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

Brain Stimulation (Nov 2020)

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

Affiliations

Haidar S. Dafsari: 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; Corresponding author. Department of Neurology University Hospital Cologne Kerpenerstr. 62 50937 Cologne, Germany.
Maria Gabriela dos Santos Ghilardi: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
Veerle Visser-Vandewalle: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany
Alexandra Rizos: National Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, United Kingdom
Keyoumars Ashkan: National Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, United Kingdom
Monty Silverdale: Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
Julian Evans: Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
Raquel C.R. Martinez: 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
Rubens G. Cury: Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
Stefanie T. Jost: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
Michael T. Barbe: University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
Gereon R. Fink: 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
Angelo Antonini: Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy; Department of Neuroscience, University of Padua, Padua, Italy
K. Ray-Chaudhuri: 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
Pablo Martinez-Martin: National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
Erich Talamoni Fonoff: 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
Lars Timmermann: 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

Journal volume & issue: Vol. 13, no. 6
pp. 1697 – 1705

Abstract

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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.

Published in Brain Stimulation

ISSN: 1935-861X (Print); 1876-4754 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry
Website: https://www.journals.elsevier.com/brain-stimulation

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