Objective: To evaluate and compare patients’ and caregivers’ satisfaction with subthalamic nucleus (STN)-DBS and to identify preoperative indicators, which can prove valuable in defining postoperative satisfaction. To compare the level of improvement perceived by patients in comparison to the physicians after STN-DBS.

Background: Deep brain stimulation (DBS) is a powerful treatment for advanced Parkinson disease (PD). Studies have demonstrated DBS effectiveness to alleviate motor complications and to improve health related quality of life (HRQoL).

Method: The effects of DBS were evaluated in a large well-characterized cohort of PD patients. Demographic features, motor and non-motor scores and patients’ and caregivers’ satisfaction on various disease domains were assessed pre- and postoperatively.

Results: 145 PD patients (72% male, mean age 67±9 years (±SD), 5.4±4.2 years after DBS) were investigated. Two-thirds of the patients were satisfied with the DBS effect on motor symptoms and HRQol, 90% were satisfied with the technical aspects and 77% were satisfied due to the absence of adverse effects. While 73% of patients reported that the DBS covered their expectations, only 56% were satisfied with the effect of DBS on non-motor symptoms (NMS). There was no significant difference between patients` and caregivers` satisfaction. We identified novel preoperative predictors in terms of satisfaction. Specifically, higher education, presence of hallucinations and falls, higher Levodopa equivalent daily dose, higher disability in activities of daily living and more severe motor symptoms predicted lower postoperative satisfaction. On the other hand, longer cumulative OFF time and dyskinesia duration and higher general motor severity preoperatively were positive predictors of satisfaction with DBS.

Conclusion: Our results contribute to the discussion about DBS selection criteria and timing. Based on our data, the negative predictors for patient satisfaction are indicators of advanced disease, i.e. patients that could have benefited more from earlier surgery. DBS effectively ameliorated motor symptoms and complications but PD patients with high NMS burden were less satisfied with DBS. Patients, caregivers and clinicians evaluated the same clinical image from a different angle, which was reflected in discrepancies regarding the perception of symptom progression after DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/satisfaction-of-parkinson-patients-caregivers-and-clinicians-after-stn-dbs-and-its-predictors/