The Contribution of Subthalamic Nucleus Deep Brain Stimulation to the Improvement in Motor Functions and Quality of Life

Tödt, Inken; Al‐Fatly, Bassam; Granert, Oliver; Kühn, Andrea A.; Krack, Paul; Rau, Joern; Timmermann, Lars; Schnitzler, Alfons; Paschen, Steffen; Helmers, Ann‐Kristin; Hartmann, Andréas; Bardinet, Éric; Schuepbach, Michael; Barbe, Michael T.; Dembek, Till A.; Fraix, Valérie; Kübler, Dorothee; Brefel‐Courbon, Christine; Gharabaghi, Alireza; Wojtecki, Lars; Pinsker, Marcus O.; Thobois, Stéphane; Damier, Philippe; Witjas, Tatiana; Houeto, Jean‐Luc; Schade‐Brittinger, Carmen; Vidailhet, Marie; Horn, Andreas; Deuschl, Günther

doi:10.1002/mds.28952

Cited by 13 publications

(17 citation statements)

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“…The ~ 9% improvement in the PDQ39 summary index reported in our cohort is in line with results reported in a previous short-term neurological day clinic (Fründt et al 2018) as well as the 24-month results of the aforementioned STN-DBS trial (Schuepbach et al 2013). Interestingly, the PDQ39 improvement reported here exceeds those reported following other one-dimensional approaches (Schuepbach et al 2013;Tomlinson et al 2014;Gray et al 2022;Tödt et al 2022).…”

Section: Improvements Of Motor and Non-motor Symptoms As Well As Qolsupporting

confidence: 92%

“…First attempts to offer a multidisciplinary rehabilitation program for PD patients in a day-care unit in a district hospital obtained a ~ 4% improvement in health-related QoL after a 6-week treatment period (Trend et al 2002 ). Longer invasive neurostimulation studies report on improvements ranging between, e.g., 4.6 and 7.8 points (Schuepbach et al 2013 ; Tödt et al 2022 ). The ~ 9% improvement in the PDQ39 summary index reported in our cohort is in line with results reported in a previous short-term neurological day clinic (Fründt et al 2018 ) as well as the 24-month results of the aforementioned STN–DBS trial (Schuepbach et al 2013 ).…”

Section: Discussionmentioning

confidence: 99%

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Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease

et al. 2022

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Background Inpatient as well as outpatient care does often not meet PD-patients’ individual needs. Introduction Day-clinic concepts encompassing a multidisciplinary team as well as therapy adjustments accompanying everyday demands aim at filling this gap. Methods This is a retrospective study on short-term effects of a 3 week multidisciplinary rehabilitation program in patients with Parkinson´s disease (PD) embedded in a specialized movement disorder day-clinic. We analyzed short-term outcome of motor and non-motor symptoms (NMS) in 143 PD-patients (mean age 65.3 ± 11.9 years; Hoehn-and-Yahr-score 2.6 ± 0.7) after 3 weeks with 7.4 ± 1.8 active days of interdisciplinary day-care treatment. Participants attended the day-clinic in groups of five patients at a time. Improvements were evaluated by comparison of standardized physical therapy assessments, disease specific scores for motor symptoms (MDS–UPDRS III), mood (BDI), quality of life (PDQ39, SF36), sleep (PDSS, ESS), impulsiveness (QUIP), apathy (SAS), cognition (MMST), as well as change in medication before and directly after the intervention. Results MDS–UPDRS motor score improved significantly by 22.9 ± 21.5% (p < 0.001) and was accompanied by a significant reduction of imbalance, immobility, and weakness ranging between 6% and 17% in standardized physical therapy tests. In addition, all disease-specific non-motor scales improved significantly. Conclusions A multidisciplinary day-clinic approach can support benefit on motor, non-motor symptoms and QoL in PD-patients. Given the increase in PD incidence and prevalence as well as the significant treatment effects shown here, more day-clinic treatment opportunities ought to be implemented to improve PD treatment adapted to everyday challenges while still reducing costs to the health care system.

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Section: Improvements Of Motor and Non-motor Symptoms As Well As Qolsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease

et al. 2022

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“…Second, our research is not longitudinal and we are not able to trace long-lasting changes in IADL due to STN-DBS. Third, we do not report data on individual stimulation volumes and functional zones of the STN and their contribution to IADL changes (Tödt et al, 2022). Fourth, a modest sample size regarding DBS research and the apparent lack of cognitive decline after STN-DBS surgery in our sample might have prevented us from observing any significant interaction between the time of assessment and cognitive performance.…”

Section: Discussionmentioning

confidence: 93%

“…Deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) is a standard treatment for medication-refractory movement symptoms of PD (Perlmutter and Mink, 2006;Bronstein et al, 2011;Okun, 2014;Mueller et al, 2020). A number of works have shown that this therapy is highly effective in regaining control over PD motor symptoms and improving patients' quality of life (QoL), as well as in reducing the levodopa equivalent daily dose (LEDD) (Tomlinson et al, 2010;Bratsos et al, 2018;Tödt et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

“…Previous research of IADL in PD patients after STN-DBS used general IADL scales, such as Lawton's IADL scale, to investigate everyday performance (Gorecka-Mazur et al, 2019) or the Unified Parkinson's Disease Rating Scale (UPDRS part II) or the Schwab and England Activities of Daily Living (Deuschl et al, 2006;Kleiner-Fisman et al, 2010;Odekerken et al, 2013;Jiang et al, 2015;Tödt et al, 2022). In the current study, we sought to use a disease-specific questionnaire developed to assess IADLs in PD (Brennan et al, 2016a).…”

Section: Introductionmentioning

confidence: 99%

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The Instrumental Activities of Daily Living in Parkinson’s Disease Patients Treated by Subthalamic Deep Brain Stimulation

Bezdíček

Mana²,

Růžička³

et al. 2022

Front. Aging Neurosci.

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BackgroundEveryday functioning and instrumental activities of daily living (IADL) play a vital role in preserving the quality of life in patients with Parkinson’s disease (PD) after deep brain stimulation of the subthalamic nucleus (STN-DBS).ObjectiveThe main goal of the current study was to examine IADL change in pre-and post-surgery of the STN-DBS. We also analyzed the influence of the levodopa equivalent daily dose (LEDD) and global cognitive performance (Dementia Rating Scale; DRS-2) as covariates in relation to IADL.MethodsThirty-two non-demented PD patients were administered before and after STN-DBS neurosurgery the Penn Parkinson’s Daily Activities Questionnaire (PDAQ; self-report), the DRS-2 and Beck Depression Inventory (BDI-II) to assess IADL change, global cognition, and depression.ResultsWe found a positive effect of STN-DBS on IADL in the post-surgery phase. Moreover, lower global cognition and lower LEDD are predictive of lower IADL in both pre-surgery and post-surgery examinations.Summary/ConclusionSTN-DBS in PD is a safe method for improvement of everyday functioning and IADL. In the post-surgery phase, we show a relation of IADL to the severity of cognitive impairment in PD and to LEDD.

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Unveiling the Dominant Factors in Subthalamic Stimulation for Improving Depression in Parkinson's Disease

Zhao,

Cheng,

et al. 2024

Movement Disord Clin Pract

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BackgroundCurrently, the conclusions of studies on subthalamic nucleus (STN) deep brain stimulation (DBS) for improving Parkinson's disease (PD) with depression are inconsistent, and the reasons for improvement or deterioration remain unclear.MethodsThe aim was to investigate the prognosis of PD with depression after bilateral STN‐DBS and the factors related to the improvement in depression. The local and network effects of DBS on depression in PD (DPD) were further explored based on the volume of tissue activation (VTA). The study analyzed 80 primary PD patients who had undergone bilateral STN‐DBS, comprising 47 patients with improved depression and 33 patients without improvement. Two groups of clinical profiles and stimulation parameters were compared, and the network models for improving depression were constructed.ResultsThe improvement in depression was closely associated with improvement in anxiety (odd rate [OR] = 1.067, P = 0.006) and the standardized space left y‐coordinate (OR = 0.253, P = 0.005). The VTA overlapping with the left motor STN subregion is most significantly associated with improvement in depression (RSpearman = 0.53, P < 0.001; RPearson = 0.43, P < 0.001). The y‐coordinates in the improvement group were closer to the optimal stimulation site for improving motor symptoms. Finally, both the structural and functional network models indicate a positive correlation between depression improvement and the connectivity of the sensorimotor cortex.ConclusionThe amelioration of DPD is primarily attributed to the stimulation of bilateral motor STN, particularly on the left. However, this stimulatory effect manifests as an indirect influence.

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The Contribution of Subthalamic Nucleus Deep Brain Stimulation to the Improvement in Motor Functions and Quality of Life

Cited by 13 publications

References 60 publications

Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease

Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease

The Instrumental Activities of Daily Living in Parkinson’s Disease Patients Treated by Subthalamic Deep Brain Stimulation

Unveiling the Dominant Factors in Subthalamic Stimulation for Improving Depression in Parkinson's Disease

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