title: Subjective perceived outcome of subthalamic deep brain stimulation in Parkinson's disease one year after surgery.
abstract: OBJECTIVE
  Dissatisfaction with subthalamic deep brain stimulation (STN-DBS) despite motor improvements has been observed in Parkinson's disease (PD). Hence, we compared patient's subjective perceived outcome 12 months after surgery (12mFU) with clinical measures to identify risk factors of dissatisfaction.
  
  
  METHODS
  Patients were examined at baseline and 12mFU. Quality of life (QoL), neuropsychiatric, cognitive and neurological functioning was measured. Patients were classified concerning their subjective outcome (negative = dissatisfaction; mixed; positive = satisfaction) at 12mFU using semi-structured interviews. First, the three groups were compared concerning interview statements. Second, repeated measures ANOVAs with group as between-subjects factor were applied to find significant effects of time, group, or interaction. Third, binary logistic regression determined predictors of dissatisfaction.
  
  
  RESULTS
  Of the 28 enrolled patients, 25% perceived their outcome as negative, 32.1% as mixed, and 42.9% as positive. Concerning interview statements, dissatisfied patients mentioned significantly less often improved QoL and reduced medication, and reported worsening of mental state, and social interaction. For the whole sample, significant improvement over time was found for motor functioning, daily dopamine dosages, and QoL. Apathy significantly worsened over time, but dissatisfied patients were overall more apathetic and depressed than the other groups. Significant interaction of group and time was identified for QoL, which only improved in the mixed and satisfied group. Finally, preoperative apathy and axial symptoms predicted dissatisfaction with STN-DBS.
  
  
  CONCLUSIONS
  Although motor symptoms and QoL improved in the whole sample, 25% of patients showed disappointment with STN-DBS. Especially apathy predicts dissatisfaction and should be considered preoperatively.
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany. Electronic address: franziska.maier@uk-koeln.de.
authors.forename: Franziska
authors.initials: F
authors.lastname: Maier
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany.
authors.forename: Catharine J
authors.initials: CJ
authors.lastname: Lewis
authors.affiliation: Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Horstkoetter
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Eggers
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany.
authors.forename: Till A
authors.initials: TA
authors.lastname: Dembek
authors.affiliation: Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany.
authors.forename: Veerle
authors.initials: V
authors.lastname: Visser-Vandewalle
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
authors.affiliation: Department of Psychiatry, University of Toronto, University Health Network, Toronto, Canada.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Zurowski
authors.affiliation: Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.affiliation: Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Woopen
authors.affiliation: Department of Neurology, University of Cologne, Cologne, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D057565:Apathy / Q000502:physiology; D046690:Deep Brain Stimulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000523:psychology* / Q000628:therapy*; D010465:Perception / Q000502:physiology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
keywords: Apathy; Deep brain stimulation; Interviews; Outcome assessment; Parkinson's disease