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Quality of Life after Deep Brain Stimulation in Parkinson's Disease: Does the Target Matter?
Murcia Carretero, Sandra; Petermann, Katrin; Debove, Ines; Amstutz, Deborah; Sousa, Mário; Waskönig, Julia; Diamantaras, Andreas Antonios; Tinkhauser, Gerd; Nowacki, Andreas; Pollo, Claudio; Schuepbach, Michael; Krack, Paul; Lachenmayer, Martin Lenard.
Afiliación
  • Murcia Carretero S; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Petermann K; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Debove I; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Amstutz D; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Sousa M; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
  • Waskönig J; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Diamantaras AA; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
  • Tinkhauser G; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Nowacki A; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Pollo C; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Schuepbach M; Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Krack P; Department of Neurosurgery, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Lachenmayer ML; Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
Mov Disord Clin Pract ; 2024 Sep 03.
Article en En | MEDLINE | ID: mdl-39225548
ABSTRACT

BACKGROUND:

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an accepted therapy for Parkinson's disease (PD) with disabling motor complications. For elderly patients with poorer cognition and postural instability, GPi has been proposed as the preferable DBS target based on expert opinion, arguing GPi-DBS may be less complicated by depression, apathy, worsened verbal fluency, and executive dysfunction, resulting in greater improvement in quality of life (QoL). However, data supporting such patient-tailored approach are lacking.

OBJECTIVES:

The aims were to analyze whether the DBS target influences QoL in a PD cohort and a matched subgroup of frail patients with poor cognitive status and reduced postural stability, and whether other factors affect the QoL outcomes.

METHODS:

In this retrospective study, we analyzed a single-center cohort of 138 PD patients who received bilateral STN-DBS (117) or GPi-DBS (21) using the mentioned approach for target selection. All patients underwent standardized clinical evaluations of motor- and nonmotor signs as well as QoL before and 1 year after surgery.

RESULTS:

DBS of both targets improved motor signs, dyskinesias, and pain. QoL improved without significant difference between the targets, but with a trend for greater improvement across all QoL domains in favor of the STN, even in an STN subgroup matched to the GPi group.

CONCLUSION:

Our results contradict the prevailing belief that GPi-DBS is superior in frail PD patients with cognitive decline and postural instability, questioning the proposed patient-tailored approach of DBS target selection. Further studies are needed for a data-driven approach.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Mov Disord Clin Pract Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Mov Disord Clin Pract Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos