TY - JOUR
T1 - A prospective, controlled study of non-motor effects of subthalamic stimulation in Parkinson's disease
T2 - results at the 36-month follow-up
AU - EUROPAR and the IPMDS (International Parkinson's and Movement Disorders Society) Non-Motor Parkinson's Disease Study Group
AU - Jost, Stefanie Theresa
AU - Sauerbier, Anna
AU - Visser-Vandewalle, Veerle
AU - Ashkan, Keyoumars
AU - Silverdale, Monty
AU - Evans, Julian
AU - Loehrer, Philipp A
AU - Rizos, Alexandra
AU - Petry-Schmelzer, Jan Niklas
AU - Reker, Paul
AU - Fink, Gereon Rudolf
AU - Franklin, Jeremy
AU - Samuel, Michael
AU - Schnitzler, Alfons
AU - Barbe, Michael Thomas
AU - Antonini, Angelo
AU - Martinez-Martin, Pablo
AU - Timmermann, Lars
AU - Ray-Chaudhuri, K
AU - Dafsari, Haidar S
N1 - © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - OBJECTIVE: To examine 36-month effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on non-motor symptoms (NMS) compared with standard-of-care medical treatment (MED) in Parkinson's disease (PD).METHODS: Here we report the 36-month follow-up of a prospective, observational, controlled, international multicentre study of the NILS cohort. Assessments included NMSScale (NMSS), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). Propensity score matching resulted in a pseudo-randomised sub-cohort balancing baseline demographic and clinical characteristics between the STN-DBS and MED groups. Within-group longitudinal outcome changes were analysed using Wilcoxon signed-rank and between-group differences of change scores with Mann-Whitney U test. Strength of clinical responses was quantified with Cohen's effect size. In addition, bivariate correlations of change scores were explored.RESULTS: Propensity score matching applied on the cohort of 151 patients (STN-DBS n=67, MED n=84) resulted in a well-balanced sub-cohort including 38 patients per group. After 36 months, STN-DBS significantly improved NMSS, PDQ-8, SCOPA-motor examination and -complications and reduced LEDD. Significant between-group differences, all favouring STN-DBS, were found for NMSS, SCOPA-motor complications, LEDD (large effects), motor examination and PDQ-8 (moderate effects). Furthermore, significant differences were found for the sleep/fatigue, urinary (large effects) and miscellaneous NMSS domains (moderate effects). NMSS total and PDQ-8 change scores correlated significantly.CONCLUSIONS: This study provides Class IIb evidence for beneficial effects of STN-DBS on NMS at 36-month follow-up which also correlated with quality of life improvements. This highlights the importance of NMS for DBS outcomes assessments.
AB - OBJECTIVE: To examine 36-month effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on non-motor symptoms (NMS) compared with standard-of-care medical treatment (MED) in Parkinson's disease (PD).METHODS: Here we report the 36-month follow-up of a prospective, observational, controlled, international multicentre study of the NILS cohort. Assessments included NMSScale (NMSS), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). Propensity score matching resulted in a pseudo-randomised sub-cohort balancing baseline demographic and clinical characteristics between the STN-DBS and MED groups. Within-group longitudinal outcome changes were analysed using Wilcoxon signed-rank and between-group differences of change scores with Mann-Whitney U test. Strength of clinical responses was quantified with Cohen's effect size. In addition, bivariate correlations of change scores were explored.RESULTS: Propensity score matching applied on the cohort of 151 patients (STN-DBS n=67, MED n=84) resulted in a well-balanced sub-cohort including 38 patients per group. After 36 months, STN-DBS significantly improved NMSS, PDQ-8, SCOPA-motor examination and -complications and reduced LEDD. Significant between-group differences, all favouring STN-DBS, were found for NMSS, SCOPA-motor complications, LEDD (large effects), motor examination and PDQ-8 (moderate effects). Furthermore, significant differences were found for the sleep/fatigue, urinary (large effects) and miscellaneous NMSS domains (moderate effects). NMSS total and PDQ-8 change scores correlated significantly.CONCLUSIONS: This study provides Class IIb evidence for beneficial effects of STN-DBS on NMS at 36-month follow-up which also correlated with quality of life improvements. This highlights the importance of NMS for DBS outcomes assessments.
KW - Activities of Daily Living
KW - Aged
KW - Antiparkinson Agents/therapeutic use
KW - Combined Modality Therapy
KW - Deep Brain Stimulation/methods
KW - Fatigue/physiopathology
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Levodopa/therapeutic use
KW - Male
KW - Middle Aged
KW - Parkinson Disease/drug therapy
KW - Prospective Studies
KW - Sleep/physiology
KW - Subthalamic Nucleus/physiopathology
KW - Treatment Outcome
U2 - 10.1136/jnnp-2019-322614
DO - 10.1136/jnnp-2019-322614
M3 - Article
C2 - 32371534
SN - 0022-3050
VL - 91
SP - 687
EP - 694
JO - Journal of neurology, neurosurgery, and psychiatry
JF - Journal of neurology, neurosurgery, and psychiatry
IS - 7
ER -