Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson's disease.
BACKGROUND
Subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects.


OBJECTIVE
To compare nonmotor effects of STN-DBS and GPi-DBS.


METHODS
In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.


RESULTS
In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.


CONCLUSIONS
To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.
['Dafsari|Haidar S|HS|', 'Dos Santos Ghilardi|Maria Gabriela|MG|', 'Visser-Vandewalle|Veerle|V|', 'Rizos|Alexandra|A|', 'Ashkan|Keyoumars|K|', 'Silverdale|Monty|M|', 'Evans|Julian|J|', 'Martinez|Raquel C R|RCR|', 'Cury|Rubens G|RG|', 'Jost|Stefanie T|ST|', 'Barbe|Michael T|MT|', 'Fink|Gereon R|GR|', 'Antonini|Angelo|A|', 'Ray-Chaudhuri|K|K|', 'Martinez-Martin|Pablo|P|', 'Fonoff|Erich Talamoni|ET|', 'Timmermann|Lars|L|', '|||']
D000203:Activities of Daily Living D000368:Aged D046690:Deep Brain Stimulation D005221:Fatigue D005260:Female D005500:Follow-Up Studies D005917:Globus Pallidus D006801:Humans D007980:Levodopa D008297:Male D008875:Middle Aged D010300:Parkinson Disease D011446:Prospective Studies D011788:Quality of Life D012890:Sleep D020531:Subthalamic Nucleus D016896:Treatment Outcome
Deep brain stimulation Quality of life Nonmotor symptoms Globus Pallidus internus Non-motor symptoms Subthalamic nucleus