Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years
Authors: Jost Stefanie T. , Aloui Salima , Evans Julian , Ashkan Keyoumars , Sauerbier Anna , Rizos Alexandra , Petry-Schmelzer Jan Niklas , Gronostay Alexandra , Fink Gereon R. , Visser-Vandewalle Veerle , Antonini Angelo , Silverdale Monty , Timmermann Lars , Martinez-Martin Pablo , Chaudhuri K. Ray , Dafsari Haidar S. ,   International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group and EUROPAR, Martinez-Martin Pablo , Rodriguez-Blazquez  Carmen , Chaudhuri Ray , Rizos Alexandra , Sauerbier Anna , Parry Miriam , Trivedi Dhaval , Martino Davide , Odin Per , Antonini Angelo , Stocchi Fabrizio , van Hilten Jacobus J , van Laar Teus , Falup‐Pecurariu Cristian , Dietrichs Espen , Lyons Kelly E. , Weintraub Dan , Kurtis Monica , Serrano-Dueñas Marcos , Borges Vanderci , Behari Madhuri , Bhattacharya Kalyan , Kumar Hrishikesh , Singhal Bhim , Bhidayasiri Roongroj , Shen-Yang Lim , Gallardo Marisol , Abe Kazuo , Bostantjopoulou Sevasti , Martin Rabey Jose , Micheli Federico , Rodriguez‐Violante Mayela , Riboldazzi Giulio , Catalan Maria Jose , Ellis Cathy , Bean Lorna , Kessel Belinda , Worth Paul , Shearing Gemma , Sophia Rani , Sharma Jagdish , Silverdale Monty , Pal Suvankar , Ashkan Keyoumars , Adler Charles , Barone Paolo , Brooks David J. , Brown Richard , Cantillon Marc , Carroll Camille , Coelho Miguel , Dafsari Haidar S. , Henriksen Tove , Hu Michele , Jenner Peter , Kramberger Milica , Kumar Padma , Kurtis Mónica , Lewis Simon , Litvan Irene , Lyons Kelly , Masellis Mario , Mochizuki Hideki , Morley James F. , Nirenberg Melissa , Pagonabarraga Javier , Panicker Jalesh , Pavese Nicola , Pekkonen Eero , Postuma Ron , Rosales Raymond , Schapira Anthony , Simuni Tanya , Subramanian Indu , Tagliati Michele , Timmermann Lars , Tinazzi Michele , Toledo Jon , Tsuboi Yoshio , Walker Richard 
Published: January 2024

ImportanceDeep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life (QOL) in patients with advanced Parkinson disease (PD). However, controlled studies with more than 3 years of follow-up are lacking.ObjectiveTo investigate the long-term effects of STN-DBS on QOL compared with standard-of-care medication (MED).Design, Setting, and ParticipantsIn this prospective, observational, quasi-experimental, longitudinal nonrandomized controlled trial, 183 patients were screened for eligibility and 167 were enrolled from March 1, 2011, to May 31, 2017, at 3 European university centers. Propensity score matching for demographic and clinical characteristics was applied to 108 patients with PD (62 in the STN-DBS group and 46 in the MED group), resulting in a well-balanced, matched subcohort of 25 patients per group. Data analysis was performed from September 2022 to January 2023.ExposureTreatment for PD of STN-DBS or MED.Main Outcomes and MeasuresAssessments included Parkinson’s Disease Questionnaire 8 (PDQ-8), Unified PD Rating Scale–motor examination, Scales for Outcomes in PD–activities of daily living (ADL) and motor complications, and levodopa-equivalent daily dose. Within-group longitudinal outcome changes, between-group differences, and correlations of change scores were analyzed.ResultsThe study population in the analysis included 108 patients (mean [SD] age, 63.7 [8.3] years; 66 [61.1%] male). At 5-year follow-up, PDQ-8 and ADL worsened only in the MED group (PDQ-8 change, −10.9; 95% CI, −19.0 to −2.7; P = .01; ADL change: −2.0; 95% CI, −3.1 to −0.8; P = .002), whereas both outcomes remained stable in the STN-DBS group (PDQ-8 change, −4.3; 95% CI, −13.2 to 4.7; P = .34; ADL change, −0.8; 95% CI, −2.5 to 1.0; P = .38). Changes in PDQ-8 and ADL correlated moderately (rs = .40, P = .008). Furthermore, STN-DBS outcomes were favorable for motor complications (median difference in change scores between STN-DBS and MED, −2.0; 95% CI, −4.0 to −1.0; P = .003), mobility (−1.0; 95% CI, −2.0 to 0; P = .03), and levodopa-equivalent daily dose reduction (−821.4; 95% CI, −1111.9 to −530.8; P &amp;lt; .001).Conclusions and RelevanceThis study provides evidence of differences in QOL outcomes at 5-year follow-up between STN-DBS (stable) and MED (worsened), mainly driven by the favorable effect of STN-DBS on mobility (class IIb evidence). The association between changes in QOL and ADL, but not motor impairment or complications, highlights the relative importance of ADL outcomes for long-term DBS assessments.Trial RegistrationGerman ClinicalTrials Registry: DRKS00006735