Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease

EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group

doi:10.1038/s41531-021-00174-x

Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease

EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group

Neurology

Research output: Contribution to journal › Article › peer-review

31 Scopus citations

Abstract

To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as ‘difficulties experiencing pleasure’ and ‘problems sustaining concentration’. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.

Original language	English (US)
Article number	48
Journal	npj Parkinson's Disease
Volume	7
Issue number	1
DOIs	https://doi.org/10.1038/s41531-021-00174-x
State	Published - Dec 2021

Funding

S.T.J. reports no financial disclosures. Veerle Visser-Vandewalle is a member of the advisory boards and reports consultancies for Medtronic, Boston Scientific and St. Jude Medical. She received a grant from SAPIENS Steering Brain Stimulation. A.R. has received honorarium from UCB and was supported by a grant from Medtronic. P.A.L. was funded by the SUCCESS-Program of the University of Marburg, the Parkinson\u2019s Foundation, and the Stiftung zur F\u00F6rderung junger Neurowissenschaftler. M.S. has received honoraria from Bial, Britannia and Medtronic as well as grants from Parkinson\u2019s UK, Michael J Fox Foundation, NIHR, BBSRC, Dystonia society and Innovate UK. Julian Evans reports no financial disclosures. M.S. has received honoraria for educational meetings/travel/accommodation from Medtronic, Abbott, and UCB, grants from Parkinson\u2019s UK and Ipsen, and has acted as a consultant for Medtronic and Abbott. J.N.P.-S. has received travel grants from Boston Scientific. Anna Sauerbier reports no financial disclosures. Alexandra Gronostay reports no financial disclosures. M.T.B. received speaker\u2019s honoraria from Medtronic, Boston Scientific, Abbott (formerly St. Jude), GE Medical, UCB, Apothekerverband K\u00F6ln e.V. and Bial as well as research funding from the Felgenhauer-Stiftung, Forschungspool Klinische Studien (University of Cologne), Horizon 2020 (Gondola), Medtronic (ODIS), and Boston Scientific and advisory honoraria for the IQWIG. G.R.F. reports no financial disclosures. K.A. has received honoraria for educational meetings, travel and consultancy from Medtronic, St Jude Medical and Boston Scientific. A.A. reports personal consultancy fees from Zambon, AbbVie, Boehringer Ingelheim, GE, Neuroderm, Biogen, Bial, EVER Neuro Pharma, Therevance, Vectura grants from Chiesi Pharmaceuticals, Lundbeck, Horizon 2020 - PD_Pal Grant 825785, Ministry of Education University and Research (MIUR) Grant ARS01_01081, owns Patent WO2015110261-A1, owns shares from PD Neurotechnology Limited. P.M.-M. has received honoraria from Editorial Viguera and Movement Disorder Society for lecturing in courses; from AbbVie for speaking in experts\u2019 meetings and from AbbVie and Zambon for participating in the Advisory Board of epidemiological studies. License fee payments for the King\u2019s Parkinson\u2019s Disease Pain Scale, and grants from the International Parkinson and Movement Disorder Society for development and validation of the MDS-Non-Motor Symptoms Scale. K.R.C. has received funding from Parkinson\u2019s UK, NIHR, UCB, and the European Union; he received honoraria from UCB, Abbott, Britannia, US Worldmeds, and Otsuka Pharmaceuticals; and acted as a consultant for AbbVie, UCB, and Britannia. L.T. reports grants, personal fees and non-financial support from SAPIENS Steering Brain Stimulation, Medtronic, Boston Scientific and St. Jude Medical. H.S.D.\u2019s work was funded by the Prof. Klaus Thiemann Foundation and the Felgenhauer Foundation and has received honoraria by Boston Scientific and Medtronic. This paper is independent research funded by the German Research Foundation (Grant KFO 219).

ASJC Scopus subject areas

Neurology
Clinical Neurology
Cellular and Molecular Neuroscience

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title = "Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease",

abstract = "To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson{\textquoteright}s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as {\textquoteleft}difficulties experiencing pleasure{\textquoteright} and {\textquoteleft}problems sustaining concentration{\textquoteright}. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.",

author = "{EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson{\textquoteright}s Disease Study Group} and Jost, {Stefanie T.} and Veerle Visser-Vandewalle and Alexandra Rizos and Loehrer, {Philipp A.} and Monty Silverdale and Julian Evans and Michael Samuel and Petry-Schmelzer, {Jan Niklas} and Anna Sauerbier and Alexandra Gronostay and Barbe, {Michael T.} and Fink, {Gereon R.} and Keyoumars Ashkan and Angelo Antonini and Pablo Martinez-Martin and Chaudhuri, {K. Ray} and Lars Timmermann and Dafsari, {Haidar S.} and Roongroj Bhidayasiri and Cristian Falup-Pecurariu and Beomseok Jeon and Valentina Leta and Per Borghammer and Per Odin and Anette Schrag and Alexander Storch and Violante, {Mayela Rodriguez} and Daniel Weintraub and Charles Adler and Paolo Barone and Brooks, {David J.} and Richard Brown and Marc Cantillon and Camille Carroll and Miguel Coelho and Tove Henriksen and Michele Hu and Peter Jenner and Milica Kramberger and Padma Kumar and M{\'o}nica Kurtis and Simon Lewis and Irene Litvan and Kelly Lyons and Davide Martino and Mario Masellis and Hideki Mochizuki and Morley, {James F.} and Melissa Nirenberg and Tanya Simuni",

note = "Publisher Copyright: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = dec,

doi = "10.1038/s41531-021-00174-x",

language = "English (US)",

volume = "7",

journal = "npj Parkinson's Disease",

issn = "2373-8057",

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TY - JOUR

T1 - Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease

AU - EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group

AU - Jost, Stefanie T.

AU - Visser-Vandewalle, Veerle

AU - Rizos, Alexandra

AU - Loehrer, Philipp A.

AU - Silverdale, Monty

AU - Evans, Julian

AU - Samuel, Michael

AU - Petry-Schmelzer, Jan Niklas

AU - Sauerbier, Anna

AU - Gronostay, Alexandra

AU - Barbe, Michael T.

AU - Fink, Gereon R.

AU - Ashkan, Keyoumars

AU - Antonini, Angelo

AU - Martinez-Martin, Pablo

AU - Chaudhuri, K. Ray

AU - Timmermann, Lars

AU - Dafsari, Haidar S.

AU - Bhidayasiri, Roongroj

AU - Falup-Pecurariu, Cristian

AU - Jeon, Beomseok

AU - Leta, Valentina

AU - Borghammer, Per

AU - Odin, Per

AU - Schrag, Anette

AU - Storch, Alexander

AU - Violante, Mayela Rodriguez

AU - Weintraub, Daniel

AU - Adler, Charles

AU - Barone, Paolo

AU - Brooks, David J.

AU - Brown, Richard

AU - Cantillon, Marc

AU - Carroll, Camille

AU - Coelho, Miguel

AU - Henriksen, Tove

AU - Hu, Michele

AU - Jenner, Peter

AU - Kramberger, Milica

AU - Kumar, Padma

AU - Kurtis, Mónica

AU - Lewis, Simon

AU - Litvan, Irene

AU - Lyons, Kelly

AU - Martino, Davide

AU - Masellis, Mario

AU - Mochizuki, Hideki

AU - Morley, James F.

AU - Nirenberg, Melissa

AU - Simuni, Tanya

PY - 2021/12

Y1 - 2021/12

N2 - To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as ‘difficulties experiencing pleasure’ and ‘problems sustaining concentration’. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.

AB - To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as ‘difficulties experiencing pleasure’ and ‘problems sustaining concentration’. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.

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Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease

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