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Título
Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease
Autor(es)
Dafsari, Haidar S | Dos Santos Ghilardi, Maria Gabriela | Visser-Vandewalle, Veerle | Rizos, Alexandra | Ashkan, Keyoumars | Silverdale, Monty | Evans, Julian | Martinez, Raquel C R | Cury, Rubens G | Jost, Stefanie T | Barbe, Michael T | Fink, Gereon R | Antonini, Angelo | Ray-Chaudhuri, K | Martínez-Martín, Pablo ISCIII | Fonoff, Erich Talamoni | Timmermann, Lars | EUROPAR | IPMDS Non Motor PD Study Group
Fecha de publicación
2020-12
Cita
Brain Stimul. 2020 Nov-Dec;13(6):1697-1705.
Idioma
Inglés
Tipo de documento
journal article
Resumen
Background: Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson’s disease (PD). However, few studies have compared their nonmotor effects. Objective: To compare nonmotor effects of STN-DBS and GPi-DBS. Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, –III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size. Results: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains. Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients’ individual motor and nonmotor profiles.
Palabras clave
Deep brain stimulation | Subthalamic nucleus | Globus Pallidus internus | Non-motor symptoms | Nonmotor symptoms | Quality of life
MESH
Activities of Daily Living | Aged | Deep Brain Stimulation | Fatigue | Female | Follow-Up Studies | Globus Pallidus | Humans | Levodopa | Male | Middle Aged | Parkinson Disease | Prospective Studies | Quality of Life | Sleep | Subthalamic Nucleus | Treatment Outcome
Versión en línea
DOI
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