Non-motor outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts

Haidar Salimi Dafsari, Jan Niklas Petry-Schmelzer, K Ray-Chaudhuri, Keyoumars Ashkan, Luca Weis, Till A Dembek, Michael Samuel, Alexandra Rizos, Monty Silverdale, Michael T Barbe, Gereon R Fink, Julian Evans, Pablo Martinez-Martin, Angelo Antonini, Veerle Visser-Vandewalle, Lars Timmermann

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS.

OBJECTIVE: To investigate the impact of active contact location on NMS in STN-DBS in PD.

METHODS: In this prospective, open-label, multicenter study including 50 PD patients undergoing bilateral STN-DBS, we collected NMSScale (NMSS), NMSQuestionnaire (NMSQ), Hospital Anxiety and Depression Scale (anxiety/depression, HADS-A/-D), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, motor complications, activities of daily living (ADL), and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Changes were analyzed with Wilcoxon signed-rank/t-test and Bonferroni-correction for multiple comparisons. Although the STN was targeted visually, we employed an atlas-based approach to explore the relationship between active contact locations and DBS outcomes. Based on fused MRI/CT-images, we identified Cartesian coordinates of active contacts with patient-specific Mai-atlas standardization. We computed linear mixed-effects models with x-/y-/z-coordinates as independent, hemispheres as within-subject, and test change scores as dependent variables.

RESULTS: NMSS, NMSQ, PDQ-8, motor examination, complications, and LEDD significantly improved at follow-up. Linear mixed-effect models showed that NMS and QoL improvement significantly depended on more medial (HADS-D, NMSS), anterior (HADS-D, NMSQ, PDQ-8), and ventral (HADS-A/-D, NMSS, PDQ-8) neurostimulation. ADL improved more in posterior, LEDD in lateral neurostimulation locations. No relationship was observed for motor examination and complications scores.

CONCLUSIONS: Our study provides evidence that more anterior, medial, and ventral STN-DBS is significantly related to more beneficial non-motor outcomes.

Original languageEnglish
Pages (from-to)904-912
Number of pages9
JournalBrain Stimulation
Volume11
Issue number4
DOIs
Publication statusPublished - Apr 16 2018

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