Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease

Anna Sauerbier; Philipp Loehrer; Stefanie T Jost; Shania Heil; Jan N Petry-Schmelzer; Johanna Herberg; Pia Bachon; Salima Aloui; Alexandra Gronostay; Lisa Klingelhoefer; J Carlos Baldermann; Daniel Huys; Christopher Nimsky; Michael T Barbe; Gereon R Fink; Pablo Martinez-Martin; K Ray Chaudhuri; Veerle Visser-Vandewalle; Lars Timmermann; Daniel Weintraub; Haidar S Dafsari; EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group

doi:10.1136/jnnp-2021-326131

Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease

J Neurol Neurosurg Psychiatry. 2021 Dec;92(12):1313-1318. doi: 10.1136/jnnp-2021-326131. Epub 2021 Sep 11.

Authors

Anna Sauerbier^{1

2}, Philipp Loehrer³, Stefanie T Jost², Shania Heil², Jan N Petry-Schmelzer², Johanna Herberg², Pia Bachon², Salima Aloui², Alexandra Gronostay², Lisa Klingelhoefer⁴, J Carlos Baldermann^{2

5}, Daniel Huys⁵, Christopher Nimsky⁶, Michael T Barbe², Gereon R Fink^{2

7}, Pablo Martinez-Martin⁸, K Ray Chaudhuri^{9

10

11}, Veerle Visser-Vandewalle¹², Lars Timmermann³, Daniel Weintraub¹³, Haidar S Dafsari¹⁴; EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group

Affiliations

¹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK anna.2.sauerbier@kcl.ac.uk haidar.dafsari@uk-koeln.de.
² Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
³ Department of Neurology, University of Marburg and University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.
⁴ Deptartment of Neurology, University of Dresden and University Hospital Dresden, Dresden, Germany.
⁵ Department of Psychiatry, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
⁶ Department of Neurosurgery, University of Marburg and University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany.
⁷ Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany.
⁸ Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain.
⁹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹⁰ Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK.
¹¹ 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.
¹² Department of Stereotaxy and Functional Neurosurgery, University of Cologne and University Hospital Cologne, Cologne, Germany.
¹³ Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁴ Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany anna.2.sauerbier@kcl.ac.uk haidar.dafsari@uk-koeln.de.

Abstract

Background: The effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson's disease (PD) are understudied.

Objective: To investigate clinical predictors of STN-DBS effects on ICB.

Methods: In this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into 'QUIP-RS improvement or worsening' and analysed between-group differences.

Results: We included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the 'QUIP-RS worsening' group had more severe baseline impairment in the NMSS attention/memory domain.

Conclusions: Our results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS.

Trial registration number: DRKS00006735.

Publication types

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

MeSH terms

Aged
Compulsive Behavior / physiopathology
Compulsive Behavior / psychology*
Deep Brain Stimulation*
Female
Humans
Impulsive Behavior / physiology*
Male
Middle Aged
Parkinson Disease / physiopathology
Parkinson Disease / psychology
Parkinson Disease / therapy*
Prospective Studies
Quality of Life
Subthalamic Nucleus / physiopathology*