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The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta-Analysis.

ABSTRACT: Background:Several studies examined the influence of subthalamic nucleus-deep brain stimulation (STN-DBS) on quality of life (QoL) in patients with Parkinson's disease (PD). However, it is unclear whether this effect differs between age groups and disease durations and whether it stays consistent over time. Objectives:We assessed the influence of stimulation duration, disease duration, and age at surgery on QoL after STN-DBS. Methods:We systematically searched for studies reporting the results of the Parkinson's Disease Questionnaire 39 or 8. Studies were included if they investigated the time passed since STN-DBS or if their study cohort fell into the range of one of the following age groups: younger than 60?years or between 60 and 70?years. For each condition, a standardized mean difference meta-analysis was performed. Furthermore, all studies were categorized into short or long disease duration at surgery using a median split. Results:A total of 23 studies reporting the cumulative outcome of 76 to 802 PD patients were included in this analysis. The results demonstrate a substantial improvement of QoL after DBS that remains stable over 36 months. QoL falls to preoperative scores 60 months after surgery. However, only 3 studies could be included in this analysis. Both younger and older PD patients profit in QoL from STN-DBS, independent of the disease duration. Conclusions:The results of this analysis show an impressive improvement in QoL after STN-DBS, with a loss of QoL 60 months after DBS surgery. This highlights the need to explore the factors influencing QoL after STN-DBS to prevent or delay a decline in QoL.

SUBMITTER: Buttner C

PROVIDER: S-EPMC6749804 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta-Analysis.

Büttner Charlotte C Maack Marike M Janitzky Kathrin K Witt Karsten K

Movement disorders clinical practice 20190816 7

<h4>Background</h4>Several studies examined the influence of subthalamic nucleus-deep brain stimulation (STN-DBS) on quality of life (QoL) in patients with Parkinson's disease (PD). However, it is unclear whether this effect differs between age groups and disease durations and whether it stays consistent over time.<h4>Objectives</h4>We assessed the influence of stimulation duration, disease duration, and age at surgery on QoL after STN-DBS.<h4>Methods</h4>We systematically searched for studies r ...[more]

PMID: 31538085

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Project description:BackgroundNo clinical trials have been specifically designed to compare medical treatments after surgery in Parkinson's disease (PD).ObjectiveStudy's objective was to compare the efficacy and safety of levodopa versus dopamine agonist monotherapy after deep brain stimulation (DBS) in PD.MethodsThirty-five surgical candidates were randomly assigned to receive postoperative monotherapy with either levodopa or dopamine agonist in a randomized, single-blind study. All patients were reevaluated in short- (3 months), mid- (6 months), and long-term (2.5 years) follow-up after surgery. The primary outcome measure was the change in the Non-Motor Symptoms Scale (NMSS) 3 months after surgery. Secondary outcome measures were the percentage of patients maintaining monotherapy, change in motor symptoms, and specific non-motor symptoms (NMS). Analysis was performed primarily in the intention-to-treat population.ResultsRandomization did not significantly affect the primary outcome (difference in NMSS between treatment groups was 4.88 [95% confidence interval: -11.78-21.53, P = 0.566]). In short- and mid-term follow-up, monotherapy was safe and feasible in more than half of patients (60% in short- and 51.5% in mid-term follow-up), but it was more often possible for patients on levodopa. The ability to maintain dopamine agonist monotherapy was related to optimal contact location. In the long term, levodopa monotherapy was feasible only in a minority of patients (34.2%), whereas dopamine agonist monotherapy was not tolerated due to worsening of motor conditions or occurrence of impulse control disorders.ConclusionsThis trial provides evidence for simplifying pharmacological treatment after functional neurosurgery for PD. The reduction in dopamine receptor agonists should be attempted while monitoring for occurrence of NMSs, such as apathy and sleep disturbances. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Dataset Information

The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta-Analysis.

Publications

The Evolution of Quality of Life After Subthalamic Stimulation for Parkinson's Disease: A Meta-Analysis.

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