Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes

EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group

doi:10.1016/j.parkreldis.2023.105318

Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes

EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group

Faculty of Medicine and University Hospital of Cologne
University Hospital Marburg
KCH King's College Hospital NHS Foundation Trust
Universidade de Sao Paulo - USP
Manchester Academic Health Sciences Centre
Philipps-Universitat
Research Center Jülich
University of Padua
King's College London
Biomedical Research Unit for Dementia
SLaM South London and Maudsley NHS Foundation Trust
CIBER Enfermedades Neurodegenerativas

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

Abstract

Introduction: Deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease (PD) improving quality of life, motor, and non-motor symptoms. However, non-motor effects in PD subtypes are understudied. We hypothesized that patients with ‘postural instability and gait difficulty’ (PIGD) experience more beneficial non-motor effects than ‘tremor-dominant’ patients undergoing DBS for PD. Methods: In this prospective, observational, international multicentre study with a 6-month follow-up, we assessed the Non-Motor Symptom Scale (NMSS) as primary and the following secondary outcomes: Unified PD Rating Scale-motor examination (UPDRS-III), Scales for Outcomes in PD (SCOPA)-activities of daily living (ADL) and -motor complications, PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose (LEDD). We analysed within-group longitudinal changes with Wilcoxon signed-rank test and Benjamini-Hochberg correction for multiple comparisons. Additionally, we explored outcome between-group differences of motor subtypes with Mann-Whitney U-tests. Results: In 82 PIGD and 33 tremor-dominant patients included in this study, baseline NMSS total scores were worse in PIGD patients, both groups experienced postoperative improvements of the NMSS sleep/fatigue domain, and between-group differences in postoperative outcomes were favourable in the PIGD group for the NMSS total and miscellaneous domain scores. Conclusions: This study provides evidence of a favourable outcome of total non-motor burden in PIGD compared to tremor-dominant patients undergoing DBS for PD. These differences of clinical efficacy on non-motor aspects should be considered when advising and monitoring patients with PD undergoing DBS.

Original language	English
Article number	105318
Journal	Parkinsonism and Related Disorders
Volume	109
DOIs	https://doi.org/10.1016/j.parkreldis.2023.105318
Publication status	Published - Apr 2023

Keywords

Deep brain stimulation
Nonmotor symptoms
Postural instability and gait difficulty
Quality of life
Tremor-dominant

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10.1016/j.parkreldis.2023.105318

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@article{b52d1bcc22c7416bbab304a858818f09,

title = "Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes",

abstract = "Introduction: Deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease (PD) improving quality of life, motor, and non-motor symptoms. However, non-motor effects in PD subtypes are understudied. We hypothesized that patients with {\textquoteleft}postural instability and gait difficulty{\textquoteright} (PIGD) experience more beneficial non-motor effects than {\textquoteleft}tremor-dominant{\textquoteright} patients undergoing DBS for PD. Methods: In this prospective, observational, international multicentre study with a 6-month follow-up, we assessed the Non-Motor Symptom Scale (NMSS) as primary and the following secondary outcomes: Unified PD Rating Scale-motor examination (UPDRS-III), Scales for Outcomes in PD (SCOPA)-activities of daily living (ADL) and -motor complications, PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose (LEDD). We analysed within-group longitudinal changes with Wilcoxon signed-rank test and Benjamini-Hochberg correction for multiple comparisons. Additionally, we explored outcome between-group differences of motor subtypes with Mann-Whitney U-tests. Results: In 82 PIGD and 33 tremor-dominant patients included in this study, baseline NMSS total scores were worse in PIGD patients, both groups experienced postoperative improvements of the NMSS sleep/fatigue domain, and between-group differences in postoperative outcomes were favourable in the PIGD group for the NMSS total and miscellaneous domain scores. Conclusions: This study provides evidence of a favourable outcome of total non-motor burden in PIGD compared to tremor-dominant patients undergoing DBS for PD. These differences of clinical efficacy on non-motor aspects should be considered when advising and monitoring patients with PD undergoing DBS.",

keywords = "Deep brain stimulation, Nonmotor symptoms, Postural instability and gait difficulty, Quality of life, Tremor-dominant",

author = "Jost, \{Stefanie T.\} and Agni Konitsioti and Loehrer, \{Philipp A.\} and Keyoumars Ashkan and Alexandra Rizos and Anna Sauerbier and \{dos Santos Ghilardi\}, \{Maria Gabriela\} and Franz Rosenkranz and Lena Strobel and Alexandra Gronostay and Barbe, \{Michael T.\} and Julian Evans and Veerle Visser-Vandewalle and Christopher Nimsky and Fink, \{Gereon R.\} and Monty Silverdale and Cury, \{Rubens G.\} and Fonoff, \{Erich T.\} and Angelo Antonini and Chaudhuri, \{K. Ray\} and Lars Timmermann and Pablo Martinez-Martin and Dafsari, \{Haidar S.\} and \{EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group\}",

note = "Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = apr,

doi = "10.1016/j.parkreldis.2023.105318",

language = "English",

volume = "109",

journal = "Parkinsonism and Related Disorders",

issn = "1353-8020",

publisher = "Elsevier Limited",

}

TY - JOUR

T1 - Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes

AU - Jost, Stefanie T.

AU - Konitsioti, Agni

AU - Loehrer, Philipp A.

AU - Ashkan, Keyoumars

AU - Rizos, Alexandra

AU - Sauerbier, Anna

AU - dos Santos Ghilardi, Maria Gabriela

AU - Rosenkranz, Franz

AU - Strobel, Lena

AU - Gronostay, Alexandra

AU - Barbe, Michael T.

AU - Evans, Julian

AU - Visser-Vandewalle, Veerle

AU - Nimsky, Christopher

AU - Fink, Gereon R.

AU - Silverdale, Monty

AU - Cury, Rubens G.

AU - Fonoff, Erich T.

AU - Antonini, Angelo

AU - Chaudhuri, K. Ray

AU - Timmermann, Lars

AU - Martinez-Martin, Pablo

AU - Dafsari, Haidar S.

AU - EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group

PY - 2023/4

Y1 - 2023/4

N2 - Introduction: Deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease (PD) improving quality of life, motor, and non-motor symptoms. However, non-motor effects in PD subtypes are understudied. We hypothesized that patients with ‘postural instability and gait difficulty’ (PIGD) experience more beneficial non-motor effects than ‘tremor-dominant’ patients undergoing DBS for PD. Methods: In this prospective, observational, international multicentre study with a 6-month follow-up, we assessed the Non-Motor Symptom Scale (NMSS) as primary and the following secondary outcomes: Unified PD Rating Scale-motor examination (UPDRS-III), Scales for Outcomes in PD (SCOPA)-activities of daily living (ADL) and -motor complications, PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose (LEDD). We analysed within-group longitudinal changes with Wilcoxon signed-rank test and Benjamini-Hochberg correction for multiple comparisons. Additionally, we explored outcome between-group differences of motor subtypes with Mann-Whitney U-tests. Results: In 82 PIGD and 33 tremor-dominant patients included in this study, baseline NMSS total scores were worse in PIGD patients, both groups experienced postoperative improvements of the NMSS sleep/fatigue domain, and between-group differences in postoperative outcomes were favourable in the PIGD group for the NMSS total and miscellaneous domain scores. Conclusions: This study provides evidence of a favourable outcome of total non-motor burden in PIGD compared to tremor-dominant patients undergoing DBS for PD. These differences of clinical efficacy on non-motor aspects should be considered when advising and monitoring patients with PD undergoing DBS.

AB - Introduction: Deep brain stimulation (DBS) is a well-established treatment for patients with Parkinson's disease (PD) improving quality of life, motor, and non-motor symptoms. However, non-motor effects in PD subtypes are understudied. We hypothesized that patients with ‘postural instability and gait difficulty’ (PIGD) experience more beneficial non-motor effects than ‘tremor-dominant’ patients undergoing DBS for PD. Methods: In this prospective, observational, international multicentre study with a 6-month follow-up, we assessed the Non-Motor Symptom Scale (NMSS) as primary and the following secondary outcomes: Unified PD Rating Scale-motor examination (UPDRS-III), Scales for Outcomes in PD (SCOPA)-activities of daily living (ADL) and -motor complications, PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose (LEDD). We analysed within-group longitudinal changes with Wilcoxon signed-rank test and Benjamini-Hochberg correction for multiple comparisons. Additionally, we explored outcome between-group differences of motor subtypes with Mann-Whitney U-tests. Results: In 82 PIGD and 33 tremor-dominant patients included in this study, baseline NMSS total scores were worse in PIGD patients, both groups experienced postoperative improvements of the NMSS sleep/fatigue domain, and between-group differences in postoperative outcomes were favourable in the PIGD group for the NMSS total and miscellaneous domain scores. Conclusions: This study provides evidence of a favourable outcome of total non-motor burden in PIGD compared to tremor-dominant patients undergoing DBS for PD. These differences of clinical efficacy on non-motor aspects should be considered when advising and monitoring patients with PD undergoing DBS.

KW - Deep brain stimulation

KW - Nonmotor symptoms

KW - Postural instability and gait difficulty

KW - Quality of life

KW - Tremor-dominant

UR - https://www.scopus.com/pages/publications/85149034797

U2 - 10.1016/j.parkreldis.2023.105318

DO - 10.1016/j.parkreldis.2023.105318

M3 - Article

C2 - 36842866

AN - SCOPUS:85149034797

SN - 1353-8020

VL - 109

JO - Parkinsonism and Related Disorders

JF - Parkinsonism and Related Disorders

M1 - 105318

ER -

Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes

Abstract

Keywords

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