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

Abstract

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.

Effect of deep brain stimulation on caregivers of patients with Parkinson's disease: A systematic review

“…N ≥ 3 and 7. article in English. The quality threshold for inclusion was based on an in-house checklist for quality assessment (range 0-22, higher scores reflect lower quality, see appendix B); low-quality studies (score < 11) were excluded [22,23]. Data extraction was performed using piloted forms (see appendix C).…”

What contributes to quality of life in Parkinson’s disease: a re-evaluation

“…Clearly, the presence of other clinical features of PD, particularly when severe, can also be associated with reduced HR-QoL, as examined in studies in different populations (eg, tertiary care, younger age groups or later disease stage), or examining specific aspects such as fatigue, apathy or pain in more detail 10 11. Their improvement, for example, of dyskinesia, can lead to an improvement of HR-QoL 12. However, depression, when measured, has uniformly been shown to be the most robust predictor of HR-QOL scores in virtually all studies when included in the assessment.…”

Surgical Management of Parkinson's Disease in the Elderly

“…Improvement of QoL should be the goal of any given therapy for PD, and despite the well documented improvement of QoL after DBS, there is a debate regarding the magnitude of effect and domains affected by DBS in elderly PD patients. 18 Beyond age, other factors such as L-dopa response, severity of disease and QoL at baseline, as well as severity of motor fluctuations and dyskinesia may play a role, and to date there is no single biomarkers to predict DBS outcomes. 75 Ultimately, finding an ageindependent biomarker predicting DBS outcome is the final goal to expand this powerful treatment to all patients age in an effective and safe manner.…”

“…A retrospective study evaluated the response to STN DBS up to 4 years in a group of 30 patients with an average age of 77.5 years (range 75.0-84.5) and mean disease duration of 11.8 years. 18 Authors reported that there was an improvement of motor scores and motor complications, but no improvement in QoL and axial subscores. 75 Considering a different age cut-off of 65 years, another small study with 20 subjects in each age group also found that improvement in QoL (measured with the PDQ-39) was not significantly different between age groups 1 and 2 years after STN DBS.…”

“…17 A recent systematic review focused on QoL found that in four studies higher age was associated with lower improvement in QoL domains in the short-term follow-up, whereas in other six studies there was no correlation between age and postoperative QoL. 18 TABLE 1 The selection of advanced treatments for PD patients involves four steps Since the success rate of DBS depends on a precise indication, 19 and that age is one vital element to be considered, this topic reunites most of the specialist's concerns when selecting patients for DBS therapy. Our aim was to review the literature covering the issues of age and DBS.…”