Objective: To investigate long-term outcome of subthalamic stimulation (STN-DBS).in Parkinson’s disease (PD) patients with early motor complications.

Background: STN-DBS improves motor complications and quality of life in patients with advanced complicated PD. It has also been shown to improve quality of life in PD patients with early motor complications as demonstrated in the EARLYSTIM trial and a monocentric pilot study. However, long-term outcome of early STN-DBS after the 1.5 or 2 years of controlled follow-up in the published studies has not yet been addressed. Initial L-DOPA response of PD motor symptoms is a mean widely used to pre-operatively predict favorable outcome in STN-DBS, whether this is also true for long-term outcome in early STN-DBS patients remains to be investigated.

Methods: The 20 patients from the pilot study[1] were assessed 10 years after randomization. They initially had PD with early motor complications and were randomized to STN-DBS or best medical treatment (BMT) for 1.5 years. Parkinsonian motor signs, activities of daily living, quality of life, mood, and cognitive function were examined using the same instruments as in the pilot study (Unified PD Rating Scale UPDRS, PD Questionnaire-39, Beck Depression Inventory, Mattis Dementia Rating Scale). [1] Schuepbach WMM, Maltête D et al. Neurosurgery at an earlier stage of Parkinson’s disease: A randomized controlled trial. Neurology 2007;68(4):267-271.

Results: Of the initial 20 patients, 4 had died (2 deaths per group). All surviving 16 patients could be assessed 10.4±0.4 years (mean±SD) after randomization at 58.8±3.2 years of age and 17.4±1.3 years of disease duration. All patients initially randomized to BMT had meanwhile undergone STN-DBS at varying delays according to their individual choices. Follow-up assessments were performed 10.5±0.4 years and 7.7±2.2 years after DBS-surgery respectively. At last follow-up, there were no differences between groups for all outcomes. Multivariate analysis showed a negative correlation of long-term UPDRS-II, UPDRS-III and axial score at last follow-up with initial L-DOPA-response (UPDRS-II ON R=-0,54, UPDRS-II OFF R=-0,66, UPDRS-III ON R=-0,64, axial score (ON) R=-0,58).

Conclusions: 10 years after randomization, all surviving patients of the pilot trial could be reassessed. There were no differences in long-term outcomes between groups. No deleterious long-term effect of early STN-DBS in PD could be identified.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/stn-dbs-in-parkinsons-disease-with-early-motor-complications-a-10-year-follow-up/