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Non-motor outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts

Research output: Contribution to journalArticle

Haidar Salimi Dafsari, Jan Niklas Petry-Schmelzer, K. Ray-Chaudhuri, Keyoumars Ashkan, Luca Weis, Till A. Dembek, Michael Samuel, Alexandra Rizos, Monty Silverdale, Michael T. Barbe, Gereon R. Fink, Julian Evans, Pablo Martinez-Martin, Angelo Antonini, Veerle Visser-Vandewalle, Lars Timmermann, EUROPAR the IPMDS Non Motor PD Study Group

Original languageEnglish
JournalBrain Stimulation
Early online date16 Mar 2018
DOIs
Accepted/In press12 Mar 2018
E-pub ahead of print16 Mar 2018

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Abstract

Background
Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS.

Objective
To investigate the impact of active contact location on NMS in STN-DBS in PD.

Methods
In this prospective, open-label, multicenter study including 50 PD patients undergoing bilateral STN-DBS, we collected NMSScale (NMSS), NMSQuestionnaire (NMSQ), Hospital Anxiety and Depression Scale (anxiety/depression, HADS-A/-D), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, motor complications, activities of daily living (ADL), and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Changes were analyzed with Wilcoxon signed-rank/t-test and Bonferroni-correction for multiple comparisons. Although the STN was targeted visually, we employed an atlas-based approach to explore the relationship between active contact locations and DBS outcomes. Based on fused MRI/CT-images, we identified Cartesian coordinates of active contacts with patient-specific Mai-atlas standardization. We computed linear mixed-effects models with x-/y-/z-coordinates as independent, hemispheres as within-subject, and test change scores as dependent variables.

Results
NMSS, NMSQ, PDQ-8, motor examination, complications, and LEDD significantly improved at follow-up. Linear mixed-effect models showed that NMS and QoL improvement significantly depended on more medial (HADS-D, NMSS), anterior (HADS-D, NMSQ, PDQ-8), and ventral (HADS-A/-D, NMSS, PDQ-8) neurostimulation. ADL improved more in posterior, LEDD in lateral neurostimulation locations. No relationship was observed for motor examination and complications scores.

Conclusions
Our study provides evidence that more anterior, medial, and ventral STN-DBS is significantly related to more beneficial non-motor outcomes.

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