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Long-term clinical outcomes of bilateral GPi deep brain stimulation in advanced Parkinson's disease: 5 years and beyond.
J Neurosurg. 2020 Oct 09 [Online ahead of print]JN

Abstract

OBJECTIVE

Few studies have reported long-term outcomes of globus pallidus internus (GPi) deep brain stimulation (DBS) in Parkinson's disease (PD). The authors aimed to investigate long-term outcomes of bilateral GPi DBS for 5 years and beyond for PD patients.

METHODS

The authors retrospectively analyzed the clinical outcomes in 65 PD patients treated with bilateral GPi DBS at a single center. The outcome measures of motor symptoms and health-related quality of life (HRQoL) included the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39). Scores at baseline were compared with those at 1, 3, 5, and 6-8 years after implantation using Wilcoxon signed-rank tests with α correction.

RESULTS

GPi DBS significantly improved the off-medication UPDRS III total scores, UPDRS IV, and dyskinesia score at 1 year when compared with baseline (all p < 0.001). The off- and on-medication tremor scores, UPDRS IV, and dyskinesia scores showed moderate and sustained improvement (the ranges of the mean percentage improvement at each time point were 61%-75%, 30%-80%, 29%-40%, and 40%-65%, respectively) despite lacking statistical significance at long-term follow-up with diminishing sample sizes. The off-medication UPDRS III total scores did not show significant improvement at 5 years or later, primarily because of worsening in rigidity, akinesia, speech, gait, and postural stability scores. The on-medication UPDRS III total scores also worsened over time, with a significant worsening at 6-8 years when compared with baseline (p = 0.008). The HRQoL analyses based on the PDQ-39 revealed significant improvement in the activities of daily living and discomfort domains at 1 year (p = 0.003 and 0.006, respectively); however, all the domains showed gradual worsening at the later time points without reaching statistical significance. At 3 years, the communication domain showed significant worsening compared with baseline scores (p = 0.002).

CONCLUSIONS

GPi DBS in PD patients in this single-center cohort was associated with sustained long-term benefits in the off- and on-medication tremor score and motor complications. HRQoL and the cardinal motor symptoms other than tremor may worsen gradually in the long term. When counseling patients, it is important to recognize that benefits in tremor and dyskinesia are expected to be most persistent following bilateral GPi DBS implantation.

Authors+Show Affiliations

1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and. 2Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and. Departments of3Clinical and Health Psychology and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and. Departments of3Clinical and Health Psychology and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.4Neurosurgery, University of Florida, Gainesville, Florida; and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.1Department of Neurology, Norman Fixel Institute for Neurological Diseases, and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33035998

Citation

Tsuboi, Takashi, et al. "Long-term Clinical Outcomes of Bilateral GPi Deep Brain Stimulation in Advanced Parkinson's Disease: 5 Years and Beyond." Journal of Neurosurgery, 2020, pp. 1-10.
Tsuboi T, Lemos Melo Lobo Jofili Lopes J, Moore K, et al. Long-term clinical outcomes of bilateral GPi deep brain stimulation in advanced Parkinson's disease: 5 years and beyond. J Neurosurg. 2020.
Tsuboi, T., Lemos Melo Lobo Jofili Lopes, J., Moore, K., Patel, B., Legacy, J., Ratajska, A. M., Bowers, D., Eisinger, R. S., Almeida, L., Foote, K. D., Okun, M. S., & Ramirez-Zamora, A. (2020). Long-term clinical outcomes of bilateral GPi deep brain stimulation in advanced Parkinson's disease: 5 years and beyond. Journal of Neurosurgery, 1-10. https://doi.org/10.3171/2020.6.JNS20617
Tsuboi T, et al. Long-term Clinical Outcomes of Bilateral GPi Deep Brain Stimulation in Advanced Parkinson's Disease: 5 Years and Beyond. J Neurosurg. 2020 Oct 9;1-10. PubMed PMID: 33035998.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term clinical outcomes of bilateral GPi deep brain stimulation in advanced Parkinson's disease: 5 years and beyond. AU - Tsuboi,Takashi, AU - Lemos Melo Lobo Jofili Lopes,Janine, AU - Moore,Kathryn, AU - Patel,Bhavana, AU - Legacy,Joseph, AU - Ratajska,Adrianna M, AU - Bowers,Dawn, AU - Eisinger,Robert S, AU - Almeida,Leonardo, AU - Foote,Kelly D, AU - Okun,Michael S, AU - Ramirez-Zamora,Adolfo, Y1 - 2020/10/09/ PY - 2020/02/27/received PY - 2020/06/05/accepted PY - 2020/10/9/entrez PY - 2020/10/10/pubmed PY - 2020/10/10/medline KW - ADL = activity of daily living KW - AE = adverse events KW - BDI-II = Beck Depression Inventory–II KW - DBS = deep brain stimulation KW - DRS-2 = Dementia Rating Scale–2 KW - GPi = globus pallidus internus KW - HRQoL = health-related quality of life KW - LEDD = levodopa equivalent daily dose KW - PD = Parkinson’s disease KW - PDQ-39 = Parkinson’s Disease Questionnaire KW - Parkinson’s disease KW - SAS = Starkstein Apathy Scale KW - STN = subthalamic nucleus KW - UPDRS = Unified Parkinson’s Disease Rating Scale KW - deep brain stimulation KW - functional neurosurgery KW - globus pallidus internus KW - quality of life SP - 1 EP - 10 JF - Journal of neurosurgery JO - J Neurosurg N2 - OBJECTIVE: Few studies have reported long-term outcomes of globus pallidus internus (GPi) deep brain stimulation (DBS) in Parkinson's disease (PD). The authors aimed to investigate long-term outcomes of bilateral GPi DBS for 5 years and beyond for PD patients. METHODS: The authors retrospectively analyzed the clinical outcomes in 65 PD patients treated with bilateral GPi DBS at a single center. The outcome measures of motor symptoms and health-related quality of life (HRQoL) included the Unified Parkinson's Disease Rating Scale (UPDRS) and the Parkinson's Disease Questionnaire (PDQ-39). Scores at baseline were compared with those at 1, 3, 5, and 6-8 years after implantation using Wilcoxon signed-rank tests with α correction. RESULTS: GPi DBS significantly improved the off-medication UPDRS III total scores, UPDRS IV, and dyskinesia score at 1 year when compared with baseline (all p < 0.001). The off- and on-medication tremor scores, UPDRS IV, and dyskinesia scores showed moderate and sustained improvement (the ranges of the mean percentage improvement at each time point were 61%-75%, 30%-80%, 29%-40%, and 40%-65%, respectively) despite lacking statistical significance at long-term follow-up with diminishing sample sizes. The off-medication UPDRS III total scores did not show significant improvement at 5 years or later, primarily because of worsening in rigidity, akinesia, speech, gait, and postural stability scores. The on-medication UPDRS III total scores also worsened over time, with a significant worsening at 6-8 years when compared with baseline (p = 0.008). The HRQoL analyses based on the PDQ-39 revealed significant improvement in the activities of daily living and discomfort domains at 1 year (p = 0.003 and 0.006, respectively); however, all the domains showed gradual worsening at the later time points without reaching statistical significance. At 3 years, the communication domain showed significant worsening compared with baseline scores (p = 0.002). CONCLUSIONS: GPi DBS in PD patients in this single-center cohort was associated with sustained long-term benefits in the off- and on-medication tremor score and motor complications. HRQoL and the cardinal motor symptoms other than tremor may worsen gradually in the long term. When counseling patients, it is important to recognize that benefits in tremor and dyskinesia are expected to be most persistent following bilateral GPi DBS implantation. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/33035998/Long_term_clinical_outcomes_of_bilateral_GPi_deep_brain_stimulation_in_advanced_Parkinson's_disease:_5_years_and_beyond_ L2 - https://thejns.org/doi/10.3171/2020.6.JNS20617 DB - PRIME DP - Unbound Medicine ER -