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A prospective, controlled study of non-motor effects of subthalamic stimulation in Parkinson's disease: Results at the 36-month follow-up

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Stefanie Theresa Jost, Anna Sauerbier, Anna Sauerbier, Veerle Visser-Vandewalle, Keyoumars Ashkan, Monty Silverdale, Julian Evans, Philipp A. Loehrer, Alexandra Rizos, Jan Niklas Petry-Schmelzer, Paul Reker, Gereon Rudolf Fink, Jeremy Franklin, Michael Samuel, Alfons Schnitzler, Michael Thomas Barbe, Angelo Antonini, Angelo Antonini, Pablo Martinez-Martin, Lars Timmermann & 3 more K. Ray-Chaudhuri, K. Ray-Chaudhuri, Haidar S. Dafsari

Original languageEnglish
Pages (from-to)687-694
Number of pages8
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume91
Issue number7
DOIs
Published1 Jul 2020

King's Authors

Abstract

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.

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