Deep brain stimulation outcomes in the malignant end of Parkinson's disease spectrum. (May 2021)

• Record Type: Journal Article
• Authors: Artusi, Carlo Alberto; Romagnolo, Alberto; Imbalzano, Gabriele; Montanaro, Elisa; Zibetti, Maurizio; Rizzone, Mario Giorgio; Lopiano, Leonardo
• Is Part Of: Parkinsonism & related disorders. Volume 86(2021)
• Page Start: 5
• Page End: 9
• Publication Date: 2021-05
• Subjects: Deep brain stimulation -- Parkinson's disease -- Phenotype -- Malignant -- Benign; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2021.03.017
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: Heterogeneity of Parkinson's Disease (PD) phenotype may influence deep brain stimulation (DBS) outcome. However, DBS response in the malignant end of the PD spectrum has been poorly investigated. Objective: To evaluate and compare DBS outcomes in malignant and benign PD patients, defined according to motor and non-motor symptom presentation at the presurgical selection. Methods: We categorized a cohort of 154 parkinsonian patients fulfilling criteria for subthalamic nucleus (STN)-DBS into malignant, benign, and intermediate subtypes, according to a recently validated clinical PD classification. DBS efficacy on daily living independence (Schwab and England –S&E-score ≥70%), motor symptoms, and motor fluctuations (Unified Parkinson's Disease Rating Scale -UPDRS- part-III and -IV, and Ambulatory Capacity Measure) were compared between malignant and benign patients, using corrected binary logistic regressions and repeated measure general linear model. Results: One year after surgery, the probability of losing daily life independence was 16-fold higher in malignant patients, even after adjusting for age at PD onset, PD duration, and percentage of motor improvement after STN-DBS (OR: 16.233; p: 0.035). Conversely, malignant and benign patients showed a similar extent of improvement after STN-DBS (p > 0.05) in motor symptoms, motor fluctuations, and ambulatory capacity, both in medication-ON and medication-OFF conditions. Conclusion: DBS candidates in the malignant end of the PD spectrum may profit from a similar improvement of motor symptoms and fluctuations after STN-DBS when compared to benign PD. However, patients of the malignant group have a lower probability of maintaining independence in daily life early after surgery. Highlights: Distinct Parkinson's disease phenotypes may have a differential response to STN-DBS. Malignant patients had a similar improvement in motor symptoms and fluctuations. Malignant patients had 16-fold higher probability of losing independence after 1 year.