Outcomes of STN-DBS in PD Patients With Different Rates of Disease Progression Over One Year of Follow-Up.

Renli Qi,Honggao Jiang,Lei Yin,Yushan Li,Yubin Li,Ye Chen,Xin Geng,Wei Wang,Baihui Huang,Anxiong Liu,Yanghong Zou,Xuelan Yang,Jinghui Li,Hualin Yu

doi:10.3389/fneur.2020.00600

Abstract

Parkinson's disease (PD) is a progressive neurodegenerative disorder, and the rate of progression is different across individuals. Subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to produce long-term symptom improvement in PD. In this retrospective study, we wanted to explore the effects of bilateral STN-DBS in PD patients with different rates of disease progression. Forty patients with PD were included. An index of progression rate was calculated by the ratio of the Unified Parkinson Disease Rating Scale, part III (UPDRS-III), score in the off-medication condition at baseline and disease duration. The patients were divided into fast-, medium-, and slow-progression groups by this index. The outcome measurements at the 1st, 6th, and 12th months after surgery were the changes in UPDRS-III scores in the off-medication/on-stimulation condition compared with the baseline. We found the following. (1). Motor functions in the different PD progression groups were improved by bilateral STN-DBS treatment at 1 year of follow-up. (2). However, compared to the slow- and medium-progression groups, the fast-progression group had less improvement at the 6th- and 12th-month follow-up. The results indicated that bilateral STN-DBS can improve motor functions of Parkinson's patients over the 1-year follow-up. Moreover, the outcomes in the slow- and medium-progression patients were better than those with fast-progression rates.

Highlights

Parkinson’s disease (PD) is a common neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra accompanied by clinical symptoms of bradykinesia, tremor at rest, rigidity, postural instability, asymmetric onset, and levodopa responsiveness [1, 2]
Previous work indicated that PD is a progressive disease, and the motor deterioration might progress linearly in proportion to disease duration [4,5,6]; the group information in this study was based on the index of progression rate, which was calculated by the ratios of the UPDRS-III scores in the offmedication condition and disease duration at baseline
This finding may indicate that our patients in the fast group are not multiple-system atrophy with predominant parkinsonism (MSA-P), which would account for deterioration to greater severity and disability in a shorter time [15], accompanied by a poor response to levodopa [16]

Summary

Introduction

Parkinson’s disease (PD) is a common neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra accompanied by clinical symptoms of bradykinesia, tremor at rest, rigidity, postural instability, asymmetric onset, and levodopa responsiveness [1, 2]. PD is a progressive neurodegenerative disorder, and studies indicate that motor deterioration might progress linearly in proportion to disease duration [4,5,6]. The motor improvement induced by STN-DBS is sustained for up to 5–8 years after surgery, but some of the initial improvements, mainly regarding axial signs, progressively deteriorated [8, 9]. The reported improvements of motor function vary from 40 to 70% in off-medication/onstimulation conditions at the 12th months after surgery [9,10,11]. It is necessary to explore the effects of STN-DBS on PD patients with different rates of progression. We wanted to explore the effects of STN-DBS on PD patients with different progression rates by comparing the outcomes at the 1st, 6th, and 12th months after surgery

Methods

Results

Conclusion