Objective: To determine whether there are clinical differences in Parkinson disease (PD) patients based on their indication for deep brain stimulation (DBS) surgery. 

Background: Deep brain stimulation (DBS) is an effective treatment for advanced PD motor symptoms that cannot be managed adequately with oral medications. Little is known about whether patient characteristics differ by indication for surgery. 

Methods: We retrospectively analyzed clinical characteristics of 127 PD patients who received clinical evaluations prior to deep brain stimulation between January 2010 and July 2016 at our center. Patients completed the Unified Parkinson Disease Rating Scale (UPDRS), the Parkinson’s Disease Questionnaire-39 (PDQ-39), Beck Depression Inventory-II (BDI-II), the Montreal Cognitive Assessment, Controlled Oral Word Association, semantic fluency (animals), Stroop Color Word Test, Symbol Digit Modalities Test, Wisconsin Card Sorting Test, Digit Span, Hopkins Verbal Learning Test-Revised, Brief Visuospatial Memory Test – Revised, and Trail Making Test A & B. Motor subtype was calculated using the UPDRS.¹

Results: PD subjects were 29.9% women, had a mean age of 62.0 years (SD=9.1), and had a mean duration of disease of 10.1 years (SD=4.6). Indications for deep brain stimulation surgery were motor fluctuations (n=90), medication-refractory tremor (n=22), motor fluctuations and tremor (n=8), medication intolerance (n=5), and dystonia (n=2). As expected, those receiving DBS for medication-refractory tremor were more likely to be classified as tremor-dominant disease (70.0% vs 23.3%, p<0.001). Compared to those undergoing DBS for motor fluctuations, men were more like to pursue DBS for medication-refractory tremor with or without fluctuations (n=30) (90.0% vs. 63.3%, p=0.006). Those with indication of motor fluctuations had higher UPDRS Part 2 score compared to those with medication-refractory tremor (17.4 vs 13.1 points, p=0.0006). There was no association between surgical indication and age, duration of PD, UPDRS Part 1 or Part 3 scores, any of the cognitive measures, PDQ-39 score, or BDI-II score. 

Conclusions: Patients undergoing DBS for tremor were more likely to be men. While patients with indication of motor fluctuations reported greater impairment in activities of daily living on UDPRS Part 2, this scale may not fully capture the disability associated with medication-refractory tremor as there was no difference in PDQ-39 score.

References: 1. Jankovic J, McDermott M, Carter J, Gauthier S, Goetz C, Golbe L, Huber S, Koller W, Olanow C, Shoulson I. Variable expression of Parkinson’s disease: a base‐line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology 1990;40:1529–1534

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MDS Abstracts - https://www.mdsabstracts.org/abstract/patient-characteristics-vary-by-dbs-indication-in-parkinson-disease-patients/