Bilateral Subthalamic Stimulation can Improve Sleep Quality in Parkinson’s Disease

Abstract

Abstract.Background: Sleep problems are among the most common non-motor symptoms of Parkinson's disease (PD). The PD Sleep Scale 2nd version (PDSS-2) improved the original PDSS by adding more items on different aspects of sleep problems, making it a more robust tool to evaluate the severity of sleep disturbances. However, previous studies on deep brain stimulation (DBS) have not used the PDSS-2. Objective: To determine if the PDSS-2 could detect improvement reliably in sleep problems after bilateral subthalamic nucleus DBS for PD. Methods: In this prospective study, 25 consecutive patients undergoing DBS implantation were enrolled. Patients were examined twice: 1 week prior to the DBS implantation (baseline) and 12 months postoperatively. Severity of PD symptoms were assessed by the Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Presence and severity of sleep disturbances were specifically measured by PDSS-2. Results: Total score of MDS-UPDRS improved from 81 (median, interquartile-range: 63-103) to 55 points (median, IQR: 46-75, p < 0.001). Health-related quality of life, measured by PDQ-39, also improved from 29 (IQR: 18-40) to 15 (IQR: 9-28) points (p = 0.002). Most domains of NMSS also improved. At baseline 13 patients reported sleep problems, but 1 year after DBS implantation only 3 did (p = 0.012). Although only 6 out of 15 items showed a significant decrease after DBS implantation, the total score of PDSS-2 decreased from 24 (IQR: 17-32) to 10 (IQR: 7-18) points (P < 0.001). Conclusions: Based on our results, PDSS-2 can detect improvements in sleep quality reliably after DBS implantation.

Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review

“…Deli and colleagues measured PDSS-2 scores in 13 participants with PD related sleep complaints before and after STN DBS and found significant improvement in quality of sleep at 1 year ( p < 0.001) (44). Hjort and colleagues assessed subjective sleep quality with PDSS questionnaire in 10 patients with bilateral STN DBS and compared results to controls who did not have DBS.…”

Independent validation of Parkinson’s disease Sleep Scale 2nd version (PDSS-2)

“…First, PDSS-2 was utilized in a doubleblind, placebo-controlled trial assessing the efficacy of rotigotine on nocturnal disabilities 7 . Recently the responsiveness of PDSS-2 was also demonstrated after various therapeutic interventions including levodopa/carbidopa intestinal gel 8 infusion and bilateral subthalamic deep brain stimulation 9 .…”

How Efficient Is Subthalamic Deep Brain Stimulation in Reducing Dyskinesia in Parkinson's Disease?

“…Although in 12 patients, Chou and coworkers demonstrated statistically nonsignificant improvement in parts 1 and 2 (1.3 and 3.6 points, respectively) [29], in another study, this group revealed 3.1- and 5.3-point improvement ( p < 0.05, n = 27 patients) [28]. Aiming to evaluate sleep-quality, Deli et al [30 ]showed 4.2- and 7.4-point improvement 1 year after DBS implantation ( p < 0.01, n = 25). Jafari et al [31 ]reported 4.26 points ( n = 30, p < 0.001) on part 1 and 8.5 points on part 2 ( p < 0.001).…”

“…Previously, only a few studies used the MDS-UPDRS to reveal the changes associated with STN DBS. We identified 5 studies using the keywords “MDS-UPDRS” and “DBS” or “deep brain stimulation” on July 30, 2016 [28,29,30,31,32]. Although in 12 patients, Chou and coworkers demonstrated statistically nonsignificant improvement in parts 1 and 2 (1.3 and 3.6 points, respectively) [29], in another study, this group revealed 3.1- and 5.3-point improvement ( p < 0.05, n = 27 patients) [28].…”