Journal Article

FZJ-2026-02552

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Patients with symmetric Parkinson’s disease do poorly with subthalamic stimulation

Jost, S. T. (Corresponding author) ; Atwani, C. ; Loehrer, P. A. ; Ashkan, K. ; Rizos, A. ; Petry-Schmelzer, J. N. ; Krauss, J. ; Krause, J. F. ; Konitsioti, A. M. ; Biundo, R. ; Pedrosa, D. J. ; Evans, J. ; Visser-Vandewalle, V. ; Nimsky, C. ; Fink, G. R.FZJ* ; Silverdale, M. ; Fasano, A. ; Martinez-Martin, P. ; Antonini, A. ; Borghammer, P. ; Ray Chaudhuri, K. ; Timmermann, L. ; Dafsari, H. S.

2026
BMJ Publishing Group London

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Please use a persistent id in citations: doi:10.1136/jnnp-2025-336382  doi:10.34734/FZJ-2026-02552

Abstract: Background: Motor asymmetry is a hallmark of Parkinson's disease (PD), but ~20% of patients present with symmetric motor signs, which are associated with faster disease progression and poorer dopaminergic response. The impact of motor symmetry on activities of daily living (ADL) outcomes following subthalamic deep brain stimulation (STN-DBS) remains unclear. We hypothesised that patients with symmetric PD experience less ADL improvement post-STN-DBS than asymmetric PD patients.Methods: This was a prospective, quasi-experimental, non-randomised, controlled, international multicentre study with a 6-month follow-up. The primary outcome was the Scales for Outcomes in Parkinson's Disease-Motor ADL scale. Secondary outcomes included Unified Parkinson's Disease Rating Scale motor examination and Parkinson's Disease Questionnaire-8 (PDQ-8). We defined symmetric PD as a right-to-left hemibody motor score equalling 1. We analysed within-group longitudinal changes, between-group outcome differences, effect size and correlations between PDQ-8 and motor changes. We confirmed results in a propensity-score matched subcohort with well-balanced demographic and clinical parameters.Results: We included 200 patients with asymmetric and 54 with symmetric PD. In symmetric PD, ADL remained stable, which was not associated with the observed PDQ-8 improvement. In contrast, in asymmetric PD, ADL improved with a moderate effect size, which correlated moderately with PDQ-8 improvement. In symmetric PD, the absolute risk of experiencing no clinically relevant postoperative ADL improvement was 23.8% higher.Conclusions: This study provides class IIb evidence of worse ADL outcome of STN-DBS in patients with symmetric compared with asymmetric PD. Clinicians should counsel patients with symmetric PD on their elevated risk of ADL non-response when discussing STN-DBS as a treatment option.Keywords: Activities of Daily Living; NEUROSURGERY; PARKINSON'S DISEASE; QUALITY OF LIFE.

Note: Funding This paper presents independent research funded by the National Institutefor Health Research (NIHR) Mental Health Biomedical Research Centre and DementiaUnit at South London and Maudsley NHS Foundation Trust and King’s CollegeLondon.

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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 2026

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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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