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001024588 1001_ $$0P:(DE-HGF)0$$aGronostay, Alexandra$$b0
001024588 245__ $$aStratifying quality of life outcome in subthalamic stimulation for Parkinson’s disease
001024588 260__ $$aLondon$$bBMJ Publishing Group$$c2024
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001024588 500__ $$aPaper is funded by the German Research Foundation (Grant KFO 219)
001024588 520__ $$aABSTRACTBackground Subthalamic nucleus deep brainstimulation (STN-DBS)for Parkinson’s disease (PD)improves quality of life (QoL), motor and non-motorsymptoms (NMS). However, in previous studies, 43%–49% of patients did not experience clinically relevantpostoperative QoL improvement. To inform individualisedprediction of postoperative QoL improvement, wedeveloped a stratification analysis of QoL outcomesbased on preoperative non-motortotal burden, severityof motor progression and motor response in levodopachallenge tests.Methods This was a prospective, open-label,multicentre, international study with a 6-monthfollow-up.A distribution-basedthreshold identified’QoL responders’ in the PDQuestionnaire-8SummaryIndex (PDQ-8SI). After baseline stratification based onthe NMS Scale, Hoehn and Yahr Scale and levodoparesponse assessed with the Unified PD Rating Scale-III,we compared postoperative QoL response between thesestrata. To assess the clinical usefulness and statisticalfeasibility of stratifications, we compared cumulativedistribution function curves, respectively PDQ-8within-stratumvariation.Results All main outcomes improved postoperatively.Based on the 8.1 points threshold for clinicallymeaningful PDQ-8SI improvement, only 80/161 patientswere classified as ’QoL responders’. The absolute riskreductions for QoL non-responseamong respective non-motor,motor progression and levodopa response stratawere 23%, 8% and 3%, respectively. Only non-motorstratification reduced PDQ-8within-stratumvariationcompared with the overall cohort.Conclusions Non-motorstratification, but not motorprogression or levodopa response stratification, isclinically useful and statistically feasible for personalisedpreoperative prediction of postoperative QoL outcome ofSTN-DBSfor PD. Our findings highlight that non-motorassessments are necessary components of a case-based,holistic approach of DBS indication evaluations gearedtowards optimising postoperative QoL outcomes.
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001024588 7001_ $$00000-0003-0477-2289$$aJost, Stefanie Theresa$$b1
001024588 7001_ $$0P:(DE-HGF)0$$aSilverdale, Monty$$b2
001024588 7001_ $$0P:(DE-HGF)0$$aRizos, Alexandra$$b3
001024588 7001_ $$00000-0002-5279-2156$$aLoehrer, Philipp Alexander$$b4
001024588 7001_ $$0P:(DE-HGF)0$$aEvans, Julian$$b5
001024588 7001_ $$0P:(DE-HGF)0$$aSauerbier, Anna$$b6
001024588 7001_ $$0P:(DE-HGF)0$$aIndi, Donya$$b7
001024588 7001_ $$00000-0002-5794-7540$$aLeta, Valentina$$b8
001024588 7001_ $$0P:(DE-HGF)0$$aReker, Paul$$b9
001024588 7001_ $$0P:(DE-Juel1)131720$$aFink, Gereon Rudolf$$b10
001024588 7001_ $$0P:(DE-HGF)0$$aAshkan, Keyoumars$$b11
001024588 7001_ $$00000-0003-1040-2807$$aAntonini, Angelo$$b12
001024588 7001_ $$0P:(DE-HGF)0$$aNimsky, Christopher$$b13
001024588 7001_ $$0P:(DE-HGF)0$$aVisser-Vandewalle, Veerle$$b14
001024588 7001_ $$0P:(DE-HGF)0$$aMartinez-Martin, Pablo$$b15
001024588 7001_ $$0P:(DE-HGF)0$$aRay Chaudhuri, K.$$b16
001024588 7001_ $$0P:(DE-HGF)0$$aTimmermann, Lars$$b17
001024588 7001_ $$00000-0001-8849-4233$$aDafsari, Haidar S$$b18$$eCorresponding author
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