Journal Article

FZJ-2024-02262

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Stratifying quality of life outcome in subthalamic stimulation for Parkinson’s disease

Gronostay, A. ; Jost, S. T. ; Silverdale, M. ; Rizos, A. ; Loehrer, P. A. ; Evans, J. ; Sauerbier, A. ; Indi, D. ; Leta, V. ; Reker, P. ; Fink, G. R.FZJ* ; Ashkan, K. ; Antonini, A. ; Nimsky, C. ; Visser-Vandewalle, V. ; Martinez-Martin, P. ; Ray Chaudhuri, K. ; Timmermann, L. ; Dafsari, H. S. (Corresponding author)

2024
BMJ Publishing Group London

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Please use a persistent id in citations: doi:10.1136/jnnp-2023-332272

Abstract: 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.

Note: Paper is funded by the German Research Foundation (Grant KFO 219)

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Contributing Institute(s):

1. Kognitive Neurowissenschaften (INM-3)

Research Program(s):

1. 5251 - Multilevel Brain Organization and Variability (POF4-525) (POF4-525)

Appears in the scientific report 2024

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 10 ; JCR ; National-Konsortium ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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