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Gronostay A, Jost ST, Silverdale M, Rizos A, Loehrer PA, Evans J, Sauerbier A, Indi D, Leta V, Reker P, Fink GR, Ashkan K, Antonini A, Nimsky C, Visser-Vandewalle V, Martinez-Martin P, Ray Chaudhuri K, Timmermann L, Dafsari HS. Stratifying quality of life outcome in subthalamic stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2024; 95:630-638. [PMID: 38124227 DOI: 10.1136/jnnp-2023-332272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD) improves quality of life (QoL), motor and non-motor symptoms (NMS). However, in previous studies, 43%-49% of patients did not experience clinically relevant postoperative QoL improvement. To inform individualised prediction of postoperative QoL improvement, we developed a stratification analysis of QoL outcomes based on preoperative non-motor total burden, severity of motor progression and motor response in levodopa challenge tests. METHODS This was a prospective, open-label, multicentre, international study with a 6-month follow-up. A distribution-based threshold identified 'QoL responders' in the PDQuestionnaire-8 Summary Index (PDQ-8 SI). After baseline stratification based on the NMS Scale, Hoehn and Yahr Scale and levodopa response assessed with the Unified PD Rating Scale-III, we compared postoperative QoL response between these strata. To assess the clinical usefulness and statistical feasibility of stratifications, we compared cumulative distribution function curves, respectively PDQ-8 within-stratum variation. RESULTS All main outcomes improved postoperatively. Based on the 8.1 points threshold for clinically meaningful PDQ-8 SI improvement, only 80/161 patients were classified as 'QoL responders'. The absolute risk reductions for QoL non-response among respective non-motor, motor progression and levodopa response strata were 23%, 8% and 3%, respectively. Only non-motor stratification reduced PDQ-8 within-stratum variation compared with the overall cohort. CONCLUSIONS Non-motor stratification, but not motor progression or levodopa response stratification, is clinically useful and statistically feasible for personalised preoperative prediction of postoperative QoL outcome of STN-DBS for PD. Our findings highlight that non-motor assessments are necessary components of a case-based, holistic approach of DBS indication evaluations geared towards optimising postoperative QoL outcomes. TRIAL REGISTRATION NUMBER GermanClinicalTrialsRegister: #6735.
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Affiliation(s)
- Alexandra Gronostay
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Stefanie Theresa Jost
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | | | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK
| | - Anna Sauerbier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Donya Indi
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Valentina Leta
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Paul Reker
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Haidar S Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Sauerbier A, Herberg J, Stopic V, Loehrer PA, Ashkan K, Rizos A, Jost ST, Petry-Schmelzer JN, Gronostay A, Schneider C, Visser-Vandewalle V, Evans J, Nimsky C, Fink GR, Antonini A, Martinez-Martin P, Silverdale M, Weintraub D, Schrag A, Ray Chaudhuri K, Timmermann L, Dafsari HS. Predictors of short-term anxiety outcome in subthalamic stimulation for Parkinson's disease. NPJ Parkinsons Dis 2024; 10:114. [PMID: 38851717 PMCID: PMC11162430 DOI: 10.1038/s41531-024-00701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/02/2024] [Indexed: 06/10/2024] Open
Abstract
The effects of subthalamic nucleus deep brain stimulation (STN-DBS) on anxiety in Parkinson's disease (PD) are understudied. We identified clinical predictors of STN-DBS effects on anxiety in this study. In this prospective, open-label, multicentre study, we assessed patients with anxiety undergoing STN-DBS for PD preoperatively and at 6-month follow-up postoperatively. We assessed the Hospital Anxiety and Depression Scale (HADS-anxiety and depression subscales), Unified PD Rating Scale-motor examination, Scales for Outcomes in PD-motor (SCOPA-M)-activities of daily living (ADL) and -motor complications, Non-Motor Symptom Scale (NMSS), PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose. We tested changes at follow-up with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We identified patients with a clinically relevant anxiety improvement of anxiety based on a designated threshold of ½ standard deviation of baseline HADS-anxiety. Moreover, we investigated predictors of HADS-anxiety changes with correlations and linear regressions. We included 50 patients with clinically relevant baseline anxiety (i.e., HADS-anxiety ≥ 8) aged 63.1 years ± 8.3 with 10.4 years ± 4.5 PD duration. HADS-anxiety improved significantly at 6-month follow-up as 80% of our cohort experienced clinically relevant anxiety improvement. In predictor analyses, worse baseline SCOPA-ADL and NMSS-urinary domain were associated with greater HADS-anxiety improvements. HADS-anxiety and PDQ-8 changes correlated moderately. Worse preoperative ADL and urinary symptoms predicted favourable postoperative anxiety outcome, which in turn was directly proportionate to greater QoL improvement. This study highlights the importance of detailed anxiety assessments alongside other non-motor and motor symptoms when advising and monitoring patients undergoing STN-DBS for PD.
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Affiliation(s)
- Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Johanna Herberg
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Vasilija Stopic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Christian Schneider
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Christopher Nimsky
- Department of Neurosurgery, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104-2676, USA
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, University College London, London, UK
| | - K Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
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3
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Loehrer PA, Bopp MHA, Dafsari HS, Seltenreich S, Knake S, Nimsky C, Timmermann L, Pedrosa DJ, Belke M. Microstructure predicts non-motor outcomes following deep brain stimulation in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:104. [PMID: 38762510 PMCID: PMC11102428 DOI: 10.1038/s41531-024-00717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/25/2024] [Indexed: 05/20/2024] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) effectively treats motor and non-motor symptoms in advanced Parkinson's disease (PD). As considerable interindividual variability of outcomes exists, neuroimaging-based biomarkers, including microstructural metrics, have been proposed to anticipate treatment response. In this prospective open-label study, we sought to detect microstructural properties of brain areas associated with short-term non-motor outcomes following STN-DBS. Thirty-seven PD patients underwent diffusion MRI and clinical assessments at preoperative baseline and 6-month follow-up. Whole brain voxel-wise analysis assessed associations between microstructural metrics and non-motor outcomes. Intact microstructure within specific areas, including the right insular cortex, right putamen, right cingulum, and bilateral corticospinal tract were associated with greater postoperative improvement of non-motor symptom burden. Furthermore, microstructural properties of distinct brain regions were associated with postoperative changes in sleep, attention/memory, urinary symptoms, and apathy. In conclusion, diffusion MRI could support preoperative patient counselling by identifying patients with above- or below-average non-motor responses.
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Affiliation(s)
- Philipp A Loehrer
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Miriam H A Bopp
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | | | - Susanne Knake
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Cologne, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Cologne, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - Marcus Belke
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
- Center for Personalized Translational Epilepsy Research (CePTER) Consortium, Cologne, Germany
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Loehrer PA, Schumacher W, Jost ST, Silverdale M, Petry-Schmelzer JN, Sauerbier A, Gronostay A, Visser-Vandewalle V, Fink GR, Evans J, Krause M, Rizos A, Antonini A, Ashkan K, Martinez-Martin P, Gaser C, Ray Chaudhuri K, Timmermann L, Baldermann JC, Dafsari HS. No evidence for an association of voxel-based morphometry with short-term non-motor outcomes in deep brain stimulation for Parkinson's disease. NPJ Parkinsons Dis 2024; 10:91. [PMID: 38671017 PMCID: PMC11053137 DOI: 10.1038/s41531-024-00695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an established therapy in advanced Parkinson's disease (PD). Motor and non-motor outcomes, however, show considerable inter-individual variability. Preoperative morphometry-based metrics have recently received increasing attention to explain treatment effects. As evidence for the prediction of non-motor outcomes is limited, we sought to investigate the association between metrics of voxel-based morphometry and short-term non-motor outcomes following STN-DBS in this prospective open-label study. Forty-nine PD patients underwent structural MRI and a comprehensive clinical assessment at preoperative baseline and 6-month follow-up. Voxel-based morphometry was used to assess associations between cerebral volume and non-motor outcomes corrected for multiple comparisons using a permutation-based approach. We replicated existing results associating volume loss of the superior frontal cortex with subpar motor outcomes. Overall non-motor burden, however, was not significantly associated with morphometric features, limiting its use as a marker to inform patient selection and holistic preoperative counselling.
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Affiliation(s)
| | - Wibke Schumacher
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Greater Manchester, United Kingdom
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
| | - Max Krause
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Radiation Oncology, Cyberknife Center, Cologne, Germany
| | - Alexandra Rizos
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Germany
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, United Kingdom
- The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Juan Carlos Baldermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg im Breisgau, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
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Jost ST, Aloui S, Evans J, Ashkan K, Sauerbier A, Rizos A, Petry-Schmelzer JN, Gronostay A, Fink GR, Visser-Vandewalle V, Antonini A, Silverdale M, Timmermann L, Martinez-Martin P, Chaudhuri KR, Dafsari HS. Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years: A Nonrandomized Controlled Trial. JAMA Netw Open 2024; 7:e2352177. [PMID: 38236600 PMCID: PMC10797423 DOI: 10.1001/jamanetworkopen.2023.52177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life (QOL) in patients with advanced Parkinson disease (PD). However, controlled studies with more than 3 years of follow-up are lacking. Objective To investigate the long-term effects of STN-DBS on QOL compared with standard-of-care medication (MED). Design, Setting, and Participants In this prospective, observational, quasi-experimental, longitudinal nonrandomized controlled trial, 183 patients were screened for eligibility and 167 were enrolled from March 1, 2011, to May 31, 2017, at 3 European university centers. Propensity score matching for demographic and clinical characteristics was applied to 108 patients with PD (62 in the STN-DBS group and 46 in the MED group), resulting in a well-balanced, matched subcohort of 25 patients per group. Data analysis was performed from September 2022 to January 2023. Exposure Treatment for PD of STN-DBS or MED. Main Outcomes and Measures Assessments included Parkinson's Disease Questionnaire 8 (PDQ-8), Unified PD Rating Scale-motor examination, Scales for Outcomes in PD-activities of daily living (ADL) and motor complications, and levodopa-equivalent daily dose. Within-group longitudinal outcome changes, between-group differences, and correlations of change scores were analyzed. Results The study population in the analysis included 108 patients (mean [SD] age, 63.7 [8.3] years; 66 [61.1%] male). At 5-year follow-up, PDQ-8 and ADL worsened only in the MED group (PDQ-8 change, -10.9; 95% CI, -19.0 to -2.7; P = .01; ADL change: -2.0; 95% CI, -3.1 to -0.8; P = .002), whereas both outcomes remained stable in the STN-DBS group (PDQ-8 change, -4.3; 95% CI, -13.2 to 4.7; P = .34; ADL change, -0.8; 95% CI, -2.5 to 1.0; P = .38). Changes in PDQ-8 and ADL correlated moderately (rs = .40, P = .008). Furthermore, STN-DBS outcomes were favorable for motor complications (median difference in change scores between STN-DBS and MED, -2.0; 95% CI, -4.0 to -1.0; P = .003), mobility (-1.0; 95% CI, -2.0 to 0; P = .03), and levodopa-equivalent daily dose reduction (-821.4; 95% CI, -1111.9 to -530.8; P < .001). Conclusions and Relevance This study provides evidence of differences in QOL outcomes at 5-year follow-up between STN-DBS (stable) and MED (worsened), mainly driven by the favorable effect of STN-DBS on mobility (class IIb evidence). The association between changes in QOL and ADL, but not motor impairment or complications, highlights the relative importance of ADL outcomes for long-term DBS assessments. Trial Registration German ClinicalTrials Registry: DRKS00006735.
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Affiliation(s)
- Stefanie T. Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Salima Aloui
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Gereon R. Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K. Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Haidar S. Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
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6
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Jost ST, Konitsioti A, Loehrer PA, Ashkan K, Rizos A, Sauerbier A, Dos Santos Ghilardi MG, Rosenkranz F, Strobel L, Gronostay A, Barbe MT, Evans J, Visser-Vandewalle V, Nimsky C, Fink GR, Silverdale M, Cury RG, Fonoff ET, Antonini A, Chaudhuri KR, Timmermann L, Martinez-Martin P, Dafsari HS. Non-motor effects of deep brain stimulation in Parkinson's disease motor subtypes. Parkinsonism Relat Disord 2023; 109:105318. [PMID: 36842866 DOI: 10.1016/j.parkreldis.2023.105318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
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.
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Affiliation(s)
- Stefanie T Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
| | - Agni Konitsioti
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- University Hospital Giessen and Marburg, Campus Marburg, Department of Neurology, Marburg, Germany
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Maria Gabriela Dos Santos Ghilardi
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Franz Rosenkranz
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Lena Strobel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | | | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK
| | - Rubens G Cury
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padova, Italy
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King's College London, United Kingdom
| | - Lars Timmermann
- University Hospital Giessen and Marburg, Campus Marburg, Department of Neurology, Marburg, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
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Gender gap in deep brain stimulation for Parkinson's disease. NPJ Parkinsons Dis 2022; 8:47. [PMID: 35444187 PMCID: PMC9021281 DOI: 10.1038/s41531-022-00305-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/10/2022] [Indexed: 11/18/2022] Open
Abstract
Previous studies have shown less access to deep brain stimulation (DBS) for Parkinson’s disease (PD) in women compared to men raising concerns about a potential gender gap resulting from nonclinical factors or gender differences in clinical efficacy for postoperative quality of life (QoL), motor, and nonmotor symptoms (NMS) outcomes. This was a cross-sectional and a longitudinal, prospective, observational, controlled, quasi-experimental, international multicenter study. A total sample size of 505 consisted of 316 consecutively referred patients for DBS indication evaluation at the University Hospital Cologne (01/2015–09/2020) and 189 consecutively treated patients at DBS centers in the University Hospitals Cologne and Marburg, Salford’s Royal Hospital Manchester, and King’s College Hospital London. In the cross-sectional cohort, we examined gender proportions at referral, indication evaluations, and DBS surgery. In the longitudinal cohort, clinical assessments at preoperative baseline and 6-month follow-up after surgery included the PD Questionnaire-8, NMSScale, Scales for Outcomes in PD-motor scale, and levodopa-equivalent daily dose. Propensity score matching resulted in a pseudo-randomized sub-cohort balancing baseline demographic and clinical characteristics between women with PD and male controls. 316 patients were referred for DBS. 219 indication evaluations were positive (women n = 102, respectively n = 82). Women with PD were disproportionally underrepresented in referrals compared to the general PD population (relative risk [RR], 0.72; 95%CI, 0.56–0.91; P = 0.002), but more likely to be approved for DBS than men (RR, 1.17; 95%CI, 1.03–1.34; P = 0.029). Nonetheless, their total relative risk of undergoing DBS treatment was 0.74 (95%CI, 0.48–1.12) compared to men with PD. At baseline, women had longer disease duration and worse dyskinesia. Exploring QoL domains, women reported worse mobility and bodily discomfort. At follow-up, all main outcomes improved equally in both genders. Our study provides evidence of a gender gap in DBS for PD. Women and men with PD have distinct preoperative nonmotor and motor profiles. We advocate that more focus should be directed toward the implementation of gender equity as both genders benefit from DBS with equal clinical efficacy. This study provides Class II evidence of beneficial effects of DBS in women with PD compared to male controls.
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