Session Information
Date: Wednesday, September 25, 2019
Session Title: Surgical Therapy
Session Time: 1:15pm-2:45pm
Location: Les Muses Terrace, Level 3
Objective: The objective of this study was to assess long-term effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on sleep in patients with Parkinson’s disease (PD).
Background: Although STN DBS has been reported to have a positive effect on sleep-wake disturbances in PD, improvement in sleep is inconsistent especially for excessive daytime sleepiness, and little known about long-term effects of STN DBS.
Method: Sixty-one patients with PD who had received a bilateral STN DBS and were followed for 3 years. The following were included: the Parkinson’s disease sleep scale (PDSS) and Epworth sleepiness scale (ESS), Unified PD Rating Scale part I-III and Hoehn & Yahr stage in the on and off anti-parkinsonian medication condition, total daily levodopa equivalent dose, quality of life measures, and depression scale measured preoperatively and at 6 months after surgery and annually thereafter.
Results: Patients who had undergone bilateral STN DBS and a follow-up evaluation at baseline (61 patients) and at 6, 12, 24 and 36 months (46 patients) were included in this study. Total PDSS score significantly improved after STN DBS from baseline up to year 3, and the largest improvement was observed at 6 months (79.0±30, 100.0±23.3, 98.8±23.0, 97.1±29.6, and 93.3±28.0 at baseline, 6, 12, 24, and 36 months, respectively, p < 0.0001 for the change over time). Among the eight PDSS items, items for sleep onset and maintenance insomnia, nocturnal restlessness, nocturnal psychosis, nocturnal motor symptoms, and daytime dozing showed significant improvement after STN DBS. Total ESS score and total sleep hours per day did not show significant changes after STN DBS (p = 0.4264 for the change over time). Changes in total PDSS were associated with changes in the depression and motivation items in the Unified PD Rating Scale part I, depression scale, and quality of life measures, but those variables at baseline were not predictive of changes in total PDSS after STN DBS.
Conclusion: In our longitudinal follow-up study of 3 years, bilateral STN DBS in PD significantly improved sleep parameters especially for sleep onset and maintenance, nocturnal motor symptoms, and nocturnal psychosis. However, STN DBS did not significantly reduce excessive daytime sleepiness despite significant reductions in antiparkinsonian medications.
References: 1. Simuni T, Sethi K. Nonmotor manifestations of Parkinson’s disease. Annals of neurology. 2008;64 Suppl 2:S65-80. 2. Khoo TK, Yarnall AJ, Duncan GW, et al. The spectrum of nonmotor symptoms in early Parkinson disease. Neurology. 2013;80(3):276-281. 3. Suzuki K, Miyamoto M, Miyamoto T, Iwanami M, Hirata K. Sleep disturbances associated with Parkinson’s disease. Parkinson’s disease. 2011;2011:219056. 4. Deuschl G, Schade-Brittinger C, Krack P, et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. The New England journal of medicine. 2006;355(9):896-908. 5. Liu KD, Shan DE, Kuo TB, Yang CC. The effects of bilateral stimulation of the subthalamic nucleus on heart rate variability in patients with Parkinson’s disease. Journal of neurology. 2013;260(7):1714-1723. 6. Iranzo A, Valldeoriola F, Santamaria J, Tolosa E, Rumia J. Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. Journal of neurology, neurosurgery, and psychiatry. 2002;72(5):661-664. 7. Monaca C, Ozsancak C, Jacquesson JM, et al. Effects of bilateral subthalamic stimulation on sleep in Parkinson’s disease. Journal of neurology. 2004;251(2):214-218. 8. Amara AW, Standaert DG, Guthrie S, Cutter G, Watts RL, Walker HC. Unilateral subthalamic nucleus deep brain stimulation improves sleep quality in Parkinson’s disease. Parkinsonism & related disorders. 2012;18(1):63-68. 9. Odekerken VJ, van Laar T, Staal MJ, et al. Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson’s disease (NSTAPS study): a randomised controlled trial. The Lancet. Neurology. 2013;12(1):37-44. 10. Jiang LL, Liu JL, Fu XL, et al. Long-term Efficacy of Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease: A 5-year Follow-up Study in China. Chinese medical journal. 2015;128(18):2433-2438. 11. Hjort N, Ostergaard K, Dupont E. Improvement of sleep quality in patients with advanced Parkinson’s disease treated with deep brain stimulation of the subthalamic nucleus. Movement disorders : official journal of the Movement Disorder Society. 2004;19(2):196-199. 12. Merlino G, Lettieri C, Mondani M, et al. Microsubthalamotomy improves sleep in patients affected by advanced Parkinson’s disease. Sleep medicine. 2014;15(6):637-641. 13. Chahine LM, Ahmed A, Sun Z. Effects of STN DBS for Parkinson’s disease on restless legs syndrome and other sleep-related measures. Parkinsonism & related disorders. 2011;17(3):208-211. 14. Nishida N, Murakami T, Kadoh K, et al. Subthalamic nucleus deep brain stimulation restores normal rapid eye movement sleep in Parkinson’s disease. Movement disorders : official journal of the Movement Disorder Society. 2011;26(13):2418-2422. 15. Peppe A, Pierantozzi M, Baiamonte V, et al. Deep brain stimulation of pedunculopontine tegmental nucleus: role in sleep modulation in advanced Parkinson disease patients: one-year follow-up. Sleep. 2012;35(12):1637-1642. 16. Breen DP, Low HL, Misbahuddin A. The Impact of Deep Brain Stimulation on Sleep and Olfactory Function in Parkinson’s Disease. The open neurology journal. 2015;9:70-72. 17. Lyons KE, Pahwa R. Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease. Journal of neurosurgery. 2006;104(4):502-505. 18. Chou KL, Persad CC, Patil PG. Change in fatigue after bilateral subthalamic nucleus deep brain stimulation for Parkinson’s disease. Parkinsonism & related disorders. 2012;18(5):510-513. 19. Lilleeng B, Gjerstad M, Baardsen R, Dalen I, Larsen JP. The long-term development of non-motor problems after STN-DBS. Acta neurologica Scandinavica. 2015;132(4):251-258. 20. Eugster L, Bargiotas P, Bassetti CL, Michael Schuepbach WM. Deep brain stimulation and sleep-wake functions in Parkinson’s disease: A systematic review. Parkinsonism & related disorders. 2016;32:12-19.
To cite this abstract in AMA style:
J. Choi, H. Kim, D. Yoo, J. Im, S. Paek, B. Jeon. Long-term effects of bilateral subthalamic nucleus stimulation on sleep in patients with Parkinson’s disease [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/long-term-effects-of-bilateral-subthalamic-nucleus-stimulation-on-sleep-in-patients-with-parkinsons-disease/. Accessed September 7, 2024.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-effects-of-bilateral-subthalamic-nucleus-stimulation-on-sleep-in-patients-with-parkinsons-disease/