Objective: To investigate nonmotor effects of bilateral subthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) in Parkinson’s disease (PD).

Background: Bilateral STN-DBS as well as bilateral GPi-DBS improves quality of life and motor symptoms in PD. Beneficial non-motor effects have been reported for STN-DBS, whereas few studies have investigated a wide range of NMS in patients with PD undergoing GPi-DBS. Therefore, we conducted a comparative investigation of non-motor effects for these two DBS targets. We hypothesized that (1) GPi-DBS has beneficial effects on NMS and (2) STN-DBS and GPi-DBS have distinct non-motor effect profiles.

Methods: In this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n=40) or GPi-DBS (n=20), we examined PDQuestionnaire (PDQ), Nonmotor Symptom Scale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Intra-group changes from baseline to follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Differences between STN-DBS and GPi-DBS were explored with Mann-Whitney-U or unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.

Results: In both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly from baseline to follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV improvement. While NMSS total score outcomes were similar, explorative NMSS domain analyses resulted in distinct profiles. Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS improved the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.

Conclusions: To our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD patients. This study highlights the importance of comprehensive assessments of NMS to tailor the choice of DBS target to patients’ individual motor and nonmotor profiles.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/beneficial-nonmotor-effects-of-subthalamic-and-pallidal-dbs-in-parkinsons-disease/