Stratifying quality of life outcome in subthalamic stimulation for Parkinson's disease

Alexandra Gronostay; Stefanie Theresa Jost; Monty Silverdale; Alexandra Rizos; Philipp Alexander Loehrer; Julian Evans; Anna Sauerbier; Donya Indi; Valentina Leta; Paul Reker; Gereon Rudolf Fink; Keyoumars Ashkan; Angelo Antonini; Christopher Nimsky; Veerle Visser-Vandewalle; Pablo Martinez-Martin; K Ray Chaudhuri; Lars Timmermann; Haidar S Dafsari

doi:10.1136/jnnp-2023-332272

Stratifying quality of life outcome in subthalamic stimulation for Parkinson's disease

J Neurol Neurosurg Psychiatry. 2023 Dec 19:jnnp-2023-332272. doi: 10.1136/jnnp-2023-332272. Online ahead of print.

Authors

Alexandra Gronostay¹, Stefanie Theresa Jost¹, Monty Silverdale², Alexandra Rizos³, Philipp Alexander Loehrer⁴, Julian Evans², Anna Sauerbier^{1

3}, Donya Indi¹, Valentina Leta³, Paul Reker¹, Gereon Rudolf Fink^{1

5}, Keyoumars Ashkan³, Angelo Antonini⁶, Christopher Nimsky⁷, Veerle Visser-Vandewalle⁸, Pablo Martinez-Martin⁹, K Ray Chaudhuri^{3

10}, Lars Timmermann⁴, Haidar S Dafsari¹¹

Affiliations

¹ Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
² Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK.
³ Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
⁴ Department of Neurology, Philipps-University Marburg, Marburg, Germany.
⁵ Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany.
⁶ Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), Padova University, Padova, Italy.
⁷ Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany.
⁸ Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
⁹ Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain.
¹⁰ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹¹ Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany haidar.dafsari@uk-koeln.de.

PMID: 38124227
DOI: 10.1136/jnnp-2023-332272

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.

Keywords: PARKINSON'S DISEASE.