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

W.M. Michael Schuepbach Lisa Tonder Alfons Schnitzler 1 Paul Krack 2 Joern Rau Andreas Hartmann Thomas Hälbig Fanny Pineau 3 Andrea Falk Laura Paschen Stephen Paschen Jens Volkmann 4 Haidar Dafsari Michael Barbe Gereon Fink Andrea Kühn Andreas Kupsch 5 Gerd-H. Schneider Eric Seigneuret 6 Valérie Fraix 7 Andrea Kistner 8 P. Patrick Chaynes Fabienne Ory-Magne 9 Christine Brefel-Courbon 10 Jan Vesper Lars Wojtecki 1 Stéphane Derrey 11, 12, 13, 14 David Maltête 15 Philippe Damier 16 Pascal Derkinderen 17 Friederike Sixel-Döring Claudia Trenkwalder 18 Alireza Gharabaghi 19 Tobias Wächter 20 Daniel Weiss 21 Marcus Pinsker 4 Jean-Marie Regis Tatiana Witjas Stéphane Thobois 22 Patrick Mertens 23 Karina Knudsen Carmen Schade-Brittinger 24 Jean-Luc Houeto 25, 26 Yves Agid 27 Marie Vidailhet 28 Lars Timmermann 1 Günther Deuschl 4
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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