Long-term impact on quality of life of subthalamic nucleus stimulation in Parkinson’s disease

Lezcano, Elena; Gómez‐Esteban, Juan Carlos; Tijero, Beatriz; Bilbao, G.; Lambarri, Imanol; Rodríguez, Olivia; Villoria, R.; Dolado, Ainara; Berganzo, Koldo; Molano, Ana; Gopegui, E. Ruiz de; Pomposo, Iñigo; Gabilondo, Iñigo; Zarranz, J.J.

doi:10.1007/s00415-016-8077-4

Cited by 50 publications

(60 citation statements)

References 32 publications

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“…Of note, the high heterogeneity of the 36‐month follow‐up data and the 60‐month follow‐up data, respectively, may question the predictive value when exactly QoL starts to decrease after STN‐DBS. However, a return to PDQ‐39 baseline levels has consistently been observed in all studies investigating QoL 5 years after DBS . The PDQ provides an overview over the subjective well‐being of the patient and could be affected by the satisfaction paradox, which is known as the discrepancy between expectations derived from objective data and the subjective self‐appraisal by the patient.…”

Section: Resultsmentioning

confidence: 93%

The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta‐Analysis

Büttner

Maack

Janitzky

et al. 2019

Movement Disord Clin Pract

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Background Several studies examined the influence of subthalamic nucleus–deep brain stimulation (STN‐DBS) on quality of life (QoL) in patients with Parkinson's disease (PD). However, it is unclear whether this effect differs between age groups and disease durations and whether it stays consistent over time. Objectives We assessed the influence of stimulation duration, disease duration, and age at surgery on QoL after STN‐DBS. Methods We systematically searched for studies reporting the results of the Parkinson's Disease Questionnaire 39 or 8. Studies were included if they investigated the time passed since STN‐DBS or if their study cohort fell into the range of one of the following age groups: younger than 60 years or between 60 and 70 years. For each condition, a standardized mean difference meta‐analysis was performed. Furthermore, all studies were categorized into short or long disease duration at surgery using a median split. Results A total of 23 studies reporting the cumulative outcome of 76 to 802 PD patients were included in this analysis. The results demonstrate a substantial improvement of QoL after DBS that remains stable over 36 months. QoL falls to preoperative scores 60 months after surgery. However, only 3 studies could be included in this analysis. Both younger and older PD patients profit in QoL from STN‐DBS, independent of the disease duration. Conclusions The results of this analysis show an impressive improvement in QoL after STN‐DBS, with a loss of QoL 60 months after DBS surgery. This highlights the need to explore the factors influencing QoL after STN‐DBS to prevent or delay a decline in QoL.

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Section: Resultsmentioning

confidence: 93%

The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta‐Analysis

Büttner

Maack

Janitzky

et al. 2019

Movement Disord Clin Pract

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“…Studies were subdivided by follow-up to account for differences in the time course of QoL following DBS: short-term follow-up (6 months), intermediate followup (6 months to 5 years) and long-term follow-up (>5 years). Most studies reported an improvement in QoL, although only on a subscale level in some studies [13][14][15][16][17][18][19][20][21]. One study reported no change in QoL [22].…”

Section: Resultsmentioning

confidence: 99%

“…Baseline QoL scores were positively correlated with PDQ39 improvement in three studies (1-to 5-year follow-up) [16,24,25], whereas one study with 1-year follow-up found that patients with worse baseline QoL had a higher odds of becoming a 'responder' in terms of PDQ39 improvement after STN DBS [21]. At 6 years' follow-up, baseline QoL was not significantly associated with postoperative PDQ39 SI change [18].…”

Section: Psychosocial Variablesmentioning

confidence: 93%

What predicts quality of life after subthalamic deep brain stimulation in Parkinson’s disease? A systematic review

Geraedts

Feleus

Marinus

et al. 2020

Euro J of Neurology

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Background and purpose Subthalamic deep brain stimulation (STN DBS) is an effective therapy against medication‐refractory motor complications in patients with Parkinson’s disease. However, it remains difficult to predict which baseline patient characteristics are associated with quality of life (QoL) after surgery. The objective was to identify preoperative factors associated with QoL after STN DBS by systematically reviewing publications of sufficient methodological quality. Methods Main databases were systematically searched up to March 2019 to identify studies that investigated factors associated with QoL after STN DBS in patients with idiopathic Parkinson’s disease. Results In all, 869 studies were identified, of which 18 fulfilled the inclusion criteria. Higher QoL after DBS appears to be associated with a large preoperative difference between ON and OFF motor function in some studies, although there was no clear association of severity of motor function or motor complications with postoperative QoL. Lower severity of dyskinesias was associated with greater postoperative QoL improvement but has been insufficiently studied. Higher baseline QoL was suggestive of higher postoperative QoL. Four studies suggested that older age at surgery is associated with a lower improvement, although six other studies reported no association. No or limited evidence was found for cognitive impairment or psychiatric dysfunction. Conclusion Various relative contraindications for STN DBS such as cognitive impairment and psychiatric dysfunction appear to be unrelated to postoperative QoL. However, the lack of clear correlations with disease‐related variables suggests that QoL may be individually influenced by other factors, indicating that an ideal preoperative patient profile with regard to QoL improvement cannot be readily provided.

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“…Use of the UPDRS part IV has demonstrated that STN DBS significantly improves dyskinesia 14-16, 18, 19,21-23, 26 and motor fluctuations, and that these improvements mostly persist beyond 5 years 15,16,18,19,[21][22][23] . In one study, use of diary data also revealed improvements in motor fluctuations and dyskinesia up to 5 years after STN DBS 28 .…”

Section: [H3] Motor Functionmentioning

confidence: 94%

“…We identified 15 studies of STN DBS in which outcome measures included UPDRS part III scores that were recorded pre-operatively and after 5 years (to enable analysis of the motor effects of DBS) when patients were in off periods but receiving DBS [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . We identified only two similar studies of GPi DBS (reported in three articles), which we therefore consider separately [29][30][31] .…”

Section: [H1] Reported Long-term Outcomesmentioning

confidence: 99%

Long-term outcomes of deep brain stimulation in Parkinson disease

2019

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| The efficacy of deep brain stimulation (DBS) for Parkinson disease (PD) is well established for up to 1 or 2 years, but long-term outcome data are still limited. In this Review, we critically discuss the evidence on the long-term outcomes of DBS and consider the clinical implications. Although many patients are lost to follow-up, the evidence indicates that subthalamic nucleus DBS improves motor function for up to 10 years, although the magnitude of improvement tends to decline over time. Functional scores recorded during onmedication periods worsen faster than those recorded in off periods, consistent with the degeneration of non-dopaminergic pathways. Dyskinesia, motor fluctuations and activities of daily living in off periods remain improved at 5 years, but quality of life scores have usually fallen below pre-operative levels.The incidence and severity of dementia among patients receiving DBS are comparable to those among patients who receive medical treatment. Severe adverse events are rare, but adverse events such as dysarthria are common and probably under-reported. Long-term data on the outcomes of globus pallidus interna DBS are limited and mostly confirm the efficacy for dyskinesia. A trend towards offering DBS in the earlier stages of PD creates a need to identify factors that predict long-term outcomes and to discuss realistic expectations with patients pre-operatively.

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Long-term impact on quality of life of subthalamic nucleus stimulation in Parkinson’s disease

Cited by 50 publications

References 32 publications

The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta‐Analysis

The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta‐Analysis

What predicts quality of life after subthalamic deep brain stimulation in Parkinson’s disease? A systematic review

Long-term outcomes of deep brain stimulation in Parkinson disease

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