Objective: To identify whether postoperative stimulation challenge test alters patients’ impression of change and satisfaction after Deep Brain Stimulation of the Subthalamic Nucleus (STN DBS) for Parkinson’s Disease (PD).

Background: Previous literature demonstrates a discrepancy between objective improvement and patients’ perception thereof, with several patients reporting mixed or negative outcomes in terms of postoperative satisfaction. Due to recall bias, patients may be unaware of the actual DBS benefits as OFF-time or dyskinesias are no longer perceived to the same extent after DBS. A more accurate perception of motor function facilitated by switching the stimulator OFF may alter patients’ impression of DBS effects and improve postoperative satisfaction.

Method: PD patients underwent preoperative levodopa challenge tests prior to STN DBS surgery and were invited for stimulation challenge tests 1-2 years after surgery. Postoperatively, MDS-UPDRS III in Med-OFF / Stim-OFF, Med-OFF / Stim-ON, Med-ON / Stim-ON and Med-ON / Stim-OFF conditions quantified motor severity; SENS-PD scores quantified non-dopaminergic severity. Patients filled out ‘Global Impression of Change’ (GIC) and ‘Global Satisfaction with Surgery’ (GSS) Likert scales four weeks prior to the follow-up examination, and immediately after stimulation challenge tests.

Results: In forty-two patients GIC and GSS scores were significantly higher after ON-OFF testing (GIC: Z=-3.48; GSS: Z=-3.07). Postoperative Med-ON / Stim-ON severity was lower than preoperative Med-ON severity (mean (SD) MDS-UPDRS III  18.8 (9.1) vs. 22.6 (9.5), 95%CI of difference 0.2 – 7.4). There were no significant differences between preoperative and postoperative assessments for OFF (Med-OFF / Stim-OFF) severity or SENS-PD scores. Higher non-dopaminergic disease severity was associated with lower GIC and GSS scores (OR (95%CI) GIC: 1.2 (1.1 – 1.4); GSS: 1.2 (1.0 – 1.4). Severity of motor symptoms or magnitude of motor improvement during stimulation challenge testing  was not significantly correlated with GIC or GSS responses.

Conclusion: Confrontation with OFF severity improves patients’ satisfaction of STN DBS, suggesting  that ON-OFF testing should be recommended after DBS in case of suboptimal subjective responses.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/stimulation-challenge-test-after-stn-dbs-improves-postoperative-satisfaction-in-patients-with-parkinsons-disease/