Long-term Parkinson’s disease quality of life after staged DBS: STN vs GPi and first vs second lead

Stephanie Cernera, Robert S. Eisinger, Joshua K. Wong, Kwo Wei David Ho, Janine Lobo Lopes, Kevin To, Samuel Carbunaru, Adolfo Ramirez-Zamora, Leonardo Almeida, Kelly D. Foote, Michael S. Okun, Aysegul Gunduz

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Deep brain stimulation (DBS) for Parkinson’s disease (PD) improves quality of life (QoL), but longitudinal follow-up data are scarce. We sought to quantify long-term benefits of subthalamic nucleus (STN) vs globus pallidus internus (GPi), and unilateral vs staged bilateral PD-DBS on postoperative QoL. This is a retrospective, longitudinal, non-randomized study using the PD QoL questionnaire (PDQ)-39 in patients with STN- or GPi-DBS, and with unilateral (N = 191) or staged bilateral (an additional contralateral lead implant) surgery (N = 127 and 156 for the first and second lead, respectively). Changes in PDQ-39 summary index (PDQ-39SI) and subscores throughout 60 months of follow-up were used as the primary analysis. We applied mixed models that included levodopa and covariates that differed at baseline across groups. For unilateral implantation, we observed an initial improvement in PDQ-39SI of 15.55 ± 3.29% (µ ± SE) across both brain targets at 4 months postoperatively. Unilateral STN patients demonstrated greater improvement in PDQ-39SI than GPi patients at 4 and 18 months postoperatively. Analysis of patients with staged bilateral leads revealed an initial 25.34 ± 2.74% (µ ± SE) improvement in PDQ-39SI at 4 months after the first lead with further improvement until 18 months, with no difference across targets. Scores did not improve after the second lead with gradual worsening starting at 18 months postoperatively. STN-DBS provided greater short-term QoL improvement than GPi-DBS for unilateral surgery. For staged bilateral DBS, overall QoL improvement was explained primarily by the first lead. Decision-making for patients considering DBS should include a discussion surrounding the potential risks and benefits from a second DBS lead.

Original languageEnglish (US)
Article number13
Journalnpj Parkinson's Disease
Volume6
Issue number1
DOIs
StatePublished - Dec 1 2020
Externally publishedYes

Bibliographical note

Funding Information:
Stephanie Cernera, R.S.E., J.K.W., K.W.D.H, J.L.L., K.T., and Samuel Carbunaru have no financial disclosures to report. L.A. has received honoraria as a consultant for Medtronic and Boston Scientific. A.R.-Z. serves as a consultant for the National Parkinson Foundation and has received research consulting honoraria from Medtronic and Bracket. K.D.F. has received research grant support from Medtronic, St. Jude (now Abbott), Boston Scientific, Neuropace, and Functional Neuromodula-tion. He has also received fellowship support from Medtronic. He has not received any personal remuneration from any industrial source in the past 12 months. M.S.O. serves as a consultant for the National Parkinson Foundation and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. M.S.O.’s DBS research is supported by: R01 NR014852. M.S.O. has previously received honoraria, but in the past >60 months has received no support from industry. M.S.O. has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, and Cambridge (movement disorders books). M.S.O. is an associate editor for “New England Journal of Medicine Journal Watch Neurology”. M.S.O. has participated in CME and educational activities on movement disorders (in the past 36 months) months sponsored by PeerView, Prime, QuantiaMD, WebMD, MedNet, Henry Stewart, and by Vanderbilt University. The institution and not M.S.O. receives grants from Medtronic, AbbVie, Allergan, and ANS/St. Jude, and the Principal Investigator (PI) has no financial interest in these grants. M.S.O. has participated as a site PI and/or co-investigator for several NIH, foundation, and industry sponsored trials over the years, but has not received honoraria. M.S.O. and A.G. received device donations from Medtronic.

Funding Information:
This work is supported by the National Institutes of Health Clinical and Translational Science Awards to the University of Florida (TL1 TR001428) to R.S.E. This work is also supported by the National Institute of Neurological Disorders And Stroke of the National Institutes of Health under Award Number F30NS111841 to R.S.E., T32 NS082168 to S.C., and F31NS115363 to S.C. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors are especially appreciative of all patients who have consented to the UF INFORM database and the INFORM staff, especially Chuck E. Jacobson. The authors would like to thank the entire Brain Mapping Laboratory at the University of Florida. We acknowledge the support of the Norman Fixel Institute for Neurological Diseases, the Parkinson’s Foundation Center of Excellence, and Tyler’s Hope for a Dystonia Cure.

Publisher Copyright:
© 2020, The Author(s).

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