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Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease.
Brain Stimul. 2020 Nov - Dec; 13(6):1697-1705.BS

Abstract

BACKGROUND

Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects.

OBJECTIVE

To compare nonmotor effects of STN-DBS and GPi-DBS.

METHODS

In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.

RESULTS

In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.

CONCLUSIONS

To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.

Authors+Show Affiliations

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. Electronic address: haidar.dafsari@uk-koeln.de.Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom.Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom.Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil.Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy; Department of Neuroscience, University of Padua, Padua, Italy.National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil.University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33038595

Citation

Dafsari, Haidar S., et al. "Beneficial Nonmotor Effects of Subthalamic and Pallidal Neurostimulation in Parkinson's Disease." Brain Stimulation, vol. 13, no. 6, 2020, pp. 1697-1705.
Dafsari HS, Dos Santos Ghilardi MG, Visser-Vandewalle V, et al. Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease. Brain Stimul. 2020;13(6):1697-1705.
Dafsari, H. S., Dos Santos Ghilardi, M. G., Visser-Vandewalle, V., Rizos, A., Ashkan, K., Silverdale, M., Evans, J., Martinez, R. C. R., Cury, R. G., Jost, S. T., Barbe, M. T., Fink, G. R., Antonini, A., Ray-Chaudhuri, K., Martinez-Martin, P., Fonoff, E. T., & Timmermann, L. (2020). Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease. Brain Stimulation, 13(6), 1697-1705. https://doi.org/10.1016/j.brs.2020.09.019
Dafsari HS, et al. Beneficial Nonmotor Effects of Subthalamic and Pallidal Neurostimulation in Parkinson's Disease. Brain Stimul. 2020 Nov - Dec;13(6):1697-1705. PubMed PMID: 33038595.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease. AU - Dafsari,Haidar S, AU - Dos Santos Ghilardi,Maria Gabriela, AU - Visser-Vandewalle,Veerle, AU - Rizos,Alexandra, AU - Ashkan,Keyoumars, AU - Silverdale,Monty, AU - Evans,Julian, AU - Martinez,Raquel C R, AU - Cury,Rubens G, AU - Jost,Stefanie T, AU - Barbe,Michael T, AU - Fink,Gereon R, AU - Antonini,Angelo, AU - Ray-Chaudhuri,K, AU - Martinez-Martin,Pablo, AU - Fonoff,Erich Talamoni, AU - Timmermann,Lars, AU - ,, Y1 - 2020/10/07/ PY - 2019/11/07/received PY - 2020/08/07/revised PY - 2020/09/25/accepted PY - 2020/10/11/pubmed PY - 2020/10/11/medline PY - 2020/10/10/entrez KW - Deep brain stimulation KW - Globus Pallidus internus KW - Non-motor symptoms KW - Nonmotor symptoms KW - Quality of life KW - Subthalamic nucleus SP - 1697 EP - 1705 JF - Brain stimulation JO - Brain Stimul VL - 13 IS - 6 N2 - BACKGROUND: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects. OBJECTIVE: To compare nonmotor effects of STN-DBS and GPi-DBS. METHODS: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. RESULTS: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. CONCLUSIONS: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles. SN - 1876-4754 UR - https://www.unboundmedicine.com/medline/citation/33038595/Beneficial_nonmotor_effects_of_subthalamic_and_pallidal_neurostimulation_in_Parkinson's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1935-861X(20)30258-8 DB - PRIME DP - Unbound Medicine ER -