Deep Brain Stimulation Impact on Social and Occupational Functioning in Parkinson's Disease with Early Motor Complications

Abstract

Background Deep brain stimulation (DBS) improves motor symptoms and quality of life in patients with Parkinson's disease (PD) and early motor complications, suggesting that DBS could be prescribed to the working‐age PD population. Objectives To investigate the effect of DBS compared with best medical therapy (BMT) on social, psychosocial, and occupational functioning in patients with PD ≤60 years of age with early motor complications, its correlates, and possible underlying rationale. Methods Methods included analyses of the Social and Occupational Functioning Assessment Scale, Scales for Outcomes for Parkinson's–Psychosocial, Professional Fitness, Starkstein Apathy Scale, and Schwab and England Activities of Daily Living Scale from the EARLYSTIM study. Results Compared with BMT, DBS resulted in significantly greater improvements from baseline through 24 months in social,occupational, and psychosocial functioning. Yet, work status in the 2 groups did not differ at baseline and 24 months. Physicians reported a significantly higher percentage of patients in the BMT group unable to work at 24 months relative to baseline compared with the DBS group. Apathy was significantly worse in patients for whom physicians overrated ability to work when compared with patients’ own ratings than in the group of patients who physicians' ability to work ratings were comparable to, or worse than, patients' self‐ratings of ability to work. Conclusions For patients aged ≤60 years with PD and early motor complications, DBS provided significant improvements in social, occupational, and psychosocial function, but not in the actual work engagement compared with BMT at 2 years. Apathy may impact ability to work.

Time to workforce exit after a Parkinson’s disease diagnosis

“…The finding that persons with PD receiving DAT during follow-up had significantly shorter workforce survival than those that did not (Fig. 6 ) contrasts previous studies indicating that DAT might help sustain working ability 14 , 15 and performance of daily activities 13 in PD. However, DATs are typically initiated during mid-to-advanced stages of PD, at which point a significant portion of working-age persons with PD have already left the workforce 1 .…”

“…Evidence of beneficial effects on workforce participation is an important justification of potential new therapeutic options for PD, such as stem cell therapy 12 . Exploratory studies on the current generation of device-aided treatment (deep brain stimulation, levodopa-carbidopa intestinal gel, or subcutaneous apomorphine infusion; DAT) indicate that there are positive effects on the working ability of persons with PD and motor complications 13 – 15 .…”

Advances in DBS Technology and Novel Applications: Focus on Movement Disorders

“…Moreover, noticeable improvements are reported in freezing of gait at 2-year follow-up [13]. Furthermore, the early surgical group demonstrated better social, occupational, and psychosocial function [14].…”

Investigation of Magnetoelectric Sensor Requirements for Deep Brain Stimulation Electrode Localization and Rotational Orientation Detection

“…Thus, programming of the implanted pulse generator (IPG) or neurostimulator is a time-consuming, iterative, and trial-and-error based process [ 4 , 5 , 6 , 7 ]. DBS continues to be the subject of intensive fundamental and clinical research [ 8 , 9 ]. The number of diseases for which DBS is emerging as a potentially effective therapeutic measure is steadily growing.…”