Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease

Haidar Salimi Dafsari, Prashanth Reddy, Christiane Herchenbach, Stefanie Wawro, Jan Niklas Petry-Schmelzer, Veerle Visser-Vandewalle, Alexandra Rizos, Monty Silverdale, Keyoumars Ashkan, Michael Samuel, Julian Evans, Carlo A. Huber, Gereon R. Fink, Angelo Antonini, K. Ray Chaudhuri, Pablo Martinez-Martin, Lars Timmermann

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Background: STN-DBS is well established to improve motor symptoms and quality of life in patients with PD. While non-motor symptoms are crucial for quality of life in these patients, only neuropsychiatric and neuropsychological symptoms have been systematically studied in a longitudinal design so far. However, these are only a part of the non-motor symptoms spectrum. Hypothesis: We hypothesized that STN-DBS is associated with a beneficial effect on a range of non-motor symptoms. Methods: In this multicenter, open, prospective, international study (EuroInf-study, UKCRN10084/DRKS00006735) we investigated non-motor effects of STN-DBS in "real-life" use. We evaluated Non-motor Symptom Scale, and Questionnaire, PD Questionnaire-8, Scales for Outcomes of PD motor examination and complications, and activities of daily living preoperatively and at 6 months follow-up in 60 consecutive patients (35 male, mean age: 61.6 ± 7.8 years, mean disease duration: 10.4 ± 4.2 years). Results: All outcomes improved significantly at 6 months follow-up (PD Questionaire-8, p = 0.006; activities of daily living, p = 0.012; all others, p <0.001; Wilcoxon signed-rank, respectively paired t-test; Bonferroni-correction). Post-hoc analyses of Non-motor Symptom Scale domains showed a significant reduction of sleep/fatigue and miscellaneous domains (p ≤ 0.001), perceptual problems/hallucinations (p = 0.036), and urinary (p = 0.018) scores. Effect sizes were "moderate" for Non-motor Symptom Scale, and motor complications, "large" for motor examination, and "small" for other outcomes. Conclusions: This study provides evidence that bilateral STN-DBS improves non-motor burden in patients with PD and opens the door to a more balanced evaluation of DBS outcomes. Further randomized studies are needed to confirm these findings and compare DBS non-motor effects to other invasive therapies of advanced PD.

Original languageEnglish
JournalBrain Stimulation
DOIs
Publication statusAccepted/In press - May 18 2015

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Parkinson Disease
Activities of Daily Living
Quality of Life
Hallucinations
Fatigue
Sleep
Prospective Studies
Surveys and Questionnaires
Therapeutics

Keywords

  • Deep brain stimulation
  • Non-Motor Symptom Scale
  • Nonmotor symptoms
  • Quality of life

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)
  • Biophysics

Cite this

Dafsari, H. S., Reddy, P., Herchenbach, C., Wawro, S., Petry-Schmelzer, J. N., Visser-Vandewalle, V., ... Timmermann, L. (Accepted/In press). Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease. Brain Stimulation. https://doi.org/10.1016/j.brs.2015.08.005

Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease. / Dafsari, Haidar Salimi; Reddy, Prashanth; Herchenbach, Christiane; Wawro, Stefanie; Petry-Schmelzer, Jan Niklas; Visser-Vandewalle, Veerle; Rizos, Alexandra; Silverdale, Monty; Ashkan, Keyoumars; Samuel, Michael; Evans, Julian; Huber, Carlo A.; Fink, Gereon R.; Antonini, Angelo; Chaudhuri, K. Ray; Martinez-Martin, Pablo; Timmermann, Lars.

In: Brain Stimulation, 18.05.2015.

Research output: Contribution to journalArticle

Dafsari, HS, Reddy, P, Herchenbach, C, Wawro, S, Petry-Schmelzer, JN, Visser-Vandewalle, V, Rizos, A, Silverdale, M, Ashkan, K, Samuel, M, Evans, J, Huber, CA, Fink, GR, Antonini, A, Chaudhuri, KR, Martinez-Martin, P & Timmermann, L 2015, 'Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease', Brain Stimulation. https://doi.org/10.1016/j.brs.2015.08.005
Dafsari HS, Reddy P, Herchenbach C, Wawro S, Petry-Schmelzer JN, Visser-Vandewalle V et al. Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease. Brain Stimulation. 2015 May 18. https://doi.org/10.1016/j.brs.2015.08.005
Dafsari, Haidar Salimi ; Reddy, Prashanth ; Herchenbach, Christiane ; Wawro, Stefanie ; Petry-Schmelzer, Jan Niklas ; Visser-Vandewalle, Veerle ; Rizos, Alexandra ; Silverdale, Monty ; Ashkan, Keyoumars ; Samuel, Michael ; Evans, Julian ; Huber, Carlo A. ; Fink, Gereon R. ; Antonini, Angelo ; Chaudhuri, K. Ray ; Martinez-Martin, Pablo ; Timmermann, Lars. / Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease. In: Brain Stimulation. 2015.
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AU - Dafsari, Haidar Salimi

AU - Reddy, Prashanth

AU - Herchenbach, Christiane

AU - Wawro, Stefanie

AU - Petry-Schmelzer, Jan Niklas

AU - Visser-Vandewalle, Veerle

AU - Rizos, Alexandra

AU - Silverdale, Monty

AU - Ashkan, Keyoumars

AU - Samuel, Michael

AU - Evans, Julian

AU - Huber, Carlo A.

AU - Fink, Gereon R.

AU - Antonini, Angelo

AU - Chaudhuri, K. Ray

AU - Martinez-Martin, Pablo

AU - Timmermann, Lars

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N2 - Background: STN-DBS is well established to improve motor symptoms and quality of life in patients with PD. While non-motor symptoms are crucial for quality of life in these patients, only neuropsychiatric and neuropsychological symptoms have been systematically studied in a longitudinal design so far. However, these are only a part of the non-motor symptoms spectrum. Hypothesis: We hypothesized that STN-DBS is associated with a beneficial effect on a range of non-motor symptoms. Methods: In this multicenter, open, prospective, international study (EuroInf-study, UKCRN10084/DRKS00006735) we investigated non-motor effects of STN-DBS in "real-life" use. We evaluated Non-motor Symptom Scale, and Questionnaire, PD Questionnaire-8, Scales for Outcomes of PD motor examination and complications, and activities of daily living preoperatively and at 6 months follow-up in 60 consecutive patients (35 male, mean age: 61.6 ± 7.8 years, mean disease duration: 10.4 ± 4.2 years). Results: All outcomes improved significantly at 6 months follow-up (PD Questionaire-8, p = 0.006; activities of daily living, p = 0.012; all others, p <0.001; Wilcoxon signed-rank, respectively paired t-test; Bonferroni-correction). Post-hoc analyses of Non-motor Symptom Scale domains showed a significant reduction of sleep/fatigue and miscellaneous domains (p ≤ 0.001), perceptual problems/hallucinations (p = 0.036), and urinary (p = 0.018) scores. Effect sizes were "moderate" for Non-motor Symptom Scale, and motor complications, "large" for motor examination, and "small" for other outcomes. Conclusions: This study provides evidence that bilateral STN-DBS improves non-motor burden in patients with PD and opens the door to a more balanced evaluation of DBS outcomes. Further randomized studies are needed to confirm these findings and compare DBS non-motor effects to other invasive therapies of advanced PD.

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