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 (26) , Jan Vesper (5) , Lars Wojtecki (5) , Stéphane Derrey (27, 28, 29, 30) , David Maltête (31) , Philippe Damier (32) , Pascal Derkinderen (33) , Friederike Sixel-Döring (34, 35) , Claudia Trenkwalder (36) , Alireza Gharabaghi (37) , Tobias Wächter (38) , Daniel Weiss (39) , Marcus O. Pinsker (14) , Jean-Marie Regis (40) , Tatiana Witjas (41) , Stéphane Thobois (42) , Patrick Mertens (43) , Karina Knudsen (44) , Carmen Schade-Brittinger (45) , Jean-Luc Houeto (46, 47) , Yves Agid (48) , Marie Vidailhet (49) , Lars Timmermann (5) , Günther Deuschl (14)

1 UNIBE - Universität Bern [Bern]
2 ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
3 CIC AP-HP (pitie-Salpetriere)/inserm
4 Medtronic Inc [Minneapolis, MI, USA]
5 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
6 UNIGE - Université de Genève = University of Geneva
7 Centre de coordination des essais cliniques, Philipps-University, Marburg, Allemagne.
8 CIC Neurosciences - Centre d'investigation clinique Neurosciences [CHU Pitié Salpêtrière]
9 NeuroCure Clinical Research Center (NCRC), Charité University Medical Center, Charité (Campus Mitte), Berlin, Germany.
10 Service de Neurologie [CHU Pitié-Salpêtrière]
11 Department of Neuroscience, Karolinska institutet, Stockholm, Sweden
12 Department of Neurology, University Medical Center Schleswig-Holstein, Arnold-Heller-Street 3, Kiel 24105, Germany.
13 Department of Neurology, Christian-Albrechts-University, Kiel, Germany.
14 CAU - Christian-Albrechts-Universität zu Kiel
15 University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.
16 National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK.
17 University of Cologne
18 Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité-Universitätsmedizin, Berlin, Germany.
19 NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany.
20 Charité - UniversitätsMedizin = Charité - University Hospital [Berlin]
21 Department of Neurology & Neurosurgery, Charite University Medicine Berlin, Campus Virchow Klinikum & Benjamin Franklin, Berlin, Germany.
22 CHU - Centre Hospitalier Universitaire [Grenoble]
23 GIN - Grenoble Institut des Neurosciences
24 UM des troubles du mouvement
25 Service d'Anatomie et Cytopathologie [Toulouse]
26 CIC 1436 - Centre d'investigation clinique de Toulouse
27 Service de neurochirurgie [CHU Rouen]
28 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
29 UNIROUEN - Université de Rouen Normandie
30 IRIB - Institute for Research and Innovation in Biomedicine
31 Service de neurologie [Rouen]
32 Clinique neurologique
33 Neuropathies du système nerveux entérique et pathologies digestives; implication des cellules gliales entériques
34 Paracelsus-Elena-Klinik, Kassel, Germany.
35 Department of Neurology, Philipps University Marburg, Germany.
36 Paracelsus Elena Klinik
37 Department of Neurosurgery, University of Tuebingen
38 Center of Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen
39 University of Vermont [Burlington]
40 Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit CHU Timone Marseille, France.
41 AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France.
42 Service de Neurologie
43 Service Public de Wallonie
44 Department of Nuclear Medicine and PET Centre Aarhus University Hospital, Institute of Clinical Medicine Aarhus University, Norrebrogade 44, Building 10, 8000, Aarhus C, Denmark.
45 Somnomar
46 Service de neurologie [Poitiers]
47 CIC - Poitiers
48 Neurologie et thérapeutique expérimentale
49 CRICM - Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière

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.

Domains: Life Sciences [q-bio]; Biochemistry, Molecular Biology; Genomics [q-bio.GN]; Life Sciences [q-bio]; Biochemistry, Molecular Biology; Biochemistry [q-bio.BM]; Life Sciences [q-bio]; Food and Nutrition

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, 2019, 92 (10), pp.e1109-e1120. ⟨10.1212/WNL.0000000000007037⟩. ⟨hal-02373051⟩