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Bhanupriya R, Haridoss M, Lakshmi GS, Bagepally BS. Health-related quality of life in Parkinson's disease: systematic review and meta-analysis of EuroQol (EQ-5D) utility scores. Qual Life Res 2024; 33:1781-1793. [PMID: 38581635 DOI: 10.1007/s11136-024-03646-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Evaluating the Health-related quality of life (HRQoL) of individuals with Parkinson's disease (PD) holds significant importance in clinical and research settings. The EQ-5D is a widely recognized tool for comprehensive measurement of HRQoL using utility values. This study aims to systematically review and synthesize EQ-5D utility values from existing literature on patients with PD and their caregivers. METHODS We conducted a systematic search for studies that provided EQ-5D utility scores for patients with PD, using PubMed-Medline, Scopus, and Embase and selected the studies. The selected studies underwent systematic review, including an assessment of their quality. We performed a meta-analysis using a random-effect model and conducted a meta-regression analysis to investigate sources of heterogeneity among the studies. RESULTS The search result of 13,417 articles that were reviewed, 130 studies with 33,914 participants were selected for systematic review, and 79 studies were included for meta-analysis. The pooled EQ-5D utility values and visual analog score (VAS) among PD were 62.72% (60.53-64.93, I2 = 99.56%) and 0.60 (0.55-0.65, I2 = 99.81%), respectively. The pooled scores for caregivers' EQ-VAS and EQ-5D utility were 70.10% (63.99-76.20, I2 = 98.25%) and 0.71 (0.61-0.81, I2 = 94.88%), respectively. Disease duration (P < 0.05) showed a negative correlation with EQ-5D utility values on meta-regression. CONCLUSION The pooled utility values of PD and their caregivers help to understand their HRQoL and aid in conducting health economics research. The negative association between disease duration and utility values highlights the evolving nature of HRQoL challenges, suggesting the need for appropriate long-term disease management.
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Affiliation(s)
| | | | | | - Bhavani Shankara Bagepally
- ICMR-National Institute of Epidemiology, Chennai, India.
- Health Technology Assessment Resource Centre ICMR-NIE, ICMR-National Institute of Epidemiology, Ayapakkam, Chennai, 600077, India.
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Sandoval-Pistorius SS, Hacker ML, Waters AC, Wang J, Provenza NR, de Hemptinne C, Johnson KA, Morrison MA, Cernera S. Advances in Deep Brain Stimulation: From Mechanisms to Applications. J Neurosci 2023; 43:7575-7586. [PMID: 37940596 PMCID: PMC10634582 DOI: 10.1523/jneurosci.1427-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 11/10/2023] Open
Abstract
Deep brain stimulation (DBS) is an effective therapy for various neurologic and neuropsychiatric disorders, involving chronic implantation of electrodes into target brain regions for electrical stimulation delivery. Despite its safety and efficacy, DBS remains an underutilized therapy. Advances in the field of DBS, including in technology, mechanistic understanding, and applications have the potential to expand access and use of DBS, while also improving clinical outcomes. Developments in DBS technology, such as MRI compatibility and bidirectional DBS systems capable of sensing neural activity while providing therapeutic stimulation, have enabled advances in our understanding of DBS mechanisms and its application. In this review, we summarize recent work exploring DBS modulation of target networks. We also cover current work focusing on improved programming and the development of novel stimulation paradigms that go beyond current standards of DBS, many of which are enabled by sensing-enabled DBS systems and have the potential to expand access to DBS.
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Affiliation(s)
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee 37232
| | - Allison C Waters
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York 10029
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota 55455
| | - Nicole R Provenza
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Kara A Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida 32608
| | - Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California 94143
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California-San Francisco, San Francisco, California 94143
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Kim A, Yang HJ, Kwon JH, Kim MH, Lee J, Jeon B. Mortality of Deep Brain Stimulation and Risk Factors in Patients With Parkinson's Disease: A National Cohort Study in Korea. J Korean Med Sci 2023; 38:e10. [PMID: 36647215 PMCID: PMC9842484 DOI: 10.3346/jkms.2023.38.e10] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This study aimed to investigate 1) long-term outcomes of deep brain stimulation (DBS), such as mortality after DBS as well as the causes of death, 2) demographic and socioeconomic factors influencing mortality, and 3) comorbidities affecting mortality after DBS in patients with Parkinson's disease (PD). METHODS This study analyzed the National Health Insurance Service-National Health Information Database. Data on patients with PD diagnosis codes from 2002 to 2019 were extracted and analyzed. Data on the causes of death were obtained by linking the causes of death to data from Statistics Korea. The Kaplan-Meier method with the log-rank test was used for survival analysis. Multivariate Cox regression analyses were used to estimate hazard ratios (HRs) and their 95% confidence intervals. Regarding comorbidities such as PD dementia and fracture, which did not satisfy the assumption for the proportional HR, time-dependent Cox analysis with the Mantel-Byar method was used. RESULTS From 2005 to 2017, among 156,875 patients diagnosed with PD in Korea, 1,079 patients underwent DBS surgery, and 251 (23.3%) had died by 2019. The most common cause of death (47.1%) was PD. In the multivariate Cox regression analysis, the higher the age at diagnosis and surgery, the higher the mortality rate. The men and medical aid groups had significantly higher mortality rates. PD dementia and fracture were identified as risk factors for mortality. CONCLUSION Older age at diagnosis and surgery, being male, the use of medical aid, and the comorbidity of dementia and fractures were associated with a higher risk of mortality after DBS in patients with PD. Neurologists should consider these risk factors in assessing the prognosis of PD patients undergoing DBS.
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Affiliation(s)
- Ahro Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Min-Ho Kim
- Informatization Department, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Jiho Lee
- Department of Occupational and Environmental Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Cramer SW, Do TH, Palzer EF, Naik A, Rice AL, Novy SG, Hanson JT, Piazza AN, Howard MA, Huling JD, Chen CC, McGovern RA. Persistent Racial Disparities in Deep Brain Stimulation for Parkinson's Disease. Ann Neurol 2022; 92:246-254. [PMID: 35439848 PMCID: PMC9546407 DOI: 10.1002/ana.26378] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
We sought to determine whether racial and socioeconomic disparities in the utilization of deep brain stimulation (DBS) for Parkinson's disease (PD) have improved over time. We examined DBS utilization and analyzed factors associated with placement of DBS. The odds of DBS placement increased across the study period, whereas White patients with PD were 5 times more likely than Black patients to undergo DBS. Individuals, regardless of racial background, with 2 or more comorbidities were 14 times less likely to undergo DBS. Privately insured patients were 1.6 times more likely to undergo DBS. Despite increasing DBS utilization, significant disparities persist in access to DBS. ANN NEUROL 2022;92:246–254
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Affiliation(s)
- Samuel W Cramer
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Truong H Do
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Elise F Palzer
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL
| | | | | | - Jacob T Hanson
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | | | | | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Robert A McGovern
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN.,Division of Neurosurgery, Minneapolis VA Health Care System, Minneapolis, MN
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Miyasaki JM, Lim TT, Bhidayasiri R. Editorial: Inclusion, equity, diversity and social justice in movement disorders research. Parkinsonism Relat Disord 2021; 85:114-116. [PMID: 33840573 DOI: 10.1016/j.parkreldis.2021.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Janis M Miyasaki
- Department of Medicine, Division Neurology, University of Alberta, Edmonton, Canada.
| | | | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Oxidative Stress in Parkinson's Disease: Potential Benefits of Antioxidant Supplementation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:2360872. [PMID: 33101584 PMCID: PMC7576349 DOI: 10.1155/2020/2360872] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease (PD) occurs in approximately 1% of the population over 65 years of age and has become increasingly more common with advances in age. The number of individuals older than 60 years has been increasing in modern societies, as well as life expectancy in developing countries; therefore, PD may pose an impact on the economic, social, and health structures of these countries. Oxidative stress is highlighted as an important factor in the genesis of PD, involving several enzymes and signaling molecules in the underlying mechanisms of the disease. This review presents updated data on the involvement of oxidative stress in the disease, as well as the use of antioxidant supplements in its therapy.
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Sabari J, Stefanov DG, Chan J, Goed L, Starr J. Adapted Feeding Utensils for People With Parkinson's-Related or Essential Tremor. Am J Occup Ther 2019; 73:7302205120p1-7302205120p9. [PMID: 30915973 DOI: 10.5014/ajot.2019.030759] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Our objective was to evaluate the effectiveness of four adapted feeding utensils with participants with essential tremor (ET) or tremor related to Parkinson's disease (PD). METHOD Participants performed a simulated feeding task under five conditions: (1) standard spoon (control condition), (2) weighted spoon with standard handle, (3) weighted spoon with built-up handle, (4) swivel spoon, and (5) Liftware Steady™ spoon, a product using active tremor cancellation technology. Participants rated each adapted utensil in comparison with the standard spoon regarding performance, ease of use, speed, neatness, and aesthetics. RESULTS Participants preferred the Liftware Steady spoon and weighted spoon with standard handle. Friedman's test did not reveal statistically significant differences in ratings between the two preferred utensils. CONCLUSION Participants had varied reactions to the different adaptive utensils and gave different reasons for preferences. These findings support the need for people with tremor related to ET or PD to have access to trial use of all four devices assessed in this study.
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Affiliation(s)
- Joyce Sabari
- Joyce Sabari, PhD, OTR, FAOTA, is Professor Emeritus, Occupational Therapy Program, State University of New York (SUNY) Downstate, Brooklyn;
| | - Dimitre G Stefanov
- Dimitre G. Stefanov, PhD, is Biostatistician, Scientific Computing Center, State University of New York (SUNY) Downstate, Brooklyn
| | - Judy Chan
- Judy Chan, MS, OTR, was Graduate Student, Occupational Therapy Program, State University of New York (SUNY) Downstate, Brooklyn, at the time of the study
| | - Lorraine Goed
- Lorraine Goed, MS, OTR, was Graduate Student, Occupational Therapy Program, State University of New York (SUNY) Downstate, Brooklyn, at the time of the study
| | - Joyce Starr
- Joyce Starr, MS, OTR, was Graduate Student, Occupational Therapy Program, State University of New York (SUNY) Downstate, Brooklyn, at the time of the study
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Abstract
BACKGROUND The Canada Health Act requires reasonable access to all medically necessary therapies. No information is available to assess the current access to neuromodulation across Canada. This study quantifies the current rate of deep brain stimulation (DBS) for the entire country of Canada. Analyses were performed to determine whether there were differences in access based on provincial or territorial location, rural or non-rural region, or socioeconomic status. METHODS All implanted DBS devices in Canada over a 2-year epoch (January 2015 to December 2016) were supplied by either Boston Scientific or Medtronic. Investigators received anonymized data from these companies, including patient age and home residence region. The 2016 Statistics Canada census data were used to determine the rate of DBS surgery and whether access was related to provincial location, rural versus non-rural region or socioeconomic status. RESULTS A total of 722 patients were studied. The rate of DBS surgery for the entire country was ten per million population per year. Saskatchewan was significantly above (374%) the national average, whereas Quebec (40%) and Newfoundland & Labrador (32%) were significantly below the national average. No patients from the three territories received DBS. There were no significant differences in access from rural versus non-rural areas or in regions within provinces with different socioeconomic status. CONCLUSIONS This is the first study to quantify all patients receiving DBS within an entire country. The current rate of DBS surgery within Canada is ten cases per million per year. Statistically significant regional differences were discovered and discussed.
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Predictors of Functional and Quality of Life Outcomes following Deep Brain Stimulation Surgery in Parkinson's Disease Patients: Disease, Patient, and Surgical Factors. PARKINSONS DISEASE 2017; 2017:5609163. [PMID: 28852579 PMCID: PMC5568614 DOI: 10.1155/2017/5609163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/19/2017] [Accepted: 07/09/2017] [Indexed: 11/17/2022]
Abstract
Objective The primary objective was to evaluate predictors of quality of life (QOL) and functional outcomes following deep brain stimulation (DBS) in Parkinson's disease (PD) patients. The secondary objective was to identify predictors of global improvement. Methods PD patients who underwent DBS at our Center from 2006 to 2011 were evaluated by chart review and email/phone survey. Postoperative UPDRS II and EQ-5D were analyzed using simple linear regression adjusting for preoperative score. For global outcomes, we utilized the Patient Global Impression of Change Scale (PGIS) and the Clinician Global Impression of Change Scale (CGIS). Results There were 130 patients in the dataset. Preoperative and postoperative UPDRS II and EQ-5D were available for 45 patients, PGIS for 67 patients, and CGIS for 116 patients. Patients with falls/postural instability had 6-month functional scores and 1-year QOL scores that were significantly worse than patients without falls/postural instability. For every 1-point increase in preoperative UPDRS III and for every 1-unit increase in body mass index (BMI), the 6-month functional scores significantly worsened. Patients with tremors, without dyskinesia, and without gait-freezing were more likely to have “much” or “very much” improved CGIS. Conclusions Presence of postural instability, high BMI, and worse baseline motor scores were the greatest predictors of poorer functional and QOL outcomes after DBS.
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Purvis TE, Lubelski D, Mroz TE. Is Decompressive Surgery for Cervical Spondylotic Myelopathy Effective in Patients Suffering from Concomitant Multiple Sclerosis or Parkinson's Disease? Brain Sci 2017; 7:brainsci7040039. [PMID: 28394266 PMCID: PMC5406696 DOI: 10.3390/brainsci7040039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
A subset of patients with a demyelinating disease suffer from concurrent cervical spondylotic myelopathy, both of which evince similar symptomatology. Differentiating the cause of these symptoms is challenging, and little research has been done on patients with coexisting diseases. This review explores the current literature on the appropriate surgical management of patients with concurrent multiple sclerosis (MS) and cervical spondylotic myelopathy (CSM), and those with both Parkinson’s disease (PD) and CSM. MS and CSM patients may benefit from surgery to reduce pain and radiculopathy. Surgical management in PD and CSM patients has shown minimal quality-of-life improvement. Future studies are needed to better characterize demyelinating disease patients with concurrent disease and to determine ideal medical or surgical treatment.
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Affiliation(s)
- Taylor E Purvis
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA.
- Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
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Juhász A, Deli G, Aschermann Z, Janszky J, Harmat M, Makkos A, Kovács M, Komoly S, Balás I, Dóczi T, Büki A, Kovács N. How Efficient Is Subthalamic Deep Brain Stimulation in Reducing Dyskinesia in Parkinson's Disease? Eur Neurol 2017; 77:281-287. [DOI: 10.1159/000455208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/01/2017] [Indexed: 11/19/2022]
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Horváth K, Aschermann Z, Kovács M, Makkos A, Harmat M, Janszky J, Komoly S, Karádi K, Kovács N. Minimal clinically important differences for the experiences of daily living parts of movement disorder society-sponsored unified Parkinson's disease rating scale. Mov Disord 2017; 32:789-793. [DOI: 10.1002/mds.26960] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Krisztina Horváth
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
| | - Zsuzsanna Aschermann
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Attila Makkos
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Márk Harmat
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Neurology; University of Pécs; Pécs Hungary
| | - József Janszky
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
| | - Sámuel Komoly
- Department of Neurology; University of Pécs; Pécs Hungary
| | - Kázmér Karádi
- Doctoral School of Clinical Neuroscience; University of Pécs; Pécs Hungary
- Department of Behavioral Sciences, Universiyt of Pecs, Hungary
| | - Norbert Kovács
- Department of Neurology; University of Pécs; Pécs Hungary
- MTA-PTE Clinical Neuroscience MR Research Group; Pécs Hungary
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Xiao R, Miller JA, Lubelski D, Alberts JL, Mroz TE, Benzel EC, Krishnaney AA, Machado AG. Quality of life outcomes following cervical decompression for coexisting Parkinson's disease and cervical spondylotic myelopathy. Spine J 2016; 16:1358-1366. [PMID: 27496286 DOI: 10.1016/j.spinee.2016.07.530] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/13/2016] [Accepted: 07/18/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Coexisting Parkinson's disease (PD) and cervical spondylotic myelopathy (CSM) presents a diagnostic and therapeutic challenge due to symptomatic similarities between the diseases. Whereas CSM patients are routinely treated with surgery, PD patients face poorer outcomes following spine surgery. No studies have investigated the quality of life (QOL) outcomes following decompression in coexisting PD and CSM. PURPOSE The purpose of the present study was to characterize QOL outcomes for patients with coexisting PD and CSM following cervical decompression. STUDY DESIGN/SETTING This is a matched cohort study at a single tertiary-care center. PATIENT SAMPLE Patients with coexisting PD and CSM undergoing cervical decompression between June 2009 and December 2014 were included. These patients were matched to controls with CSM alone by age, gender, American Society of Anesthesiologists classification, Modified Japanese Orthopaedic Association scores, and operative parameters. OUTCOME MEASURES The primary outcome measure was QOL outcomes assessed by change in the EuroQol 5-Dimensions (EQ-5D), Pain Disability Questionnaire (PDQ), and Patient Health Questionnaire-9 (PHQ-9) at last follow-up (LFU). Change in QOL exceeding the minimal clinically important difference (MCID) was secondary. METHODS QOL data were collected using the institutional prospectively collected database of patient-reported health status measures. Simple and multivariable regressions were used to assess the impact of PD upon change in QOL. RESULTS Eleven PD patients were matched to 44 controls. Control patients experienced QOL improvement across all three measures, whereas PD patients only improved with respect to PDQ(89.9-80.7, p=.03). Despite no significant differences in preoperative QOL, PD patients experienced poorer QOL at LFU in EQ-5D (0.526 vs. 0.707, p=.01) and PDQ (80.7 vs. 51.4, p=.03), and less frequently achieved an EQ-5D MCID (18% vs. 57%, p=.04). However, no differences in the achievement of an MCID in PDQ or PHQ-9 were observed between cohorts. Multivariable regression identified PD as a significant independent predictor of poorer improvement in EQ-5D (β=-0.09, p<.01) and failure to achieve an EQ-5D MCID (odds ratio: 0.08, p<.01). CONCLUSIONS This is the first study to characterize QOL outcomes following cervical decompression for patients with coexisting PD and CSM. Although myelopathy may have been less severe among PD patients, a significant reduction in pain-related disability was observed following decompression. However, PD predicted diminished improvement in overall QOL measured by the EQ-5D.
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Affiliation(s)
- Roy Xiao
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA
| | - Jacob A Miller
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, NA-24, Cleveland, OH 44195, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University, 855 N Wolfe St, Baltimore, MD 21205, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Edward C Benzel
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Ajit A Krishnaney
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA
| | - Andre G Machado
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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