Effects of bilateral stimulation of the subthalamic nucleus in Parkinson's disease with and without REM sleep behaviour disorder.

Bargiotas, Panagiotis; Debove, Ines; Bargiotas, Ioannis; Lachenmayer, Martin Lenard; Ntafouli, Maria; Vayatis, Nicolas; Schüpbach, Michael; Krack, Paul; Bassetti, Claudio L. (2019). Effects of bilateral stimulation of the subthalamic nucleus in Parkinson's disease with and without REM sleep behaviour disorder. Journal of neurology, neurosurgery, and psychiatry, 90(12), pp. 1310-1316. BMJ Publishing Group 10.1136/jnnp-2019-320858

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BACKGROUND Although rapid eye movement sleep behaviour disorder (RBD) in Parkinson's disease (PD) is associated with increased non-motor symptoms, its impact on the deep brain stimulation (DBS) outcome remains unclear. This is the first study to compare the post-DBS outcome between PD patients with RBD (PD-RBD+) and without (PD-RBD-). METHODS We analysed data from PD patients who were treated with bilateral DBS in the nucleus subthalamicus. Assessments included night-polysomnography (only pre-DBS), and motor and non-motor assessments pre-DBS and post-DBS. RESULTS Among 50 PD patients (29 males, mean age 62.5 years, 11.8 mean PD years), 24 (48%) had RBD. Pre-DBS, the two groups were equal in respect to sociodemographic features, disease duration and PD medications. A multivariate analysis showed that the clinical profile linked to motor, non-motor and quality of life features differed significantly between PD patients with and without RBD. The most discriminative elements were Unified Parkinson's Disease Rating Scale (UPDRS)-III, apathy and depression scores. Post-DBS, UPDRS-III, Epworth sleepiness scale and PD questionnaire improved significantly in both groups. UPDRS-II scores significantly improved in the PD-RBD+ group (-45%) but remained unchanged in the PD-RBD- group (-14%). The depression score improved significantly in the PD-RBD+ (-34%) and remained unchanged in the PD-RBD- group. The apathy score remained unchanged in the PD-RBD+ group but increased significantly in the PD-RBD- group (+33%). CONCLUSION While pre-DBS, PD patients with and without RBD showed different clinical profiles, post-DBS, the clinical profiles were comparable between the two groups. In respect to depressive symptoms, apathy and activities of daily living, PD-RBD+ patients show favourable post-DBS outcome. These findings highlight the importance of RBD assessment prior to DBS surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Bargiotas, Panagiotis; Debove, Ines; Lachenmayer, Lenard; Ntafouli, Maria; Schüpbach, Michael; Krack, Paul and Bassetti, Claudio

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1468-330X

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

26 Nov 2019 10:25

Last Modified:

26 Nov 2019 10:25

Publisher DOI:

10.1136/jnnp-2019-320858

PubMed ID:

31422368

Uncontrolled Keywords:

Parkinson’s disease REM sleep behavior disorder (RBD) non-motor symptoms quality of life subthalamic deep brain stimulation

BORIS DOI:

10.7892/boris.134842

URI:

https://boris.unibe.ch/id/eprint/134842

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