Objective: To assess long-term effectiveness of unilateral Deep Brain Stimulation (DBS) in Parkinson’s disease (PD) patients with up to 14 months of follow-up

Background: DBS effectively manages medication-refractory motor symptoms and improves quality of life in select PD patients. However, the optimal timing and staging of the surgical approach remains debated. Despite the common approach of simultaneous bilateral DBS implantation, there is value in a unilateral approach.Considering the asymmetric phenomenology in PD and increased risk of side effects after bilateral surgeries, unilateral DBS may be a preferable initial approach for select patients.

Method: We retrospectively studied PD patients undergoing unilateral or bilateral STN or Gpi DBS surgery from January 2019 to September 2023 at the University of Florida. Clinical demographic and standardized motor assessments at preoperative baseline, 3-6 months, and 10-14 months post-implantation were extracted. Group-wise comparisons utilized the Mann-Whitney U test along with Bonferroni correction (p=0.016). Multiple regression analysis controlled for confounding variables.

Results: We analyzed 180 patients (121 GPi/59 STN) with unilateral DBS. Pre-operatively, their mean (SD) Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) score in the medication Off state was 35.7 (11.7). At 3-6 months post-implantation, it decreased to 25 (10.7) and remained at 26 (12) at 10-14 months. 3-6 and 10-14-months motor scores were significantly lower than baseline (p<0.001 for both). We compared the unilateral outcomes with data extracted from 49 patients who had bilateral lead implantations. Their mean (SD) pre-operative UPDRS-III score in the medication Off state was 36 (9.8). At 3-6 months post-implantation, it decreased to 24.3 (9.2), and at 10-14 months, it was 26.7 (11.25). 3-6 and 10-14 months follow-up scores significantly differed from baseline in the bilateral group as well (p<0.001 for both). No significant difference was observed in the percent improvement of UPDRS-III between unilateral and bilateral DBS groups at 3-6 and 10-14 months postoperatively (p=0.591 and 0.791, respectively).

Conclusion: Our findings indicate no statistically significant difference in motor score improvement between the two surgical approaches, suggesting potential comparable efficacy up to 14 months post-surgery.

References: 1. Hayashi, Y. et al. Unilateral GPi-DBS Improves Ipsilateral and Axial Motor Symptoms in Parkinson’s Disease as Evidenced by a Brain Perfusion Single Photon Emission Computed Tomography Study. Front. Hum. Neurosci. 16, 888701 (2022).
2. Germano, I. M. et al. Unilateral stimulation of the subthalamic nucleus in Parkinson disease: a double-blind 12-month evaluation study. J. Neurosurg. 101, 36–42 (2004).
3. Taba, H. A. et al. A closer look at unilateral versus bilateral deep brain stimulation: results of the National Institutes of Health COMPARE cohort. J. Neurosurg. 113, 1224–1229 (2010).
4. Zahodne, L. B. et al. Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus. J. Neurol. 256, 1321–1329 (2009).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-follow-up-of-unilateral-deep-brain-stimulation-for-parkinsons-disease/