Quality of Life after Deep Brain Stimulation in Parkinson's Disease: Does the Target Matter?
Parkinson's disease
deep brain stimulation
globus pallidus
quality of life
subthalamic nucleus
Journal
Movement disorders clinical practice
ISSN: 2330-1619
Titre abrégé: Mov Disord Clin Pract
Pays: United States
ID NLM: 101630279
Informations de publication
Date de publication:
03 Sep 2024
03 Sep 2024
Historique:
revised:
04
08
2024
received:
26
01
2024
accepted:
08
08
2024
medline:
3
9
2024
pubmed:
3
9
2024
entrez:
3
9
2024
Statut:
aheadofprint
Résumé
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an accepted therapy for Parkinson's disease (PD) with disabling motor complications. For elderly patients with poorer cognition and postural instability, GPi has been proposed as the preferable DBS target based on expert opinion, arguing GPi-DBS may be less complicated by depression, apathy, worsened verbal fluency, and executive dysfunction, resulting in greater improvement in quality of life (QoL). However, data supporting such patient-tailored approach are lacking. The aims were to analyze whether the DBS target influences QoL in a PD cohort and a matched subgroup of frail patients with poor cognitive status and reduced postural stability, and whether other factors affect the QoL outcomes. In this retrospective study, we analyzed a single-center cohort of 138 PD patients who received bilateral STN-DBS (117) or GPi-DBS (21) using the mentioned approach for target selection. All patients underwent standardized clinical evaluations of motor- and nonmotor signs as well as QoL before and 1 year after surgery. DBS of both targets improved motor signs, dyskinesias, and pain. QoL improved without significant difference between the targets, but with a trend for greater improvement across all QoL domains in favor of the STN, even in an STN subgroup matched to the GPi group. Our results contradict the prevailing belief that GPi-DBS is superior in frail PD patients with cognitive decline and postural instability, questioning the proposed patient-tailored approach of DBS target selection. Further studies are needed for a data-driven approach.
Sections du résumé
BACKGROUND
BACKGROUND
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an accepted therapy for Parkinson's disease (PD) with disabling motor complications. For elderly patients with poorer cognition and postural instability, GPi has been proposed as the preferable DBS target based on expert opinion, arguing GPi-DBS may be less complicated by depression, apathy, worsened verbal fluency, and executive dysfunction, resulting in greater improvement in quality of life (QoL). However, data supporting such patient-tailored approach are lacking.
OBJECTIVES
OBJECTIVE
The aims were to analyze whether the DBS target influences QoL in a PD cohort and a matched subgroup of frail patients with poor cognitive status and reduced postural stability, and whether other factors affect the QoL outcomes.
METHODS
METHODS
In this retrospective study, we analyzed a single-center cohort of 138 PD patients who received bilateral STN-DBS (117) or GPi-DBS (21) using the mentioned approach for target selection. All patients underwent standardized clinical evaluations of motor- and nonmotor signs as well as QoL before and 1 year after surgery.
RESULTS
RESULTS
DBS of both targets improved motor signs, dyskinesias, and pain. QoL improved without significant difference between the targets, but with a trend for greater improvement across all QoL domains in favor of the STN, even in an STN subgroup matched to the GPi group.
CONCLUSION
CONCLUSIONS
Our results contradict the prevailing belief that GPi-DBS is superior in frail PD patients with cognitive decline and postural instability, questioning the proposed patient-tailored approach of DBS target selection. Further studies are needed for a data-driven approach.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 The Author(s). Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Références
Schrag A, Jahanshahi M, Quinn N. What contributes to quality of life in patients with Parkinson's disease? J Neurol Neurosurg Psychiatry 2000;69(3):308–312.
Martinez‐Martin P, Rodriguez‐Blazquez C, Kurtis MM, Chaudhuri KR. The impact of non‐motor symptoms on health‐related quality of life of patients with Parkinson's disease. Mov Disord 2011;26(3):399–406.
Lachenmayer ML, Mürset M, Antih N, et al. Subthalamic and pallidal deep brain stimulation for Parkinson's disease‐meta‐analysis of outcomes. NPJ Parkinsons Dis 2021;7(1):77.
Dafsari HS, Dos Santos Ghilardi MG, Visser‐Vandewalle V, et al. Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease. Brain Stimul 2020;13(6):1697–1705.
Dafsari HS, Weiß L, Silverdale M, et al. Short‐term quality of life after subthalamic stimulation depends on non‐motor symptoms in Parkinson's disease. Brain Stimul 2018;11(4):867–874.
Schuepbach WMM, Tonder L, Schnitzler A, et al. Quality of life predicts outcome of deep brain stimulation in early Parkinson disease. Neurology 2019;92(10):e1109–e1120.
Deuschl G, Antonini A, Costa J, et al. European academy of neurology/Movement Disorder Society‐European section guideline on the treatment of Parkinson's disease: I. Invasive therapies. Eur J Neurol 2022;29(9):2580–2595.
Krack P, Volkmann J, Tinkhauser G, Deuschl G. Deep brain stimulation in movement disorders: from experimental surgery to evidence‐based therapy. Mov Disord 2019;34(12):1795–1810.
Obeso JA, Olanow CW, Rodriguez‐Oroz MC, Krack P, Kumar R, Lang AE. Deep‐brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 2001;345(13):956–963.
Follett KA, Weaver FM, Stern M, et al. Pallidal versus subthalamic deep‐brain stimulation for Parkinson's disease. N Engl J Med 2010;362(22):2077–2091.
Odekerken VJ, van Laar T, Staal MJ, et al. Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 2013;12(1):37–44.
Boogers A, Fasano A. A transatlantic viewpoint on the role of pallidal stimulation for Parkinson's disease. Mov Disord 2024;39(1):36–39.
Okun MS, Foote KD. Parkinson's disease DBS: what, when, who and why? The time has come to tailor DBS targets. Expert Rev Neurother 2010;10(12):1847–1857.
Bronstein JM, Tagliati M, Alterman RL, et al. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol 2011;68(2):165.
Williams NR, Foote KD, Okun MS. STN vs. GPi deep brain stimulation: translating the rematch into clinical practice. Mov Disord Clin Pract 2014;1(1):24–35.
Nowacki A, Debove I, Fiechter M, et al. Targeting accuracy of the subthalamic nucleus in deep brain stimulation surgery: comparison between 3 T T2‐weighted magnetic resonance imaging and microelectrode recording results. Oper Neurosurg (Hagerstown) 2018;15(1):66–71.
Fitzpatrick R, Peto V, Jenkinson C, Greenhall R, Hyman N. Health‐related quality of life in Parkinson's disease: a study of outpatient clinic attenders. Mov Disord 1997;12(6):916–922.
Martinez‐Martin P, Jeukens‐Visser M, Lyons KE, et al. Health‐related quality‐of‐life scales in Parkinson's disease: critique and recommendations. Mov Disord 2011;26(13):2371–2380.
Fahn SER. Members of the UPDRS development committee. Unified Parkinson's disease rating scale. Recent Dev Parkinsons Dis 1987;2:293–304.
Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society‐sponsored revision of the unified Parkinson's disease rating scale (MDS‐UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008;23(15):2129–2170.
Lang A. Clinical rating scales and videotape analysis. In: Koller WCPG, ed. Therapy of Parkinson's Disease. New York: Marcel Dekker; 1990:3–30.
Marconi R, Lefebvre‐Caparros D, Bonnet AM, Vidailhet M, Dubois B, Agid Y. Levodopa‐induced dyskinesias in Parkinson's disease phenomenology and pathophysiology. Mov Disord 1994;9(1):2–12.
Folstein MF, Folstein SE, McHugh PR. "mini‐mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–198.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23(1):56–62.
Starkstein SE, Mayberg HS, Preziosi TJ, Andrezejewski P, Leiguarda R, Robinson RG. Reliability, validity, and clinical correlates of apathy in Parkinson's disease. J Neuropsychiatry Clin Neurosci 1992;4(2):134–139.
Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983;17(1):45–56.
Goetz CG, Stebbins GT, Tilley BC. Calibration of unified Parkinson's disease rating scale scores to Movement Disorder Society‐unified Parkinson's disease rating scale scores. Mov Disord 2012;27(10):1239–1242.
Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord 2010;25(15):2649–2653.
Schade S, Mollenhauer B, Trenkwalder C. Levodopa equivalent dose conversion factors: an updated proposal including Opicapone and safinamide. Mov Disord Clin Pract 2020;7(3):343–345.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2022 https://www.R-project.org/.
Stekhoven DJ, Bühlmann P. MissForest–non‐parametric missing value imputation for mixed‐type data. Bioinformatics 2012;28(1):112–118.
Feldman BE. Relative importance and value SSRN; 2005. https://doi.org/10.2139/ssrn.2255827.
Groemping U. Relative importance for linear regression in R: the package relaimpo. J Stat Soft 2006;17(1):1–27.
Sekhon JS, Grieve RD. A matching method for improving covariate balance in cost‐effectiveness analyses. Health Econ 2012;21(6):695–714.
Wickham H. ggplot2: Elegant Graphics for Data Analysis. New York: Springer‐Verlag; 2016 https://ggplot2.tidyverse.org.
Deuschl G, Schade‐Brittinger C, Krack P, et al. A randomized trial of deep‐brain stimulation for Parkinson's disease. N Engl J Med 2006;355(9):896–908.
Weaver FM, Follett KA, Stern M, et al. Randomized trial of deep brain stimulation for Parkinson disease: thirty‐six‐month outcomes. Neurology 2012;79(1):55–65.
Cernera S, Eisinger RS, Wong JK, et al. Long‐term Parkinson's disease quality of life after staged DBS: STN vs GPi and first vs second lead. NPJ Parkinsons Dis 2020;6:13.
Zahodne LB, Okun MS, Foote KD, et al. Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus. J Neurol 2009;256(8):1321–1329.
Daniels C, Krack P, Volkmann J, et al. Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable? Mov Disord 2011;26(14):2516–2521.
Sobstyl M, Ząbek M, Górecki W, Mossakowski Z. Quality of life in advanced Parkinson's disease after bilateral subthalamic stimulation: 2 years follow‐up study. Clin Neurol Neurosurg 2014;124:161–165.
Flouty O, Yamamoto K, Germann J, et al. Idiopathic Parkinson's disease and chronic pain in the era of deep brain stimulation: a systematic review and meta‐analysis. J Neurosurg 2022;137(6):1821–1830.
Gong S, Xu M, Tao Y, et al. Comparison of subthalamic nucleus and Globus pallidus internus deep brain stimulation surgery on Parkinson disease‐related pain. World Neurosurg 2020;135:e94–e99.
Lhommée E, Klinger H, Thobois S, et al. Subthalamic stimulation in Parkinson's disease: restoring the balance of motivated behaviours. Brain 2012;135(Pt 5):1463–1477.
Martinez‐Fernandez R, Pelissier P, Quesada JL, et al. Postoperative apathy can neutralise benefits in quality of life after subthalamic stimulation for Parkinson's disease. J Neurol Neurosurg Psychiatry 2016;87(3):311–318.
Thobois S, Lhommée E, Klinger H, et al. Parkinsonian apathy responds to dopaminergic stimulation of D2/D3 receptors with piribedil. Brain 2013;136(Pt 5):1568–1577.
Béreau M, Kibleur A, Servant M, et al. Motivational and cognitive predictors of apathy after subthalamic nucleus stimulation in Parkinson's disease. Brain 2024;147(2):472–485.
Lachenmayer ML, Bettschen C, Bernasconi C, et al. Stimulation of the globus pallidus internus in the treatment of Parkinson's disease: long‐term results of a monocentric cohort. Parkinsonism Relat Disord 2019;64:118–123.
Debove I, Petermann K, Nowacki A, et al. Deep brain stimulation: when to test directional? Mov Disord Clin Pract 2023;10(3):434–439.
Ory‐Magne F, Brefel‐Courbon C, Simonetta‐Moreau M, et al. Does ageing influence deep brain stimulation outcomes in Parkinson's disease? Mov Disord 2007;22(10):1457–1463.
Witt K, Daniels C, Krack P, et al. Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease. J Neurol Sci 2011;310(1–2):261–266.