Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease
Background: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson’s disease (PD). However, few studies have compared their nonmotor effects. Objective: To compare nonmotor effects of STN-DBS and GPi-DBS. Me...
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Format: | Article |
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Elsevier
2020-11-01
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Series: | Brain Stimulation |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X20302588 |
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doaj-24ed330912fb47738b3ae96d0bd6c132 |
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Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Haidar S. Dafsari Maria Gabriela dos Santos Ghilardi Veerle Visser-Vandewalle Alexandra Rizos Keyoumars Ashkan Monty Silverdale Julian Evans Raquel C.R. Martinez Rubens G. Cury Stefanie T. Jost Michael T. Barbe Gereon R. Fink Angelo Antonini K. Ray-Chaudhuri Pablo Martinez-Martin Erich Talamoni Fonoff Lars Timmermann |
spellingShingle |
Haidar S. Dafsari Maria Gabriela dos Santos Ghilardi Veerle Visser-Vandewalle Alexandra Rizos Keyoumars Ashkan Monty Silverdale Julian Evans Raquel C.R. Martinez Rubens G. Cury Stefanie T. Jost Michael T. Barbe Gereon R. Fink Angelo Antonini K. Ray-Chaudhuri Pablo Martinez-Martin Erich Talamoni Fonoff Lars Timmermann Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease Brain Stimulation Deep brain stimulation Subthalamic nucleus Globus Pallidus internus Non-motor symptoms Nonmotor symptoms Quality of life |
author_facet |
Haidar S. Dafsari Maria Gabriela dos Santos Ghilardi Veerle Visser-Vandewalle Alexandra Rizos Keyoumars Ashkan Monty Silverdale Julian Evans Raquel C.R. Martinez Rubens G. Cury Stefanie T. Jost Michael T. Barbe Gereon R. Fink Angelo Antonini K. Ray-Chaudhuri Pablo Martinez-Martin Erich Talamoni Fonoff Lars Timmermann |
author_sort |
Haidar S. Dafsari |
title |
Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease |
title_short |
Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease |
title_full |
Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease |
title_fullStr |
Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease |
title_full_unstemmed |
Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease |
title_sort |
beneficial nonmotor effects of subthalamic and pallidal neurostimulation in parkinson’s disease |
publisher |
Elsevier |
series |
Brain Stimulation |
issn |
1935-861X |
publishDate |
2020-11-01 |
description |
Background: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson’s disease (PD). However, few studies have compared their nonmotor effects. Objective: To compare nonmotor effects of STN-DBS and GPi-DBS. Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, –III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. Results: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients’ individual motor and nonmotor profiles. |
topic |
Deep brain stimulation Subthalamic nucleus Globus Pallidus internus Non-motor symptoms Nonmotor symptoms Quality of life |
url |
http://www.sciencedirect.com/science/article/pii/S1935861X20302588 |
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doaj-24ed330912fb47738b3ae96d0bd6c1322021-03-19T07:23:05ZengElsevierBrain Stimulation1935-861X2020-11-0113616971705Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s diseaseHaidar S. Dafsari0Maria Gabriela dos Santos Ghilardi1Veerle Visser-Vandewalle2Alexandra Rizos3Keyoumars Ashkan4Monty Silverdale5Julian Evans6Raquel C.R. Martinez7Rubens G. Cury8Stefanie T. Jost9Michael T. Barbe10Gereon R. Fink11Angelo Antonini12K. Ray-Chaudhuri13Pablo Martinez-Martin14Erich Talamoni Fonoff15Lars Timmermann16University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, United Kingdom; Corresponding author. Department of Neurology University Hospital Cologne Kerpenerstr. 62 50937 Cologne, Germany.Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilUniversity of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, GermanyNational Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, United KingdomNational Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, United KingdomDepartment of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United KingdomDepartment of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United KingdomDivision of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, BrazilDivision of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, BrazilUniversity of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, GermanyUniversity of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, GermanyUniversity of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, GermanyParkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy; Department of Neuroscience, University of Padua, Padua, ItalyNational Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United KingdomNational Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, SpainDivision of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil; Laboratory of Neuromodulation, Institute of Teaching and Research, Hospital Sirio-Libanês, São Paulo, BrazilUniversity of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, GermanyBackground: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson’s disease (PD). However, few studies have compared their nonmotor effects. Objective: To compare nonmotor effects of STN-DBS and GPi-DBS. Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, –III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. Results: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients’ individual motor and nonmotor profiles.http://www.sciencedirect.com/science/article/pii/S1935861X20302588Deep brain stimulationSubthalamic nucleusGlobus Pallidus internusNon-motor symptomsNonmotor symptomsQuality of life |