Objective: To compare assessment tools for capturing the therapeutic effect of DBS for treating PD using the original UPDRS and The Movement Disorder Society-sponsored revision of the scale (MDS-UPDRS).

Background: The UPDRS was the most commonly used clinical rating scale for PD for over two decades. In 2001, The Movement Disorder Society sponsored a critique of the UPDRS, which identified strengths and weaknesses of the scale. In 2007, MDS-UPDRS was developed to address the weaknesses. In a study comparing UPDRS and MDS-UPDRS using data from 877 non-DBS PD patients, the MDS-UPDRS showed high internal consistency and correlated with the original UPDRS.

Methods: PD patients were recruited through the UCSF Movement Disorder Center. Patients requiring bilateral DBS (STN or GPi) and preferred having DBS leads placed using the interventional MRI (iMRI) method were considered for enrollment. Patients were evaluated at baseline and at 12 months after surgery using the original UPDRS and the MDS-UPDRS in both the OFF and ON medication state. Changes between baseline and 12 month assessments were evaluated for parts I-IV in both rating scales.

Results: Advanced PD patients (N=18, 12M/6F) were enrolled. The mean age at time of surgery was 63.7 ± 5.9 yrs, and duration of PD was 10.3 ± 3.2 yrs. At 12 months, the mean motor (part III) scores showed statistically significant improvement in both scales (OFF ΔUPDRS: 16.3 ± 11.4, p<0.001; OFF ΔMDS-UPDRS: 19.2 ± 14.5, p<0.001; ON ΔUPDRS: 5.2 ± 9.3, p=0.03; ON ΔMDS-UPDRS: 9.6 ± 12.4, p=0.004). There was a greater effect size noted with the MDS-UPDRS scores, which was largely attributed to improvement in tremor amplitudes and constancy of rest tremor found in MDS-UPDRS scores. Neither scale showed significant improvement in part I (UPDRS: p=0.12, MDS-UPDRS: p=0.17), and both scales showed significant improvement in Part II (UPDRS: p=0.002, MDS-UPDRS: p=0.004) and Part IV (UPDRS: p=0.001, MDS-UPDRS: p=0.001).

Conclusions: Our finding supports the validity of the MDS-UPDRS as an evaluation tool for assessing the therapeutic effect of DBS in PD. The MDS-UDPRS III subscale appeared more sensitive to identifying greater change in tremor characterization after surgery than the traditional UPDRS. Future DBS surgical trials should consider using the MDS-UPDRS as it may allow for detection of smaller differences and smaller sample sizes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparison-of-change-in-the-updrs-verses-mds-updrs-in-a-population-of-parkinsons-disease-pd-patients-treated-with-deep-brain-stimulation-dbs/