Department of Neurology, University Hospital Cologne, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.
Department of Neurology, University Hospital Cologne, Cologne, Germany.
Brain Stimul. 2018 Jul-Aug;11(4):867-874. doi: 10.1016/j.brs.2018.02.015. Epub 2018 Feb 24.
Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome.
We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome.
In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and -activities of daily living, levodopa equivalent daily dose. We dichotomized patients into "QoL responders"/"non-responders" and screened for factors associated with QoL improvement with (1) Spearman-correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions using aforementioned "responders/non-responders" as dependent variable.
All outcomes improved significantly on follow-up. However, approximately 44% of patients were categorized as "QoL non-responders". Spearman-correlations, linear and logistic regression analyses were significant for NMSS and NMSQ but not for SCOPA-motor examination. Post-hoc, we identified specific NMS (flat moods, difficulties experiencing pleasure, pain, bladder voiding) as significant contributors to QoL outcome.
Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies investigating motor and non-motor PD clusters may enable stratifying QoL outcomes and help predict patients' individual prospects of benefiting from DBS.
丘脑底核（STN）深部脑刺激（DBS）可改善晚期帕金森病（PD）患者的生活质量（QoL）、运动和非运动症状（NMS）。然而，对于 QoL 结果，已经观察到相当大的个体间变异性。
我们假设人口统计学和术前 NMS 特征可以预测术后 QoL 结果。
在这项正在进行的前瞻性多中心研究（科隆、曼彻斯特、伦敦）中，我们共纳入 88 名患者，收集了以下术前和术后 6 个月随访时的量表：帕金森病问卷-8（PDQ-8）、NMS 量表（NMSS）、非运动症状问卷（NMSQ）、帕金森病结局量表（SCOPA）-运动检查、-并发症和-日常生活活动，左旋多巴等效日剂量。我们将患者分为“QoL 反应者”/“非反应者”，并筛选与 QoL 改善相关的因素，包括：（1）基线测试分数与 QoL 改善之间的 Spearman 相关性，（2）以基线测试分数为自变量、QoL 改善为因变量的逐步线性回归，（3）使用上述“反应者/非反应者”作为因变量的逻辑回归。
所有结局在随访时均显著改善。然而，约 44%的患者被归类为“QoL 非反应者”。Spearman 相关性、线性和逻辑回归分析对 NMSS 和 NMSQ 有意义，但对 SCOPA-运动检查无意义。事后分析发现，特定的 NMS（情绪低落、体验愉悦困难、疼痛、膀胱排空）是 QoL 结果的重要贡献者。
我们的研究结果表明，STN-DBS 后 QoL 的改善取决于术前 NMS 特征。这些发现对于 DBS 治疗的建议和患者选择具有重要意义。未来研究调查运动和非运动 PD 集群可能会使 QoL 结果分层，并有助于预测患者从 DBS 中获益的个体前景。
