Health‐Related quality of life in patients with advanced Parkinson's disease treated with deep brain stimulation of the subthalamic nuclei

Abstract

Parkinson's disease (PD) is a progressive neurodegenerative disorder for which there is as yet no cure. It affects many aspects of patients' lives, only some of which can be monitored by available clinical rating scales. In the past decade, there has been a new emphasis on the use of health-related quality of life (HRQOL) measures to describe patient response to treatment. We describe patient-reported HRQOL in subjects who underwent bilateral deep brain stimulation (DBS) of the subthalamic nuclei (STN) for the treatment of PD, compared with a similar group of subjects who did not receive surgical treatment. A consecutive series of patients (n = 11) with advanced idiopathic PD were treated with DBS of the STN. This surgically treated group was compared prospectively with a similar group of patients (n =13) awaiting surgery. Self-reported HRQOL, measured by the Parkinson's Disease Questionnaire (PDQ-39) was evaluated at three time periods T(0), T(3), and T(6). The surgery group was evaluated according to the Unified Parkinson's Disease Rating Sale (UPDRS) before (T(0)), 3 (T(3)), and 6 months (T(6)) after surgery. HRQOL, UPDRS part II and III, duration of off periods, and dyskinesias improved significantly from T(0) to T(3) and from T(0) to T(6) for the surgery group but not for the nonsurgery group. Ten of the 11 patients treated with DBS of the STN reported a lower summary score (indicating better HRQOL) 6 months after surgery. The results of this prospective controlled study suggest that patients with advanced idiopathic PD treated with DBS of the STN obtain significant improvements in patient reported HRQOL and in clinical outcomes 3 and 6 months after surgery.

Only physical aspects of quality of life are significantly improved by bilateral subthalamic stimulation in Parkinson’s disease

“…Over the last years, when performed in experienced centers, STN-DBS is generally a safe and effective intervention, and different groups showed consistently improvement in cardinal motor manifestations of PD [8,12,13,19] and in global QoL regardless of the scale used, either generic (SF36) or specific scale (PDQ39) [7,16,20]. In our study, with a 12 month follow-up, STN-DBS was an overall effective intervention.With regard to QoL comparing our PDQ39 data to the results of Peto's study [21], our mean scores before surgery were similar to that of patients with ten years duration of disease.…”

“…Only few studies have already assessed the impact of STN-DBS on QoL [7,10,11,16,27]. Lagrange et al [10] assessed the impact of bilateral STN stimulation in 60 PD patients before and 12 months after surgery.…”

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; …”

Effect of Motor Improvement on Quality of Life following Subthalamic Stimulation Is Mediated by Changes in Depressive Symptomatology

“…Preliminary data are, nonetheless, encouraging. Not only do patients report significant improvements on disease-specific QOL questionnaires after STN-DBS [3,4], but such QOL improvements are discerned even in comparison to a PD control group on the waiting list for surgery and receiving optimal medical therapy [5]. The critical factors underlying QOL improvement remain to be elucidated, but Martí-nez-Martín et al [6] found that the percentage change in QOL (the PDQ-39 Summary Index) among 17 patients evaluated before and 6 months after surgery was related to the percent improvement in the right extremity Abnormal Involuntary Movement Scale score.…”