Impact of Deep Brain Stimulation on Daily Routine Driving Practice in Patients with Parkinson’s Disease

Abstract

Objective. To determine the influence of deep brain stimulation (DBS) on daily routine driving behavior in Parkinson's disease (PD) patients. Methods. A cross-sectional questionnaire survey was done in 121 DBS-PD patients. The influences of patient characteristics and DBS on current driving and driving at time of surgery and the predictive value of the preoperative levodopa-test on postoperative driving were evaluated. Results. 50% of 110 driving-license holders currently drove. 63.0% rated themselves as safe drivers, 39.4% reported improvement, and 10.9% noted deterioration in driving after DBS surgery. Inactive drivers had quit driving mainly due to disease burden (90.9%). Active drivers were younger, more often males, and less impaired according to H&Y and MMSE, had surgery more recently, and reported more often overall benefit from DBS. H&Y “on” and UPDRS III “off” scores at time of surgery were lower in pre- and postoperative active than in inactive drivers. Tremor and akinesia were less frequent reasons to quit driving after than before DBS surgery. Postoperatively, 22.7% (10/44) of patients restarted and 10.6% (7/66) of patients discontinued driving, independently of H&Y stage. The preoperative levodopa-test was not predictive for the postoperative driving outcome. Conclusion. 50% of PD patients with DBS drive. DBS surgery changes daily routine driving behavior.

Impact of Tremor on Patients With Early Stage Parkinson's Disease

“…After receiving DBS, patients experienced improvement in numerous aspects of daily life, including more satisfying relationships, reduced visibility of PD, improved performance at work, and greater independence. According to a survey examining the impact of DBS therapy on routine driving for PD patients, tremor and akinesia were the two PD symptoms most improved by DBS ( 38 ). DBS plus medication may attenuate resting and postural tremor frequency in addition to amplitude, unlike medication alone which only reduces amplitude ( 39 ).…”

Fahrkompetenz und Morbus Parkinson

“…Die tiefe Hirnstimulation (THS) führt mehrheitlich zu einer Verbesserung motorischer Funktionen [34]. Besonders bei jüngeren Patienten und milderen motorischen Symptomen besteht eine höhere Wahrscheinlichkeit für das Wiederreichen der Fahrtüchtigkeit [35]. Eine mögliche Verschlechterung kognitiver Funktionen in Zusammenhang mit THS wird kontrovers diskutiert [36,37].…”

Fahrtauglichkeit bei Parkinson-Erkrankung

“…Die Anzahl derjenigen Patienten mit Parkinson-Erkrankung, die berichten, postoperativ wieder mit dem Autofahren zu beginnen, ist größer als die Zahl der Betroffenen, die mit dem Fahren aufhören. Ferner berichten 40% der Patienten nach THS-Operation über eine verbesserte, 10% allerdings auch über eine verschlechterte Fahrsicherheit [2]. Positive fahrrelevante Aspekte der THS könnten sich aus der Verbesserung der Motorik und durch die Reduktion der Medikamentendosis einschließlich ihrer Nebenwirkungen ergeben.…”