Long-term clinical outcomes of bilateral GPi deep brain stimulation in advanced Parkinson’s disease: 5 years and beyond

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  • 1 Department of Neurology, Norman Fixel Institute for Neurological Diseases, and
  • 3 Departments of Clinical and Health Psychology and
  • 4 Neurosurgery, University of Florida, Gainesville, Florida; and
  • 2 Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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OBJECTIVE

Few studies have reported long-term outcomes of globus pallidus internus (GPi) deep brain stimulation (DBS) in Parkinson’s disease (PD). The authors aimed to investigate long-term outcomes of bilateral GPi DBS for 5 years and beyond for PD patients.

METHODS

The authors retrospectively analyzed the clinical outcomes in 65 PD patients treated with bilateral GPi DBS at a single center. The outcome measures of motor symptoms and health-related quality of life (HRQoL) included the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Parkinson’s Disease Questionnaire (PDQ-39). Scores at baseline were compared with those at 1, 3, 5, and 6–8 years after implantation using Wilcoxon signed-rank tests with α correction.

RESULTS

GPi DBS significantly improved the off-medication UPDRS III total scores, UPDRS IV, and dyskinesia score at 1 year when compared with baseline (all p < 0.001). The off- and on-medication tremor scores, UPDRS IV, and dyskinesia scores showed moderate and sustained improvement (the ranges of the mean percentage improvement at each time point were 61%–75%, 30%–80%, 29%–40%, and 40%–65%, respectively) despite lacking statistical significance at long-term follow-up with diminishing sample sizes. The off-medication UPDRS III total scores did not show significant improvement at 5 years or later, primarily because of worsening in rigidity, akinesia, speech, gait, and postural stability scores. The on-medication UPDRS III total scores also worsened over time, with a significant worsening at 6–8 years when compared with baseline (p = 0.008). The HRQoL analyses based on the PDQ-39 revealed significant improvement in the activities of daily living and discomfort domains at 1 year (p = 0.003 and 0.006, respectively); however, all the domains showed gradual worsening at the later time points without reaching statistical significance. At 3 years, the communication domain showed significant worsening compared with baseline scores (p = 0.002).

CONCLUSIONS

GPi DBS in PD patients in this single-center cohort was associated with sustained long-term benefits in the off- and on-medication tremor score and motor complications. HRQoL and the cardinal motor symptoms other than tremor may worsen gradually in the long term. When counseling patients, it is important to recognize that benefits in tremor and dyskinesia are expected to be most persistent following bilateral GPi DBS implantation.

ABBREVIATIONS ADL = activity of daily living; AE = adverse events; BDI-II = Beck Depression Inventory–II; DBS = deep brain stimulation; DRS-2 = Dementia Rating Scale–2; GPi = globus pallidus internus; HRQoL = health-related quality of life; LEDD = levodopa equivalent daily dose; PD = Parkinson’s disease; PDQ-39 = Parkinson’s Disease Questionnaire; SAS = Starkstein Apathy Scale; STN = subthalamic nucleus; UPDRS = Unified Parkinson’s Disease Rating Scale.

Supplementary Materials

    • Supplementary Tables 1–3 (PDF 378 KB)

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Contributor Notes

Correspondence Takashi Tsuboi: Norman Fixel Institute for Neurological Diseases, Gainesville, FL. takashi80@gmail.com; takashi.tsuboi@neurology.ufl.edu.

INCLUDE WHEN CITING Published online October 9, 2020; DOI: 10.3171/2020.6.JNS20617.

Disclosures D.B. has received research grants from the Parkinson’s Foundation, NIH, and the McKnight Research Foundation. L.A. works as a consultant and participates in advisory boards for Boston Scientific and Medtronic and has received honoraria for these services. K.D.F. reports grants from NIH and other funding from the Donnellan/Einstein/Merz Chair (no direct remuneration to K.D.F.) during this study; grants and nonfinancial support from Medtronic; grants from St. Jude, Functional Neuromodulation, and Boston Scientific; and grants and other funding from NeuroPace. Additionally, K.D.F. has a patent (US 8295935 B2) issued for a DBS cranial lead fixation device that was not used for this research and for which no personal remuneration or royalty has been realized for K.D.F. M.S.O. serves as a consultant for the Parkinson’s Foundation and has received research grants from NIH, the Parkinson’s Foundation, the Michael J. Fox Foundation, the Parkinson Alliance, the Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. M.S.O. has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford, and Cambridge (movement disorders books). M.S.O. is an associate editor for New England Journal of Medicine and Journal Watch Neurology, and is also an associate editor for JAMA Neurology. M.S.O. has participated in CME and educational activities on movement disorders sponsored by the Academy for Healthcare Learning, PeerView, Prime, QuantiaMD, WebMD/Medscape, Medicus, MedNet, Einstein, Henry Stewart, the American Academy of Neurology, the Movement Disorders Society, and Vanderbilt University. The institution, not M.S.O., receives grants from Medtronic, Abbvie, Boston Scientific, Abbott, and Allergan, and the PI has no financial interest in these grants. M.S.O. has participated as a site PI and/or coinvestigator for several NIH, foundation, and industry-sponsored trials over the years but has not received honoraria. Research projects at the University of Florida receive device and drug donations. A.R.Z. serves as a consultant for the National Parkinson Foundation and has received research consulting honoraria from Medtronic, Boston Scientific, CNS Ratings, and Bracket.

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