Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable?
Identifieur interne : 000812 ( Main/Curation ); précédent : 000811; suivant : 000813Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable?
Auteurs : Christine Daniels [Allemagne] ; Paul Krack [Allemagne] ; Jens Volkmann [Allemagne] ; Jan Raethjen [Allemagne] ; Markus O. Pinsker [Allemagne] ; Manja Kloss [Allemagne] ; Volker Tronnier [Allemagne] ; Alfons Schnitzler [Allemagne] ; Lars Wojtecki [Allemagne] ; Kai Bötzel [Allemagne] ; Adrian Danek [Allemagne] ; Rüdiger Hilker [Allemagne] ; Volker Sturm [Allemagne] ; Andreas Kupsch [Allemagne] ; Elfriede Karner [Autriche] ; Günther Deuschl [Allemagne] ; Karsten Witt [Allemagne]Source :
- Movement Disorders [ 0885-3185 ] ; 2011-12.
English descriptors
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in PD. However, QoL fails to improve in a relevant proportion of patients. We studied clinical baseline and progression parameters associated with improvement in QoL after DBS. Data from a German randomized, controlled study comparing DBS (60 patients) with best medical treatment (59 patients) were analyzed. Changes in patients' QoL were assessed using the Parkinson's Disease Questionnaire (PDQ‐39) at baseline and at the 6‐month follow‐up. For the STN‐DBS patients, the changes in PDQ‐39 were correlated with predefined clinical preoperative and progression parameters. Scores for QoL improved after STN‐DBS for 57% of the patients, and for 43% patients, they did not improve. Patients with improvement in QoL showed significantly higher cumulative daily “off” time. Changes in the PDQ‐39 showed a significant positive correlation with the cumulative daily off time at baseline. Logistic regression analysis revealed that 1 additional hour off time at baseline increases the odds for improvement on PDQ‐39 by a factor of 1.33 (odds ratio). In the postoperative course, changes in the PDQ‐39 significantly correlated with the reduction of cumulative daily off time, an improvement on the UPDRS (UPDRS III off), and positive mood changes. Among the baseline parameters, the cumulative daily off time is the strongest predictor for improvement in disease‐related QoL after DBS. Improvement in QoL after STN‐DBS is also correlated with changes in motor functions and changes in depression and anxiety. © 2011 Movement Disorder Society
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DOI: 10.1002/mds.23907
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type="main" xml:lang="en">Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable?</title><author><name sortKey="Daniels, Christine" sort="Daniels, Christine" uniqKey="Daniels C" first="Christine" last="Daniels">Christine Daniels</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Christian‐Albrechts‐University, Kiel, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Christian‐Albrechts‐University, Kiel</wicri:regionArea></affiliation></author><author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Christian‐Albrechts‐University, Kiel, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Christian‐Albrechts‐University, Kiel</wicri:regionArea></affiliation></author><author><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Christian‐Albrechts‐University, Kiel, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Christian‐Albrechts‐University, Kiel</wicri:regionArea></affiliation></author><author><name sortKey="Raethjen, Jan" sort="Raethjen, Jan" uniqKey="Raethjen J" first="Jan" last="Raethjen">Jan Raethjen</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Christian‐Albrechts‐University, Kiel, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Christian‐Albrechts‐University, Kiel</wicri:regionArea></affiliation></author><author><name sortKey="Pinsker, Markus O" sort="Pinsker, Markus O" uniqKey="Pinsker M" first="Markus O." last="Pinsker">Markus O. Pinsker</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurosurgery, Christian‐Albrechts‐University, Kiel</wicri:regionArea></affiliation></author><author><name sortKey="Kloss, Manja" sort="Kloss, Manja" uniqKey="Kloss M" first="Manja" last="Kloss">Manja Kloss</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Heidelberg University, Heidelberg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Heidelberg University, Heidelberg</wicri:regionArea></affiliation></author><author><name sortKey="Tronnier, Volker" sort="Tronnier, Volker" uniqKey="Tronnier V" first="Volker" last="Tronnier">Volker Tronnier</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurosurgery, Heidelberg University, Heidelberg, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurosurgery, Heidelberg University, Heidelberg</wicri:regionArea></affiliation></author><author><name sortKey="Schnitzler, Alfons" sort="Schnitzler, Alfons" uniqKey="Schnitzler A" first="Alfons" last="Schnitzler">Alfons Schnitzler</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Heinrich Heine University, Dusseldorf, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Heinrich Heine University, Dusseldorf</wicri:regionArea></affiliation></author><author><name sortKey="Wojtecki, Lars" sort="Wojtecki, Lars" uniqKey="Wojtecki L" first="Lars" last="Wojtecki">Lars Wojtecki</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Heinrich Heine University, Dusseldorf, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Heinrich Heine University, Dusseldorf</wicri:regionArea></affiliation></author><author><name sortKey="Botzel, Kai" sort="Botzel, Kai" uniqKey="Botzel K" first="Kai" last="Bötzel">Kai Bötzel</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Ludwig‐Maximilians‐University, Munich, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Ludwig‐Maximilians‐University, Munich</wicri:regionArea></affiliation></author><author><name sortKey="Danek, Adrian" sort="Danek, Adrian" uniqKey="Danek A" first="Adrian" last="Danek">Adrian Danek</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Ludwig‐Maximilians‐University, Munich, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Ludwig‐Maximilians‐University, Munich</wicri:regionArea></affiliation></author><author><name sortKey="Hilker, Rudiger" sort="Hilker, Rudiger" uniqKey="Hilker R" first="Rüdiger" last="Hilker">Rüdiger Hilker</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Cologne University, Cologne, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Cologne University, Cologne</wicri:regionArea></affiliation></author><author><name sortKey="Sturm, Volker" sort="Sturm, Volker" uniqKey="Sturm V" first="Volker" last="Sturm">Volker Sturm</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurosurgery, Cologne University, Cologne, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurosurgery, Cologne University, Cologne</wicri:regionArea></affiliation></author><author><name sortKey="Kupsch, Andreas" sort="Kupsch, Andreas" uniqKey="Kupsch A" first="Andreas" last="Kupsch">Andreas Kupsch</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Charité Hospital, Humboldt University, Berlin, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Charité Hospital, Humboldt University, Berlin</wicri:regionArea></affiliation></author><author><name sortKey="Karner, Elfriede" sort="Karner, Elfriede" uniqKey="Karner E" first="Elfriede" last="Karner">Elfriede Karner</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Innsbruck Medical University, Innsbruck, Austria</mods:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Department of Neurology, Innsbruck Medical University, Innsbruck</wicri:regionArea></affiliation></author><author><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Christian‐Albrechts‐University, Kiel, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Christian‐Albrechts‐University, Kiel</wicri:regionArea></affiliation></author><author><name sortKey="Witt, Karsten" sort="Witt, Karsten" uniqKey="Witt K" first="Karsten" last="Witt">Karsten Witt</name><affiliation wicri:level="1"><mods:affiliation>Department of Neurology, Christian‐Albrechts‐University, Kiel, Germany</mods:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Christian‐Albrechts‐University, Kiel</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">Movement Disorders</title><title level="j" type="abbrev">Mov. Disord.</title><idno type="ISSN">0885-3185</idno><idno type="eISSN">1531-8257</idno><imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher><pubPlace>Hoboken</pubPlace><date type="published" when="2011-12">2011-12</date><biblScope unit="volume">26</biblScope><biblScope unit="issue">14</biblScope><biblScope unit="page" from="2516">2516</biblScope><biblScope unit="page" to="2521">2521</biblScope></imprint><idno type="ISSN">0885-3185</idno></series><idno type="istex">A5E7E464341E6A4CAE24AA74AABD71E1210FB514</idno><idno type="DOI">10.1002/mds.23907</idno><idno type="ArticleID">MDS23907</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Parkinson's disease</term><term>deep brain stimulation</term><term>quality of life</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in PD. However, QoL fails to improve in a relevant proportion of patients. We studied clinical baseline and progression parameters associated with improvement in QoL after DBS. Data from a German randomized, controlled study comparing DBS (60 patients) with best medical treatment (59 patients) were analyzed. Changes in patients' QoL were assessed using the Parkinson's Disease Questionnaire (PDQ‐39) at baseline and at the 6‐month follow‐up. For the STN‐DBS patients, the changes in PDQ‐39 were correlated with predefined clinical preoperative and progression parameters. Scores for QoL improved after STN‐DBS for 57% of the patients, and for 43% patients, they did not improve. Patients with improvement in QoL showed significantly higher cumulative daily “off” time. Changes in the PDQ‐39 showed a significant positive correlation with the cumulative daily off time at baseline. Logistic regression analysis revealed that 1 additional hour off time at baseline increases the odds for improvement on PDQ‐39 by a factor of 1.33 (odds ratio). In the postoperative course, changes in the PDQ‐39 significantly correlated with the reduction of cumulative daily off time, an improvement on the UPDRS (UPDRS III off), and positive mood changes. Among the baseline parameters, the cumulative daily off time is the strongest predictor for improvement in disease‐related QoL after DBS. Improvement in QoL after STN‐DBS is also correlated with changes in motor functions and changes in depression and anxiety. © 2011 Movement Disorder Society</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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