1. Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease
- Author
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Gereon R. Fink, Daniel Weintraub, Pablo Martinez-Martin, Michael T. Barbe, J. Carlos Baldermann, K. Ray Chaudhuri, Philipp Alexander Loehrer, Salima Aloui, Haidar S. Dafsari, Veerle Visser-Vandewalle, Stefanie T Jost, Jan N. Petry-Schmelzer, Shania Heil, Johanna Herberg, Lars Timmermann, Daniel Huys, Christopher Nimsky, Anna Sauerbier, Lisa Klingelhoefer, Pia Bachon, and Alexandra Gronostay
- Subjects
Male ,medicine.medical_specialty ,Post hoc ,Deep Brain Stimulation ,Disease ,symbols.namesake ,Rating scale ,Subthalamic Nucleus ,Internal medicine ,Medicine ,Humans ,In patient ,ddc:610 ,Prospective Studies ,Aged ,Movement Disorders ,business.industry ,Parkinson Disease ,Middle Aged ,Psychiatry and Mental health ,Bonferroni correction ,Subthalamic stimulation ,Brain stimulation ,Impulsive Behavior ,symbols ,Compulsive Behavior ,Quality of Life ,Surgery ,Compulsive behaviour ,Female ,Neurology (clinical) ,business - Abstract
BackgroundThe effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson’s disease (PD) are understudied.ObjectiveTo investigate clinical predictors of STN-DBS effects on ICB.MethodsIn this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into ‘QUIP-RS improvement or worsening’ and analysed between-group differences.ResultsWe included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the ‘QUIP-RS worsening’ group had more severe baseline impairment in the NMSS attention/memory domain.ConclusionsOur results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS.Trial registration numberDRKS00006735.
- Published
- 2021
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