Bilateral subthalamic nucleus stimulation and quality of life in advanced Parkinson's disease

Abstract

We examined the impact of the subthalamic nuclei (STN) deep brain stimulation (DBS) on the health-related quality of life (QoL) of patients with advanced Parkinson's disease (PD). Seventeen consecutive patients with refractory motor fluctuations and dyskinesia were included in the study (mean age, 60.9 +/- 7.7 years [range, 43-74 years]; disease duration, 16.4 +/- 8.5 years [range, 7-38 years]; mean off-medication Hoehn and Yahr stage, 4.23 +/- 0.66 [range, 2.5-5]). Each patient's assessment was carried out using common rating scales, following the Core Assessment Program for Intracerebral Transplantation (CAPIT) protocol. Dyskinesia and emotional state were evaluated through the Abnormal Involuntary Movement Scale (AIMS) and the Hospital Anxiety and Depression Scale (HAD). QoL was assessed by means of the Parkinson's Disease Questionnaire Spanish version (PDQ-39). Significant benefit was obtained in the motor manifestations and complications of disease, as well as in the functional state and mood (P < 0.001). Some QoL dimensions (mobility and activities of daily living) and the PDQ-39 Summary Index (PDQ-39SI) showed a significant improvement (P < 0.001). Benefit was modest (P < 0.05) for three other domains (emotional well-being, stigma, bodily discomfort) and nil for the rest. There was no correlation between the change obtained in the QoL (PDQ-39SI) and in the other variables. As measured by the PDQ-39, STN-DBS significantly improves important aspects of QoL in patients with advanced PD.

Deep Brain Stimulation for Parkinson’s Disease

“…Quality of life improves after STN DBS, 56,[63][64][65][66][67] and this improvement correlates with motor benefit. 65 In support of this finding, the physical markers for quality of life are reported to improve significantly, but other aspects such as mental, emotional well-being, social support, cognition, and communication show no improvement.…”

“…65 In support of this finding, the physical markers for quality of life are reported to improve significantly, but other aspects such as mental, emotional well-being, social support, cognition, and communication show no improvement. 66,67 The improvement in quality of life is maintained over time. 64,65 The caregiver's quality of life can also improve.…”

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

“…In most patients, DBS alleviates parkinsonian motor signs, shortens 'off' periods, and reduces druginduced dyskinesias, dystonia, and motor fluctuations (Rodriguez-Oroz et al, 2004;Anderson et al, 2005;Weaver et al, 2005;Portman et al, 2006;Bronstein et al, 2011). In general, both GPi-and STN-DBS are more effective than medical management alone to alleviate motor deficits in patients with advanced PD (Just and Ostergaard, 2002;Martinez-Martin et al, 2002;Troster et al, 2003;Lezcano et al, 2004;Diamond and Jankovic, 2005;Erola et al, 2005;Halbig et al, 2005;Lyons and Pahwa, 2005;Deuschl et al, 2006;Rodrigues et al, 2007a, b;Montel and Bungener, 2009;Weaver et al, 2009b;Zahodne et al, 2009). In contrast to patients with GPi-DBS, those with STN-DBS are often able to substantially reduce the medication doses (Breit et al, 2004; …”

Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

“…The calculated incidence of complications associated with laparoscopic bariatric surgery, obtained from the case series, 4,8,10,17,28,38,44,45,52,74,77,82,83,91,120 is summarized in Table 1; complications associated with DBS studies are shown in Table 2. 6,7,9,12,16,20,26,27,31,37,39,47,[55][56][57][58][59][60][61]64,[67][68][69]71,78,80,81,84,[86][87][88][89][96][97]…”