Patients with symmetric Parkinson's disease do poorly with subthalamic stimulation.
Patients with symmetric Parkinson's disease do poorly with subthalamic stimulation.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
DE · Author affiliation · country only
Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany stefanie.jost@uk-koeln.de haidar.dafsari@uk-koeln.de.Location evidence
Gießen, DE · Author affiliation
Department of Neurology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany.Location evidence
London, GB · Author affiliation
Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.Location evidence
Bonn, DE · Author affiliation
Department of Parkinson, Sleep and Movement Disorders, University Hospital Bonn, Bonn, Germany.Location evidence
Padua, IT · Author affiliation
Department of General Psychology, University of Padua, Padua, Italy.Location evidence
Salford, GB · Author affiliation
Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK.Location evidence
Manchester, GB · Author affiliation
Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK.Location evidence
Jülich, DE · Author affiliation
Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.Location evidence
Toronto, CA · Author affiliation
Krembil Research Institute, Toronto, Ontario, Canada.Location evidence
Madrid, ES · Author affiliation
Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain.Location evidence
DK · Author affiliation · country only
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.Location evidence
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Original abstract
BackgroundMotor asymmetry is a hallmark of Parkinson's disease (PD), but ~20% of patients present with symmetric motor signs, which are associated with faster disease progression and poorer dopaminergic response. The impact of motor symmetry on activities of daily living (ADL) outcomes following subthalamic deep brain stimulation (STN-DBS) remains unclear. We hypothesised that patients with symmetric PD experience less ADL improvement post-STN-DBS than asymmetric PD patients.MethodsThis was a prospective, quasi-experimental, non-randomised, controlled, international multicentre study with a 6-month follow-up. The primary outcome was the Scales for Outcomes in Parkinson's Disease-Motor ADL scale. Secondary outcomes included Unified Parkinson's Disease Rating Scale motor examination and Parkinson's Disease Questionnaire-8 (PDQ-8). We defined symmetric PD as a right-to-left hemibody motor score equalling 1. We analysed within-group longitudinal changes, between-group outcome differences, effect size and correlations between PDQ-8 and motor changes. We confirmed results in a propensity-score matched subcohort with well-balanced demographic and clinical parameters.ResultsWe included 200 patients with asymmetric and 54 with symmetric PD. In symmetric PD, ADL remained stable, which was not associated with the observed PDQ-8 improvement. In contrast, in asymmetric PD, ADL improved with a moderate effect size, which correlated moderately with PDQ-8 improvement. In symmetric PD, the absolute risk of experiencing no clinically relevant postoperative ADL improvement was 23.8% higher.ConclusionsThis study provides class IIb evidence of worse ADL outcome of STN-DBS in patients with symmetric compared with asymmetric PD. Clinicians should counsel patients with symmetric PD on their elevated risk of ADL non-response when discussing STN-DBS as a treatment option.