Abstract
To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as ‘difficulties experiencing pleasure’ and ‘problems sustaining concentration’. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.
Highlights
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established therapy with long-term efficacy improving motor symptoms, quality of life (QoL), and non-motor symptoms (NMS) in patients with Parkinson’s disease (PD)[1,2,3,4,5]
We report the 36-month effects of subthalamic nucleus deep brain stimulation (STN-DBS) on QoL in a cohort of 73 patients with PD
We observed significant improvements in QoL following STN-DBS at a short-term, i.e., 6month follow-up with subsequent decrements in gains at 36month follow-up when only 38% of the patients experienced a sustained clinically relevant QoL improvement compared to preoperative baseline
Summary
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established therapy with long-term efficacy improving motor symptoms, quality of life (QoL), and non-motor symptoms (NMS) in patients with Parkinson’s disease (PD)[1,2,3,4,5]. On the individual level, 43–49% of patients experience no clinically relevant improvement of QoL postoperatively at 6-month follow-up[6,9,10]. Identifying preoperative factors that predict QoL outcome could support the decision-making process for DBS eligibility and improve individual treatment results. Amongst other parameters younger age, worse baseline QoL, and specific NMS have been identified as predictors of more considerable QoL improvement at 6-month follow-up. It is unclear which demographic and clinical parameters influence the evolution of QoL beyond such a short-term follow-up. We investigated predictors of QoL outcome after STN-DBS at 36-month follow-up and, based on previous studies with shorter follow-up periods, hypothesized that QoL outcome depends on demographic and non-motor predictors as well as baseline QoL
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