Predictors of Long‐Term Outcome of Subthalamic Stimulation in Parkinson Disease

Abstract

Objective This study was undertaken to identify preoperative predictive factors of long‐term motor outcome in a large cohort of consecutive Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN‐DBS). Methods All consecutive PD patients who underwent bilateral STN‐DBS at the Grenoble University Hospital (France) from 1993 to 2015 were evaluated before surgery, at 1 year (short‐term), and in the long term after surgery. All available demographic variables, neuroimaging data, and clinical characteristics were collected. Preoperative predictors of long‐term motor outcome were investigated by performing survival and univariate/multivariate Cox regression analyses. Loss of motor benefit from stimulation in the long term was defined as a reduction of less than 25% in the Movement Disorder Society–sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) part III scores compared to the baseline off‐medication scores. As a secondary objective, potential predictors of short‐term motor outcome after STN‐DBS were assessed by performing univariate and multivariate linear regression analyses. Results In the long‐term analyses (mean follow‐up = 8.4 ± 6.26 years, median = 10 years, range = 1–17 years), 138 patients were included. Preoperative higher frontal score and off‐medication MDS‐UPDRS part III scores predicted a better long‐term motor response to stimulation, whereas the presence of vascular changes on neuroimaging predicted a worse motor outcome. In 357 patients with available 1‐year follow‐up, preoperative levodopa response, tremor dominant phenotype, baseline frontal score, and off‐medication MDS‐UPDRS part III scores predicted the short‐term motor outcome. Interpretation Frontal lobe dysfunction, disease severity in the off‐medication condition, and the presence of vascular changes on neuroimaging represent the main preoperative clinical predictors of long‐term motor STN‐DBS effects. ANN NEUROL 2021;89:587–597

Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review

“…The evidence for the predictive value of the levodopa responsiveness in the long term was relatively scarce. A few studies, at the level of individuals, indicate a limited predictive value of the preoperative levodopa responsiveness for long‐term motor outcomes after STN DBS 8,20,21 . The present analysis provides the evidence at the study level.…”

Can Levodopa Challenge Testing Predict the Effect of Deep Brain Stimulation? One-Year Outcomes in a Chinese Cohort

“…A greater improvement in QoL is associated with better cognitive function ( Liu et al, 2019 ). Other groups ( Park et al, 2020 ; Cavallieri et al, 2021 ) reported practical evidence on PD patients with dementia, indicating worse responses to DBS intervention relative to patients without dementia. This indicates that PD patients with dementia may not show improvement after DBS.…”

Double-blind cross-over pilot trial protocol to evaluate the safety and preliminary efficacy of long-term adaptive deep brain stimulation in patients with Parkinson’s disease

“…Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD), but its progress has been hampered by stagnation in methodological, technological and device development. DBS proved to be effective in improving major PD symptoms in long-term follow-up studies [1][2][3][4][5][6][7] and currently, DBS is the surgical treatment of choice for patients with PD with medication-resistant motor fluctuations, dyskinesias and refractory tremor. 1 In particular, DBS of the subthalamic nucleus (STN) has been shown to improve motor symptoms of PD, levodopa-induced complications and overall quality of life.…”

“…1 In particular, DBS of the subthalamic nucleus (STN) has been shown to improve motor symptoms of PD, levodopa-induced complications and overall quality of life. 7 However, current devices deliver conventional DBS (cDBS) with constant stimulation parameters, not adapting real-time to clinical features, but leaving to reprogramming…”

“… 1 In particular, DBS of the subthalamic nucleus (STN) has been shown to improve motor symptoms of PD, levodopa-induced complications and overall quality of life. 7 …”