Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease

Haidar S Dafsari; Maria Gabriela Dos Santos Ghilardi; Veerle Visser-Vandewalle; Alexandra Rizos; Keyoumars Ashkan; Monty Silverdale; Julian Evans; Raquel C R Martinez; Rubens G Cury; Stefanie T Jost; Michael T Barbe; Gereon R Fink; Angelo Antonini; K Ray-Chaudhuri; Pablo Martinez-Martin; Erich Talamoni Fonoff; Lars Timmermann; EUROPAR and the IPMDS Non Motor PD Study Group

doi:10.1016/j.brs.2020.09.019

Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease

Brain Stimul. 2020 Nov-Dec;13(6):1697-1705. doi: 10.1016/j.brs.2020.09.019. Epub 2020 Oct 7.

Authors

Haidar S Dafsari¹, Maria Gabriela Dos Santos Ghilardi², Veerle Visser-Vandewalle³, Alexandra Rizos⁴, Keyoumars Ashkan⁴, Monty Silverdale⁵, Julian Evans⁵, Raquel C R Martinez⁶, Rubens G Cury², Stefanie T Jost⁷, Michael T Barbe⁷, Gereon R Fink⁸, Angelo Antonini⁹, K Ray-Chaudhuri¹⁰, Pablo Martinez-Martin¹¹, Erich Talamoni Fonoff⁶, Lars Timmermann¹²; EUROPAR and the IPMDS Non Motor PD Study Group

Affiliations

¹ University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. Electronic address: haidar.dafsari@uk-koeln.de.
² Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
³ University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany.
⁴ National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.
⁵ Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom.
⁶ Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, Brazil.
⁷ University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
⁸ 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.
⁹ Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy; Department of Neuroscience, University of Padua, Padua, Italy.
¹⁰ National 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.
¹¹ National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
¹² University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany.

PMID: 33038595
DOI: 10.1016/j.brs.2020.09.019

Abstract

Background: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects.

Objective: To compare nonmotor effects of STN-DBS and GPi-DBS.

Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.

Results: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.

Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.

Keywords: Deep brain stimulation; Globus Pallidus internus; Non-motor symptoms; Nonmotor symptoms; Quality of life; Subthalamic nucleus.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living / psychology
Aged
Deep Brain Stimulation / methods*
Fatigue / physiopathology
Female
Follow-Up Studies
Globus Pallidus / physiology*
Humans
Levodopa / pharmacology
Levodopa / therapeutic use
Male
Middle Aged
Parkinson Disease / physiopathology
Parkinson Disease / psychology*
Parkinson Disease / therapy*
Prospective Studies
Quality of Life / psychology
Sleep / drug effects
Subthalamic Nucleus / physiology*
Treatment Outcome

Substances

Levodopa