Predictors of Long-Term Outcome of Subthalamic Stimulation in Parkinson Disease.

Cavallieri, Francesco; Fraix, Valérie; Bove, Francesco; Mulas, Delia; Tondelli, Manuela; Castrioto, Anna; Krack, Paul; Meoni, Sara; Schmitt, Emmanuelle; Lhommée, Eugénie; Bichon, Amélie; Pélissier, Pierre; Chevrier, Eric; Kistner, Andrea; Seigneuret, Eric; Chabardès, Stephan; Moro, Elena (2021). Predictors of Long-Term Outcome of Subthalamic Stimulation in Parkinson Disease. Annals of neurology, 89(3), pp. 587-597. Wiley-Blackwell 10.1002/ana.25994

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OBJECTIVE

This study was undertaken to identify preoperative predictive factors of long-term motor outcome in a large cohort of consecutive Parkinson disease (PD) patients with bilateral subthalamic nucleus deep brain stimulation (STN-DBS).

METHODS

All consecutive PD patients who underwent bilateral STN-DBS at the Grenoble University Hospital (France) from 1993 to 2015 were evaluated before surgery, at 1 year (short-term), and in the long term after surgery. All available demographic variables, neuroimaging data, and clinical characteristics were collected. Preoperative predictors of long-term motor outcome were investigated by performing survival and univariate/multivariate Cox regression analyses. Loss of motor benefit from stimulation in the long term was defined as a reduction of less than 25% in the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III scores compared to the baseline off-medication scores. As a secondary objective, potential predictors of short-term motor outcome after STN-DBS were assessed by performing univariate and multivariate linear regression analyses.

RESULTS

In the long-term analyses (mean follow-up = 8.4 ± 6.26 years, median = 10 years, range = 1-17 years), 138 patients were included. Preoperative higher frontal score and off-medication MDS-UPDRS part III scores predicted a better long-term motor response to stimulation, whereas the presence of vascular changes on neuroimaging predicted a worse motor outcome. In 357 patients with available 1-year follow-up, preoperative levodopa response, tremor dominant phenotype, baseline frontal score, and off-medication MDS-UPDRS part III scores predicted the short-term motor outcome.

INTERPRETATION

Frontal lobe dysfunction, disease severity in the off-medication condition, and the presence of vascular changes on neuroimaging represent the main preoperative clinical predictors of long-term motor STN-DBS effects. ANN NEUROL 2021.

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