Objective: To evaluate the effects of Deep Brain Stimulation(DBS) on non motor symptoms(NMS) in Parkinson’s disease(PD) and compare the efficacy of pallidal(GPi) versus subthalamic(STN) stimulation.

Background: DBS is a established treatment for motor symptoms of PD, two targets are preferably used, GPi and STN. Although both of them significantly improve motor symptoms, their effects on NMS are still not well known. Considering that they tend to have their particularities, there might be a more suitable patient for each target. We present preliminary data of an ongoing study.

Methods: We designed a prospective, randomized, blind study. Patients with idiopathic PD and formal indication of treatment with DBS were enrolled. Dementia was excluded by neuropsychological assessment. They were randomly divided into two groups, one of GPi stimulation and another of STN stimulation. The evaluations occurred preoperatively and 6 months after DBS implantation and were performed on OFF med, ON med and OFF med/ON stim. Besides clinical interview, we applied UPDRS, Hoehn&Yahr, Schwab&England, Non Motor Symptoms Scale(NMSS) and Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s disease(QUIP-S). For statistical analysis we used the t-test, paired t-test, Mann-Whitney and Wilcoxon.

Results: 16 male and 10 female were included for analysis. The mean age was 51,5±8,1 years, with 11,8±3,9 years of disease. The mean Hoehn&Yahr OFFmed preoperative was 2,8±0,8. Except for gender, there were no basal differences between the groups.

Preoperative Descriptive Data

	GPi (Mean±SD)	STN (Mean±SD)	p value
Age	52±7,0	51,1±8,9	0,78
Gender	5 male, 8 female	11 male, 2 female	0,018*
Age of onset of PD (years)	40±8,4	39,6±7,9	0,91
Duration of disease	12,2±3,3	11,5±4,3	0,67
LED	1332,6±499,5	1298,2±348	0,58
Pramipexol dose	1,5±1,5	1,8±1,6	0,62
UPDRS I	3,8±2,0	3,6±2,2	0,79
UPDRS II OFFmed	24,7±3,6	26,2±5,6	0,46
UPDRS III OFFmed	41,8±7,2	44,2±6,8	0,36
UPDRS III – Axial OFFmed	7,8±3,6	8,5±4,2	0,57
UPDRS III ONmed	11,4±6,4	13,2±6,3	0,38
UPDRS III – Axial ONmed	1,9±0,8	2,4±1,9	0,94
UPDRS IV (32-35)	3,7±2,7	3,2±3,0	0,61
Schwab & England OFFmed	61,5±11,2	363,1±10,7	0,96
Hoehn & Yahr OFFmed	2,7±0,5	2,9±1,0	0,89
QUIP-S	1,8±2,2	0,3±0,6	0,12
NMSS	71,4±23,4	67,8±49,1	0,27
PDQ-39	54,3±9,9	48,8±11,3	0,22

” UPDRS part III and PDQ-39 improved with GPi and STN DBS. There was significant improvement of NMSS score (GPi p=0,001; STN p=0,019) and mood/cognition NMSS domain (GPi p=0,002; STN p=0,03) on both groups; sleep/fatigue (p=0,002) also improved on GPi, urinary (p=0,03) and miscellaneous (p=0,04) on STN group. UPDRS part I (p=0,008) and QUIP-S (p=0,03) significantly improved on GPi stimulation. The comparison between the groups showed that the STN induced a greater reduction of LED (p=0,018) and pramipexol dose (p=0,04) and improvement of total (p=0,033) and axial UPDRS part III (p=0,026). The GPi DBS, in turn, led to a greater reduction of UPDRS part I (p=0,015).

	Mean change at 06 months from baseline
	GPi (Mean±SD)	STN (Mean±SD)	p value
LED	287,2±486,1	669,3±471,0	0,018*
UPDRS part I	1,8±1,9	1,1±3,0	0,015*
UPDRS part II OFFmed	11,9±6,9	15,2±3,9	0,14
UPDRS part III OFFmed	16,4±8,2	23,6±7,0	0,033*
UPDRS part III OFFmed – Axial	3,2±3,6	5,1±2,4	0,026*
UPDRS part IV	2,6±2,5	2,3±3,2	0,532
Schwab & England OFFmed	16,9±15,4	21,5±10,3	0,219
Hoehn & Yahr OFFmed	0,2±0,4	0,4±0,7	0,335
NMSS total score	35,5±23,3	32,3±47,4	0,837
PDQ-39	26±14,3	22,6±14,1	0,797
QUIP-S	1,5±2,0	0,3±0,8	0,08

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Conclusions: DBS can also be used for the treatment of NMS, its effects on each symptom should be studied in detail. Both GPi and STN are effective, but GPi stimulation tends to be better for behavioral while STN stimulation tends to be better for motor symptoms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pallidal-versus-subthalamic-stimulation-for-pd-beyond-the-motor-effects/