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Quality of life predicts outcome of deep brain stimulation in early Parkinson disease

W.M. Michael Schuepbach 1, 2, 3 Lisa Tonder 4 Alfons Schnitzler 5 Paul Krack 6 Joern Rau 7 Andreas Hartmann 8 Thomas Hälbig 9 Fanny Pineau 10 Andrea Falk 11 Laura Paschen 12 Stephen Paschen 13 Jens Volkmann 14 Haidar Dafsari 15, 16 Michael Barbe 15 Gereon Fink 17 Andrea Kühn 18, 19 Andreas Kupsch 20 Gerd-H. Schneider 21 Eric Seigneuret 22 Valérie Fraix 23 Andrea Kistner 24 P. Patrick Chaynes 25 Fabienne Ory-Magne 26 Christine Brefel-Courbon 27 Jan Vesper 28 Lars Wojtecki 5 Stéphane Derrey 29, 30, 31, 32 David Maltête 33 Philippe Damier 34 Pascal Derkinderen 35 Friederike Sixel-Döring 36, 37 Claudia Trenkwalder 38 Alireza Gharabaghi 39 Tobias Wächter 40 Daniel Weiss 41 Marcus Pinsker 14 Jean-Marie Regis 42 Tatiana Witjas 43 Stéphane Thobois 44 Patrick Mertens 45 Karina Knudsen 46 Carmen Schade-Brittinger 47 Jean-Luc Houeto 48, 49 Yves Agid 50 Marie Vidailhet 51 Lars Timmermann 5 Günther Deuschl 14
Abstract : Objective To investigate predictors for improvement of disease-specific quality of life (QOL) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) with early motor complications. Methods We performed a secondary analysis of data from the previously published EARLYSTIM study, a prospective randomized trial comparing STN-DBS (n = 124) to best medical treatment (n = 127) after 2 years follow-up with disease-specific QOL (39-item Parkinson’s Disease Questionnaire summary index [PDQ-39-SI]) as the primary endpoint. Linear regression analyses of the baseline characteristics age, disease duration, duration of motor complications, and disease severity measured at baseline with the Unified Parkinson’s Disease Rating Scale (UPDRS) (UPDRS-III“off”and “on” medications, UPDRS-IV) were conducted to determine predictors of change in PDQ-39-SI. Results PDQ-39-SI at baseline was correlated to the change in PDQ-39-SI after 24 months in both treatment groups (p < 0.05). The higher the baseline score (worse QOL) the larger the improvement in QOL after 24 months. No correlation was found for any of the other baseline characteristics analyzed in either treatment group. Conclusion Impaired QOL as subjectively evaluated by the patient is the most important predictor of benefit in patients with PD and early motor complications, fulfilling objective gold standard inclusion criteria for STN-DBS. Our results prompt systematically including evaluation of disease-specific QOL when selecting patients with PD for STN-DBS.
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Submitted on : Wednesday, November 20, 2019 - 5:25:40 PM
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W.M. Michael Schuepbach, Lisa Tonder, Alfons Schnitzler, Paul Krack, Joern Rau, et al.. Quality of life predicts outcome of deep brain stimulation in early Parkinson disease. Neurology, American Academy of Neurology, 2019, 92 (10), pp.e1109-e1120. ⟨10.1212/WNL.0000000000007037⟩. ⟨hal-02373051⟩



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