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Short-term quality of life after subthalamic stimulation depends on non-motor symptoms in Parkinson's disease

Research output: Contribution to journalArticle

Haidar Salimi Dafsari, Luisa Weiß, Monty Silverdale, Alexandra Rizos, Prashanth Reddy, Keyoumars Ashkan, Julian Evans, Paul Reker, Jan Niklas Petry-Schmelzer, Michael Samuel, Veerle Visser-Vandewalle, Angelo Antonini, Pablo Martinez-Martin, K. Ray-Chaudhuri, Lars Timmermann

Original languageEnglish
JournalBrain Stimulation
Early online date24 Feb 2018
DOIs
Accepted/In press22 Feb 2018
E-pub ahead of print24 Feb 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 advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome. Hypothesis We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome. Methods In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and –activities of daily living, levodopa equivalent daily dose. We dichotomized patients into “QoL responders”/“non-responders” and screened for factors associated with QoL improvement with (1) Spearman-correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions using aforementioned “responders/non-responders” as dependent variable. Results All outcomes improved significantly on follow-up. However, approximately 44% of patients were categorized as “QoL non-responders”. Spearman-correlations, linear and logistic regression analyses were significant for NMSS and NMSQ but not for SCOPA-motor examination. Post-hoc, we identified specific NMS (flat moods, difficulties experiencing pleasure, pain, bladder voiding) as significant contributors to QoL outcome. Conclusions Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies investigating motor and non-motor PD clusters may enable stratifying QoL outcomes and help predict patients' individual prospects of benefiting from DBS.

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