Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease

Abstract

BackgroundThe effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson’s disease (PD) are understudied.ObjectiveTo investigate clinical predictors of STN-DBS effects on ICB.MethodsIn this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into ‘QUIP-RS improvement or worsening’ and analysed between-group differences.ResultsWe included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the ‘QUIP-RS worsening’ group had more severe baseline impairment in the NMSS attention/memory domain.ConclusionsOur results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS.Trial registration numberDRKS00006735.

Course of Impulse Control Disorder Symptoms in Parkinson's Disease: Deep Brain Stimulation Versus Medications

“…Indeed, in multivariate analyses, aside from baseline QUIP‐RS score, time‐varying LEDD was the only significant predictor of change in QUIP‐RS score over time, regardless of surgical group status. Our results are similar to another recent study without a control group which examined the short‐term effects of bilateral STN DBS in PD 31 . In that study, an overall significant change in QUIP‐RS was not observed, however baseline QUIP‐RS score and LEDD were the strongest predictors of change in post‐operative ICD symptoms 31 .…”

“…Our results are similar to another recent study without a control group which examined the short‐term effects of bilateral STN DBS in PD 31 . In that study, an overall significant change in QUIP‐RS was not observed, however baseline QUIP‐RS score and LEDD were the strongest predictors of change in post‐operative ICD symptoms 31 . In contrast to our study, it was LED‐DA rather than total LEDD that predicted the QUIP‐RS scores.…”

Microstructure predicts non-motor outcomes following Deep Brain Stimulation in Parkinson’s disease

“…Importantly, however, postoperative improvements in non-motor symptom burden were not related to improvements in LEDD, LEDD-DA, and SCOPA-motor examination scores, which is in accordance with the literature. 28,29 Therefore, the association between intact CST microstructure and beneficial postoperative non-motor outcomes seems to be independent of the motor effects of DBS and suggests that CST microstructure is inherently relevant for non-motor symptoms in PD.…”

Validation of the Japanese Version of the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease-Rating Scale (QUIP-RS)

“…While QUIP is used as a diagnostic screening tool for ICBs, the QUIP-RS is used as a rating scale for the severity of a range of ICBs. The utility of QUIP-RS in clinical and research practice has been reported in various studies [ 8 , 9 ]. Although QUIP has been translated into Japanese [ 10 ], a Japanese version of QUIP-RS has not yet been validated.…”