPi patients had a worse postural instability gait disorder (PIGD) score compared to STN patients (p < 0.01; Table 1, Supplementary Table 1)
Summary
Quality of life (QoL) is one of the most important outcome measures in healthcare[1,2]. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) is considered a safe and effective surgical treatment for PD based on randomized controlled trials that have included motor symptom scales and QoL as primary or secondary outcomes[5,6,7,8,9]. Since GPi stimulation is becoming increasingly used for PDDBS6,12–15, data are needed that compare the effects of STN or GPi stimulation on QoL measurements, and of unilateral and staged bilateral stimulation in each of these brain targets. With real-life data from standard-of-care intervention, we aimed to evaluate the long-term effects of DBS on QoL across both brain targets and surgery types, while uncovering the effects of the first vs the second lead in patients with staged bilateral implantations
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