Objective: To investigate non-motor symptoms (NMS) to find contributing factors for quality of life (QoL) outcome after subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson’s disease (PD).

Background: Class I evidence shows that STN-DBS improves QoL of patients with PD. However, previous open studies also indicate that the proportion of patients experiencing no relevant improvement of QoL is high (41-49%). While some motor characteristics have been identified as predictors of QoL improvement, little is known about the role of NMS. We hypothesized that postoperative QoL changes depend on NMS.

Methods: In this ongoing, prospective, open-label, multicenter study (Cologne, Manchester, London, Venice) including 88 patients, we collected following scales preoperatively on baseline (MedON) and on first follow-up 3-6 months after surgery (MedON/StimON): Parkinson’s disease Questionnaire-8 (PDQ-8), NMSScale (NMSS, clinician-based), NMSQuestionnaire (NMSQ, patient-based) and SCOPA-motor examination. We dichotomized patients into “responders” and “non-responders” with a cohort-based method (improvement >1/2 SD of baseline scores of respective scales). We screened for factors associated with QoL improvement with (1) Spearman-correlations between respective preoperative scores and QoL improvement, (2) step-wise linear regressions with respective preoperative scores as independent and QoL improvement as dependent variables and (3) logistic regressions using aforementioned “responders/non-responders” as dependent variable.

Results: In our cohort regarding QoL outcome, 47% of patients were categorized as “non-responders”. Spearman-correlations and linear and logistic regression analyses were significant for NMSS and NMSQ total scores, but not for SCOPA-motor examination. Post-hoc, we identified a wide range of NMS (pain, frequency of bladder voiding, falls due to fainting, subjective problems sustaining concentration and depression) as significant contributing factors for QoL outcome.

Conclusions: Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies based on motor and NMS clusters in bigger PD cohorts may allow a more precise stratification of QoL outcomes and provide more insight on patients’ individual prospects of benefiting from DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quality-of-life-after-subthalamic-stimulation-depends-on-non-motor-symptoms-in-parkinsons-disease/