A systematic review of the impact of subthalamic nucleus stimulation on the quality of life of patients with Parkinson's disease

Neurological Health: Not Merely the Absence of Disease: Current Wellbeing Instruments Across the Spectrum of Neurology

OBJECTIVE

Well-being and quality of life can vary independently of disease. Instruments measuring well-being and quality of life are commonly used in neurology, but there has been little investigation into the extent in which they accurately measure wellbeing/quality of life or if they merely reflect a diseased state of an individual.

DESIGN

Systematic searches, thematic analysis and narrative synthesis were undertaken. Individual items from instruments represented in ≥ 5 publications were categorised independently, without prior training, by five neurologists and one well-being researcher, as relating to 'disease-effect' or 'Well-being' with a study-created instrument. Items were additionally categorised into well-being domains.

DATA SOURCES

MEDLINE, EMBASE, EMCARE and PsycINFO from 1990 to 2020 were performed, across the 13 most prevalent neurological diseases.

RESULTS

301 unique instruments were identified. Multiple sclerosis had most unique instruments at 92. SF-36 was used most, in 66 studies. 22 instruments appeared in ≥ 5 publications: 19/22 'well-being' outcome instruments predominantly measured disease effect (Fleiss kappa = .60). Only 1/22 instruments was categorised unanimously as relating to well-being. Instruments predominantly measured mental, physical and activity domains, over social or spiritual.

CONCLUSIONS

Most neurological well-being or quality-of-life instruments predominantly measure disease effect, rather than disease-independent well-being. Instruments differed widely in well-being domains examined.

Antiparkinsonian Drug Reduction After Directional Versus Omnidirectional Bilateral Subthalamic Deep Brain Stimulation

BACKGROUND

Several pilot trials and the Clinical Evaluation of the Infinity Deep Brain Stimulation System (PROGRESS) study have found that directional stimulation can provide a wider therapeutic window and lower therapeutic current strength than omnidirectional stimulation.

OBJECTIVE

We conducted a single-center, open-label, registry-based, comparative trial to test the hypothesis that directional stimulation can be associated with a greater reduction in the total daily dose of antiparkinsonian medications (ApMeds) than omnidirectional stimulation.

MATERIALS AND METHODS

A total of 52 patients with directional and 57 subjects with omnidirectional bilateral subthalamic deep brain stimulation (STN-DBS) were enrolled. Preoperatively and 12 months postoperatively, the dose of different ApMeds, the number of tablets used daily, the severity of motor and nonmotor symptoms using the Movement Disorder Society-sponsored Unified Parkinson Disease Rating Scale, and the health-related quality of life (HRQoL) using the 39-item Parkinson's Disease Questionnaire (PDQ-39) were assessed.

RESULTS

According to the changes in the levodopa equivalent daily dose, directional STN-DBS led to a 13% greater reduction in the total daily dose of ApMed. The 10.3% greater reduction in the dose of levodopa was the main contributor to this difference. The number of different ApMed types also could be decreased in a greater manner with directional stimulation. The improvement in the severity of motor and nonmotor symptoms was comparable; however, we detected a 15.8% greater improvement in the global HRQoL among patients with directional stimulation according to the changes in the summary index of the PDQ-39. The total electrical energy delivered per second was comparable between the groups at 12-month postoperative visit, whereas the amplitude of stimulation was significantly lower and the impedance was significantly higher with directional leads.

CONCLUSIONS

Directional programming can further increase the reduction in the total daily dose of ApMed after STN-DBS. In addition, directional stimulation can have additional beneficial effects on the global HRQoL. The greater reduction of ApMed doses did not require more energy-consuming stimulation with directional stimulation.

Neurophysiological comparisons of subthalamic deep-brain stimulation for Parkinson's disease between patients receiving general and local anesthesia

Objectives:

Subthalamic nucleus deep-brain stimulation (STN-DBS) is suggested as a standard treatment for patients with Parkinson's disease (PD) and drug-related side effects. Most centers perform the operation under local anesthesia (LA) to ensure better microelectrode recording (MER). Given the advances in imaging and MER, general anesthesia (GA) is perceived as an alternative choice for PD patients undergoing STN-DBS. However, the outcomes in terms of clinical symptoms and MER after GA have rarely been reported. In this report, we compared the outcomes after STN-DBS for PD between patients receiving LA and GA.

Materials and Methods:

We included 16 patients with comparable severity of PD undergoing either GA (n = 8) or LA (n = 8) for STN-DBS. MER was performed in all patients for STN localization, and surgical outcomes were evaluated using the Unified PD Rating Scales, and Mini-mental status examination. All adverse effects were documented.

Results:

Both groups (GA and LA) acquired similar benefits from STN-DBS, and there were no significant differences in neuropsychiatric outcome analysis between groups. There were no significant differences in stimulation parameters and adverse effects from STN-DBS between groups. The GA group had a trend toward a lower frequency rate of STN firing on MER.

Conclusion:

Although the GA group has a lower neuronal firing frequency in the STN during surgery, STN-DBS under GA showed comparable and non-inferior outcomes as compared with STN-DBS under LA.