Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus.
While deep brain stimulation (DBS) surgery is a well-accepted treatment for Parkinson disease (PD) that improves overall quality of life (QoL), its effects across different domains of QoL are unclear. The study reported here directly compared the effects of unilateral DBS in subthalamic nucleus (STN) or globus pallidus (GPi) on QoL in 42 non-demented patients with medication-refractory PD. Patients were enrolled in the COMPARE trial, a randomized clinical trial of cognitive and mood effects of STN versus GPi DBS conducted at the University of Florida Movement Disorders Center. Patients underwent motor, mood, verbal fluency and QoL (Parkinson disease questionnaire: PDQ-39) measures before and 6 months following surgery. Groups experienced motor and mood improvements that did not differ by target. Patients with STN DBS evidenced a slight decrement on letter fluency. On average, all patients endorsed better overall QoL after surgery. However, despite similar motor and mood improvements, GPi patients improved more than STN patients (38 vs. 14%, respectively; P = 0.03). Patients reported better QoL on subscales of mobility, activities of daily living (ADLs), emotional well-being, stigma, cognition and discomfort, but not on those of social support and communication. Improvements on the mobility, ADLs, stigma and social support subscales were greater amongst GPi patients. In regression analyses, only depression changes independently predicted changes in overall QoL as well as emotional well-being and social support changes. Within the STN group only, declining category fluency scores correlated with poorer QoL on the communication subscale. Unilateral DBS in both STN and GPi improved QoL overall and in disparate domains 6 months after surgery. Patients receiving GPi DBS reported greater improvements that cannot be explained by differential mood or motor effects; however, verbal fluency changes may have partially contributed to lesser QoL improvements amongst STN patients.
Zahodne
Laura B
LB
Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610-0165, USA. lzahodne@phhp.ufl.edu
Okun
Michael S
MS
Foote
Kelly D
KD
Fernandez
Hubert H
HH
Rodriguez
Ramon L
RL
Wu
Samuel S
SS
Kirsch-Darrow
Lindsey
L
Jacobson
Charles E
CE
Rosado
Christian
C
Bowers
Dawn
D
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D001037:Aphasia / Q000209:etiology / Q000628:therapy; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy; D046690:Deep Brain Stimulation / Q000379:methods*; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy; D004351:Drug Resistance / Q000502:physiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D005917:Globus Pallidus / Q000033:anatomy & histology / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology / Q000628:therapy; D009434:Neural Pathways / Q000033:anatomy & histology / Q000502:physiology; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology; D020531:Subthalamic Nucleus / Q000033:anatomy & histology / Q000502:physiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome