Bilateral subthalamic deep brain stimulation initial impact on nonmotor and motor symptoms in Parkinson's disease

Abstract

Numerous studies document significant improvement in motor symptoms in patients with Parkinson's disease (PD) after deep brain stimulation of the subthalamic nucleus (STN-DBS). However, little is known about the initial effects of STN-DBS on nonmotor domains.Our objective was to elucidate the initial effects of STN-DBS on non-motor and motor symptoms in PD patients in a 4-month follow-up.This open prospective study followed 24 patients with PD who underwent STN-DBS. The patients were examined using dedicated rating scales preoperatively and at 1 and 4 months following STN-DBS to determine initial changes in motor and nonmotor symptoms. Patients at month 1 after STN-DBS had significantly reduced the Parkinson's disease Questionnaire scores (P = .018) and Scales for Outcomes in Parkinson's disease – Autonomic scores (P = .002); these scores had increased at Month 4 after DBS-STN. Nonmotor Symptoms Scale for Parkinson's Disease had improved significantly at Month 1 (P < .001); at Month 4, it remained significantly lower than before stimulation (P = .036). There was no significant difference in The Parkinson's Disease Sleep Scaleat Month 1 and significant improvement at Month 4 (P = .026). There were no significant changes in The Female Sexual Function Index or International Index of Erectile Function. Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III scores show significant improvements at Month 1 (P < .001) and at Month 4 (P < .001).STN-DBS in patients with advanced PD clearly improves not only motor symptoms, but also several domains of nonmotor functions, namely sleep, autonomic functions and quality of life quickly following the start of stimulation.

Clinical Impact of Deep Brain Stimulation on the Autonomic System in Patients with Parkinson's Disease

“…For example, Rukmini Mridula and colleagues 36 found a significantly higher frequency of sexual impairment in STN-DBS patients compared with PD controls, that is, those on medication only. This is in contrast to a recent study by Kurcova and colleagues, 5 which used the International Index of Erectile Function and Female Sexual Function 75 to evaluate patients at baseline, 1 month, and 4 months following surgery. They identified no significant difference or trend between the mean values of International Index of Erectile Function at baseline, 1 month, and 4 months postoperatively.…”

“…They identified no significant difference or trend between the mean values of International Index of Erectile Function at baseline, 1 month, and 4 months postoperatively. 5 The results regarding the female cohort were not deemed relevant because of the low sample size.…”

“…The effects of STN-DBS on motor and nonmotor symptoms are determined not only by the intensity of the electrical stimulation but also by the location of the stimulating electrode within the STN. 6 Despite such observations, only 1 published study has directly investigated the impact of STN-DBS on autonomic symptoms in PD 5 using the self-administered Scale for Outcomes in Parkinson's Disease for Autonomic Symptoms questionnaire, showing a significant scores reduction one month after DBS (P = 0.002). 7 On the other hand, DBS could be responsible for autonomic side effects in patients with motor disorders, including orthostatic hypotension 8 and syncope.…”

The Impact of Deep Brain Stimulation on Sleep in Parkinson’s Disease: An update

“…Breen et al evaluated 11 patients and found a trend for improvement in nocturnal restlessness (6.06 to 7.49; p = 0.206) and nocturia (5.69 to 6.91.4; p = 0.13) at six months follow-up compared to baseline values, though none of these were statistically significant [39]. A similar study of 24 patients showed that overall PDSS scores significantly improved four months after DBS (111.2 ± 21.3 to 121.7 ± 23.4; p < 0.05) [40]. The largest study with longest followup to date evaluated 46 patients up to three years after DBS, demonstrating significant and sustained improvement in overall PDSS scores compared to baseline (79.0 ± 30.0 to 93.3 ± 28.0; p < 0.006) [41].…”

“…Kurcova et al evaluated 24 patients and found a significant improvement in NMS scores four months after DBS (37.2 ± 22 to 26.6 ± 23.7; p < 0.001) [37]. Although a significant difference in the sleep subsection was seen at one month (baseline 11.5 ± 10.1 to 4.9 ± 6.6; p = 0.001), this was not sustained at four months after DBS (11.5 ± 10.1 to 6.3 ± 7.6; p = 0.123) [40]. The most conclusive data to date is from a multi-center study of 67 patients treated with STN DBS showing a significant improvement in overall NMS Quest scores at 24 months (63.2 ± 34.3 to 50.4 ± 31.3; p = 0.001) [47].…”