title: Long-term effects of bilateral subthalamic nucleus stimulation on health-related quality of life in advanced Parkinson's disease.
abstract: We evaluated the long-term effects of subthalamic nucleus (STN) stimulation on health-related quality of life (HRQL) in patients with advanced Parkinson's disease (PD). STN stimulation improves motor function and decreases medication requirements in patients with advanced PD. The impact of STN stimulation on HRQL is less well established, especially beyond 1 year after surgery. We report HRQL outcomes for 18 patients with advanced PD. Patients were evaluated with the Parkinson's Disease Questionnaire-39 (PDQ-39), the Medical Outcome Study Short Form (SF-36), and the EuroQol visual analogue scale (VAS) before surgery, 6 months postoperatively, and at a long-term follow-up visit (mean, 35.9 months; range, 18-57 months after surgery). Preoperative scores on HRQL measures were compared to results obtained at short- and long-term follow-up evaluations. The VAS and all domains of the PDQ-39 except for cognition, communication, and social support showed marked improvements at 6 months after surgery. At the long-term follow-up, there were sustained improvements in the VAS (63% improvement; P = 0.0009) and in several domains of the PDQ-39 [mobility: 20%, P = 0.01; activities of daily living (ADL): 29%, P = 0.005; emotional well-being: 26%, P = 0.02; stigma: 43%, P = 0.003; and bodily discomfort: 35%, P = 0.007]. At the long-term evaluation, only the vitality domain of the SF-36 was significantly improved from baseline (16%; P = 0.01). In this selected group of patients, many of the short-term gains in HRQL persist beyond 18 months after STN implantation. Benefits in nonmotor aspects of HRQL such as bodily discomfort and stigma appear to be among the most durable.
authors.affiliation: Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19107, USA. adsiderowf@pahosp.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Siderowf
authors.forename: Jurg L
authors.initials: JL
authors.lastname: Jaggi
authors.forename: Sharon X
authors.initials: SX
authors.lastname: Xie
authors.forename: Catherine
authors.initials: C
authors.lastname: Loveland-Jones
authors.forename: Lewis
authors.initials: L
authors.lastname: Leng
authors.forename: Howard
authors.initials: H
authors.lastname: Hurtig
authors.forename: Amy
authors.initials: A
authors.lastname: Colcher
authors.forename: Matthew
authors.initials: M
authors.lastname: Stern
authors.forename: Kelvin L
authors.initials: KL
authors.lastname: Chou
authors.forename: Grace
authors.initials: G
authors.lastname: Liang
authors.forename: Heather
authors.initials: H
authors.lastname: Maccarone
authors.forename: Tanya
authors.initials: T
authors.lastname: Simuni
authors.forename: Gordon
authors.initials: G
authors.lastname: Baltuch
mesh_terms: D000328:Adult; D000368:Aged; D003071:Cognition; D046690:Deep Brain Stimulation / Q000379:methods*; D004644:Emotions; D005260:Female; D006304:Health Status; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D007980:Levodopa