Predictors of Long-Term Outcome of Subthalamic Stimulation in Parkinson Disease.
Adult
Aged
Cerebrovascular Disorders
/ diagnostic imaging
Cognitive Dysfunction
/ epidemiology
Deep Brain Stimulation
Executive Function
Female
Follow-Up Studies
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Neuropsychological Tests
Parkinson Disease
/ epidemiology
Prognosis
Proportional Hazards Models
Severity of Illness Index
Subthalamic Nucleus
Treatment Outcome
Journal
Annals of neurology
ISSN: 1531-8249
Titre abrégé: Ann Neurol
Pays: United States
ID NLM: 7707449
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
05
04
2020
revised:
02
12
2020
accepted:
13
12
2020
pubmed:
23
12
2020
medline:
2
4
2021
entrez:
22
12
2020
Statut:
ppublish
Résumé
This study was undertaken to identify preoperative predictive factors of long-term motor outcome in a large cohort of consecutive Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN-DBS). All consecutive PD patients who underwent bilateral STN-DBS at the Grenoble University Hospital (France) from 1993 to 2015 were evaluated before surgery, at 1 year (short-term), and in the long term after surgery. All available demographic variables, neuroimaging data, and clinical characteristics were collected. Preoperative predictors of long-term motor outcome were investigated by performing survival and univariate/multivariate Cox regression analyses. Loss of motor benefit from stimulation in the long term was defined as a reduction of less than 25% in the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III scores compared to the baseline off-medication scores. As a secondary objective, potential predictors of short-term motor outcome after STN-DBS were assessed by performing univariate and multivariate linear regression analyses. In the long-term analyses (mean follow-up = 8.4 ± 6.26 years, median = 10 years, range = 1-17 years), 138 patients were included. Preoperative higher frontal score and off-medication MDS-UPDRS part III scores predicted a better long-term motor response to stimulation, whereas the presence of vascular changes on neuroimaging predicted a worse motor outcome. In 357 patients with available 1-year follow-up, preoperative levodopa response, tremor dominant phenotype, baseline frontal score, and off-medication MDS-UPDRS part III scores predicted the short-term motor outcome. Frontal lobe dysfunction, disease severity in the off-medication condition, and the presence of vascular changes on neuroimaging represent the main preoperative clinical predictors of long-term motor STN-DBS effects. ANN NEUROL 2021;89:587-597.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
587-597Informations de copyright
© 2020 American Neurological Association.
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