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

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

Haidar S Dafsari  1 , Maria Gabriela Dos Santos Ghilardi  2 , Veerle Visser-Vandewalle  3 , Alexandra Rizos  4 , Keyoumars Ashkan  4 , Monty Silverdale  5 , Julian Evans  5 , Raquel C R Martinez  6 , Rubens G Cury  2 , Stefanie T Jost  7 , Michael T Barbe  7 , Gereon R Fink  8 , Angelo Antonini  9 , K Ray-Chaudhuri  10 , Pablo Martinez-Martin  11 , Erich Talamoni Fonoff  6 , Lars Timmermann  12 ; EUROPAR and the IPMDS Non Motor PD Study Group
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Free article
Observational Study

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

Haidar S Dafsari et al. Brain Stimul. 2020 Nov-Dec.
Free article

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.

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Conflict of interest statement

Declaration of competing interest Keyoumars Ashkan has received honoraria for educational meetings, travel and consultancy from Medtronic and Boston Scientific which manufacture deep brain stimulation systems used in this study. Monty Silverdale reports no potential conflict of interest. Julian Evans reports no potential conflict of interest. Raquel C.R. Martinez reports no potential conflict of interest. Rubens G. Cury reports no potential conflict of interest. Stefanie T. Jost reports no potential conflict of interest. Michael T. Barbe reports grants from Boston Scientific and Medtronic which manufacture deep brain stimulation systems used in this study. Gereon R. Fink reports no potential conflict of interest. Angelo Antonini reports personal consultancy fees from Medtronic and Boston Scientific which manufacture deep brain stimulation systems used in this study. K. Ray Chaudhuri reports no potential conflict of interest. Pablo Martinez-Martin reports no potential conflict of interest. Erich Talamoni Fonoff is a consultant for Medtronic and Boston Scientific which manufacture deep brain stimulation systems used in this study. Lars Timmermann reports grants, personal fees and nonfinancial support from Medtronic and Boston Scientific which manufacture deep brain stimulation systems used in this study. This paper is independent research funded by the German Research Foundation (Grant KFO 219), the National Institute of Health Research (NIHR) Mental Health Biomedical Research Centre and Dementia Unit at South London and Maudsley NHS Foundation Trust and King’s College London. Additionally, an unrestricted peer reviewed educational grant was provided to support coordination of the UK dataset from Medtronic.

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