Long-term effects of pallidal or subthalamic deep brain stimulation on quality of life in Parkinson's disease
Jens Volkmann (1), Alberto Albanese (2), Jaime Kulisevsky (3), Aana-Lena Tornqvist (4), Jean-Luc Houeto (5), Bernard Pidoux (5), Anne-Marie Bonnet (5), Alexandre Mendes (6), Alim-Louis Benabid (6), Valerie Fraix (6), Nadege Van Blercom (6), Jing Xie (6), José Obeso (7), María Cruz Rodríguez-Oroz (7), Jorge Guridi (7), Alfons Schnitzler (8), Lars Timmermann (9), Alexandre A. Gironell (3), Juan Molet (3), Benta Pascual-Sedano (3), Stig Rehncrona (4), Elena Moro (10), Anthony C. Lang (10), Andres M. Lozano (11), Anna Rita Bentivoglio (12), Massimo Scerrati (2), María Fiorella Contarino (13), Luigi Romito (2), Marc Janssens (14), Yves Agid (5)
(1) Neurologische Klinik der Christian-Albrechts-Universität, Kiel, Germany
(2) Istituto Nazionale Neurologico C. Besta and Universita' Cattolica, Milan, Italy
(3) Department of Neurology, Hospital de Sant Pau and CIBERNED, Barcelona, Spain
(4) Department of Neurosurgery, University Hospital, Lund, Sweden
(5) Centre d'Investigation Clinique, Groupe Hospitalier Pitie'-Salpetriere, Paris
(6) Department of Neurology or Neurosurgery, University Hospital of Grenoble, Grenoble, France
(7) Deparment of Neurology and Neurosurgery, Neuroscience Division, Clínica Universitaria and Medical School, CIMA, and CIBERNED, Pamplona, Spain
(8) Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
(9) Neurologische Klinik, Universität zu Köln, Köln, Germany
(10) Movement Disorders Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
(11) Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
(12) Department of Neuroscience, Catholic University, Rome, Italy
(13) Department of Neurology, Academisch Medisch Centrum, Amsterdam, The Netherlands
(14) Bakken Research Center, Maastricht, The Netherlands
Magazine: Movement Disorders
Date: Jun 1, 2009Neurosurgery Neurology [SP]
We assessed the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) or internal pallidum (GPi-DBS) on health-related quality of life (HrQoL) in patients with advanced Parkinson's disease participating in a previously reported multicenter trial.
Sickness Impact Profile (SIP) questionnaires were available for analysis in a subgroup of n = 20/20 patients with GPi-DBS and n = 45/49 patients with STN-DBS at baseline, 6 and 36 months. The SIP provides a physical dimension and a psychosocial dimension sum score and 12 category scores: Alertness/Intellectual Behavior (AIB), Ambulation (A), Body Care and Movement (BCM), Communication (C), Eating (E), Emotional Behavior (EB), Home Management (HM), Mobility (M), Recreation and Pastimes (RP), Sleep and Rest (SR), Social Interaction (SI), and Work (W). Motor functioning was assessed by means of the Unified Parkinson's Disease Rating Scale and diaries. At 6 months significant improvements in off-period motor symptoms and activities of daily living were paralleled by significant reductions in the total, physical, and psychosocial SIP score in both treatment groups. At 3 years, sustained improvements were observed in the physical dimension score, BCM, E, M, RP after STN-DBS and M, SI after GPi-DBS. All other SIP subscores approached baseline values, but were still the same or better (except C) whereas motor functioning remained stable after 36 months. STN-DBS and GPi-DBS led to significant early improvements in HrQoL.
Despite sustained motor improvements many of these initial benefits were lost after 3 years. This may reflect either progression of the disease or adaptive changes in the subjective perception of health-related wellbeing over time.
CITATION Mov Disord. 2009 Jun 15;24(8):1154-61
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