TY  - JOUR
AU  - Gronostay, Alexandra
AU  - Jost, Stefanie Theresa
AU  - Silverdale, Monty
AU  - Rizos, Alexandra
AU  - Loehrer, Philipp Alexander
AU  - Evans, Julian
AU  - Sauerbier, Anna
AU  - Indi, Donya
AU  - Leta, Valentina
AU  - Reker, Paul
AU  - Fink, Gereon Rudolf
AU  - Ashkan, Keyoumars
AU  - Antonini, Angelo
AU  - Nimsky, Christopher
AU  - Visser-Vandewalle, Veerle
AU  - Martinez-Martin, Pablo
AU  - Ray Chaudhuri, K.
AU  - Timmermann, Lars
AU  - Dafsari, Haidar S
TI  - Stratifying quality of life outcome in subthalamic stimulation for Parkinson’s disease
JO  - Journal of neurology, neurosurgery, and psychiatry
VL  - 95
IS  - 7
SN  - 0022-3050
CY  - London
PB  - BMJ Publishing Group
M1  - FZJ-2024-02262
SP  - jnnp-2023-332272 -
PY  - 2024
N1  - Paper is funded by the German Research Foundation (Grant KFO 219)
AB  - ABSTRACTBackground 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.
LB  - PUB:(DE-HGF)16
C6  - 38124227
UR  - <Go to ISI:>//WOS:001143623900001
DO  - DOI:10.1136/jnnp-2023-332272
UR  - https://juser.fz-juelich.de/record/1024588
ER  -