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. 2022 May;15(2):124-131.
doi: 10.14802/jmd.21106. Epub 2022 May 26.

Development of Clinical Milestones in Parkinson's Disease After Bilateral Subthalamic Deep Brain Stimulation

Jed Noel A Ong  1   2 , Jung Hwan Shin  1 , Seungho Jeon  1 , Chan Young Lee  1 , Han-Joon Kim  1 , Sun Ha Paek  3 , Beomseok Jeon  1
Affiliations

Development of Clinical Milestones in Parkinson's Disease After Bilateral Subthalamic Deep Brain Stimulation

Jed Noel A Ong et al. J Mov Disord. 2022 May.

Abstract

Objective: Deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson's disease (PD) patients does not halt disease progression, as these patients will progress and develop disabling non-levodopa responsive symptoms. These features may act as milestones that represent the overall functionality of patients after DBS. The objective of this study was to investigate the development of clinical milestones in advanced PD patients who underwent bilateral STN-DBS.

Methods: The study evaluated PD patients who underwent STN-DBS at baseline up to their last follow-up using the Unified Parkinson's Disease Rating Scale and Hoehn and Yahr scale. The symptoms of hallucinations, dysarthria, dysphagia, frequent falls, difficulty walking, cognitive impairment and the loss of autonomy were chosen as the clinical milestones.

Results: A total of 106 patients with a mean age of 47.21 ± 10.52 years at disease onset, a mean age of 58.72 ± 8.74 years at surgery and a mean disease duration of 11.51 ± 4.4 years before surgery were included. Initial improvement of motor symptoms was seen after the surgery with the appearance of clinical milestones over time. Using the moderately disabling criteria, 81 patients (76.41%) developed at least one clinical milestone, while 48 patients (45.28%) developed a milestone when using the severely disabling criteria.

Conclusion: STN-DBS has a limited effect on axial and nonmotor symptoms of the PD patients, in contrast to the effect on motor symptoms. These symptoms may serve as clinical milestones that can convey the status of PD patients and its impact on the patients and their caregivers. Therefore, advanced PD patients, even those treated with bilateral STN-DBS, will still require assistance and cannot live independently in the long run.

Keywords: Clinical milestones; Deep brain stimulation; Parkinson disease; Subthalamic nucleus.

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Conflict of interest statement

Conflicts of Interest

The authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival plots of the clinical milestones in the 106 Parkinson’s disease patients treated with DBS of the subthalamic nucleus before surgery (time 0) up to their last follow-up. The follow-ups were performed at 6 months and 1, 2, 3, 5, 7, 10, and 13 years after the surgery. Only 17 patients reached the 13-year follow-up. The two sets of criteria used are shown in these graphs: the moderately disabling criteria (green) and severely disabling criteria (red). Seventeen patients were lost to follow-up during the observation period. A: Survival without the development of clinical milestones. B: Survival without the development of dysarthria. C: Survival without the development of difficulty walking. D: Survival without the loss of autonomy. DBS, deep brain stimulation; UPDRS, Unified Parkinson’s Disease Rating Scale; H&Y, Hoehn and Yahr.
Figure 2.
Figure 2.
Kaplan–Meier survival plots of the 106 PD patients treated with STN-DBS according to the follow-up period after STN-DBS surgery (A), disease duration (B), and age (C). PD, Parkinson’s disease; STN-DBS, deep brain stimulation of the subthalamic nucleus.
See this image and copyright information in PMC

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