Objective: To evaluate the long-term outcomes in Quality of Life (QoL) for patients with Parkinson’s disease (PwP) enrolled in a global, real-world device registry for Deep Brain Stimulation (DBS).

Background: DBS for Parkinson’s disease (PD) is associated with a significant improvement in motor symptoms and QoL outcomes.^1-7 While this therapy has demonstrated improvement in QoL outcomes in the short term, few studies have longitudinal data looking at QoL for PwP receiving DBS.^4,8-10 The EuroQol-five Domain questionnaire (EQ-5D) is a validated instrument to measure QoL for PD, comparable to disease specific measures.^11,12 Disease duration prior to DBS therapy has been studied with regard to its impact on early functional outcomes, but not with respect to QoL.¹³

Method: The Product Surveillance Registry is a DBS device registry following patients prospectively from implant through completion. This analysis includes DBS-naïve PwP with at least one paired QoL measurement from baseline to 5-year follow-up. The scores from the five domains of the EQ-5D are combined into a five digit string which is “cross-walked” to a composite score called the summary index [Range: -1.0 to 1.0 (worst to best)].¹⁴ To determine impact of DBS on QoL, the mean change in the EQ-5D summary index was calculated yearly and a signed-rank test performed to determine significance of change from baseline. In addition, the 3-year endpoint was analyzed in groups based on duration of disease (DOD) at implant.

Results: A total of 631 DBS-naïve patients were included in this analysis. Significant improvements from baseline were found at the 6- or 12-month (mean change: 0.11, p<.0001), 24-month (mean change: 0.08, p<.0001), and 36-month (mean change: 0.05, p=.0019) follow ups post-DBS implant as shown in Table 1. A significant trend was also found within 3-year follow-up among patients with disease duration of ≤ 8 years at implant (mean change: 0.09, p=.0005).

Conclusion: As PD is a neurodegenerative disease, treatment cannot prevent the advancement of the disease entirely.  However, understanding long-term outcomes may allow us to understand how DBS therapy can help mitigate symptoms that impact QoL. The findings of significant maintained improvement for patients treated earlier in their disease course may warrant clinical consideration when counseling patients.

Table 1

Table 2

References: 1. Zhang Y, Chen L, Sun B, et al. Quality of Life and Motor Outcomes in Patients With Parkinson’s Disease 12 Months After Deep Brain Stimulation in China. Neuromodulation 2023;26(2):443-450. (In eng). DOI: 10.1016/j.neurom.2022.10.047.
2. Hariz M, Blomstedt P. Deep brain stimulation for Parkinson’s disease. J Intern Med 2022;292(5):764-778. (In eng). DOI: 10.1111/joim.13541.
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6. Abboud H, Genc G, Thompson NR, et al. Predictors of Functional and Quality of Life Outcomes following Deep Brain Stimulation Surgery in Parkinson’s Disease Patients: Disease, Patient, and Surgical Factors. Parkinsons Dis 2017;2017:5609163. (In eng). DOI: 10.1155/2017/5609163.
7. Deuschl G, Antonini A, Costa J, et al. European Academy of Neurology/Movement Disorder Society-European Section Guideline on the Treatment of Parkinson’s Disease: I. Invasive Therapies. Mov Disord 2022;37(7):1360-1374. (In eng). DOI: 10.1002/mds.29066.
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9. Jost ST, Aloui S, Evans J, et al. Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years: A Nonrandomized Controlled Trial. JAMA Netw Open 2024;7(1):e2352177. (In eng). DOI: 10.1001/jamanetworkopen.2023.52177.
10. Zahra M, Durand-Zaleski I, Górecki M, Walleser Autiero S, Barnett G, Schüpbach WMM. Parkinson’s disease with early motor complications: predicting EQ-5D- 3L utilities from PDQ-39 data in the EARLYSTIM trial. Health Qual Life Outcomes 2020;18(1):49. (In eng). DOI: 10.1186/s12955-020-01299-y.
11. Xin Y, McIntosh E. Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review. Qual Life Res 2017;26(1):1-23. (In eng). DOI: 10.1007/s11136-016-1428-x.
12. Schrag A, Selai C, Jahanshahi M, Quinn NP. The EQ-5D–a generic quality of life measure-is a useful instrument to measure quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2000;69(1):67-73. (In eng). DOI: 10.1136/jnnp.69.1.67.
13. Shalash A, Alexoudi A, Knudsen K, Volkmann J, Mehdorn M, Deuschl G. The impact of age and disease duration on the long term outcome of neurostimulation of the subthalamic nucleus. Parkinsonism Relat Disord 2014;20(1):47-52. (In eng). DOI: 10.1016/j.parkreldis.2013.09.014.
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