title: Long-term impact on quality of life of subthalamic nucleus stimulation in Parkinson's disease.
abstract: Long-term impact of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on health-related quality of life (HRQOL) and associated factors in patients with Parkinson's disease (PD) are not clear. In this prospective study, we included 69 PD patients (64 % men, mean age 61.3 ± 7.4 and disease duration 13.2 ± 5.7 years) undergoing STN-DBS. They were evaluated preoperatively (baseline), 1 and 5 years postoperatively assessing 39-item Parkinson's Disease Questionnaire (PDQ-39), Schwab and England Activities of Daily Living Scale (SEADL), Unified Parkinson's Disease Rating Scale (UPDRS) off- and on-medication, patient diaries, dopaminergic treatment, mortality and surgical complications. Five years postoperatively, off-medication, there were improvements from baseline in UPDRS-II and III total (27.2 and 26.7 %, respectively) and SEADL (18.6 % more completely independent patients) (p < 0.05) scores, while on-medication, there was a deterioration in UPDRS-III (37.8 %, mainly axial signs) (p < 0.05) and minor improvements in SEADL (3.7 %). While at 1 year PDQ-39, the summary index improved substantially (36.5 %) (p < 0.05), at 5 years patients regressed (only 8.8 %) (p < 0.05), though changes in PDQ-39 subscores remained significant, with improvements in ADL (18.8 %), emotional well-being (19.0 %), stigma (36.4 %) and discomfort (20.6 %), despite worsening in communication (47.8 %) (p < 0.05). Lower preoperative PDQ-39 summary index and greater 1-year UPDRS-III-off total score gain predicted better long-term HRQOL. STN-DBS produces long-term improvements in HRQOL in PD. Preoperative HRQOL and short-term postoperative changes in off-medication motor status may predict long-term HRQOL in PD following STN-DBS.
authors.affiliation: Neurology Department, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain.|Neurodegenerative Diseases Group, BioCruces Health Research Institute, Barakaldo, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Lezcano
authors.affiliation: Neurology Department, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain. JUANCARLOS.GOMEZESTEBAN@osakidetza.eus.|Neurodegenerative Diseases Group, BioCruces Health Research Institute, Barakaldo, Spain. JUANCARLOS.GOMEZESTEBAN@osakidetza.eus.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Gómez-Esteban
authors.affiliation: Neurology Department, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain.|Neurodegenerative Diseases Group, BioCruces Health Research Institute, Barakaldo, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Tijero
authors.affiliation: Neurosurgery Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Gaizka
authors.initials: G
authors.lastname: Bilbao
authors.affiliation: Neurophysiology Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Imanol
authors.initials: I
authors.lastname: Lambarri
authors.affiliation: Radiology Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Olivia
authors.initials: O
authors.lastname: Rodriguez
authors.affiliation: Radiology Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Villoria
authors.affiliation: Radiology Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Ainara
authors.initials: A
authors.lastname: Dolado
authors.affiliation: Neurology Department, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain.|Neurodegenerative Diseases Group, BioCruces Health Research Institute, Barakaldo, Spain.
authors.forename: Koldo
authors.initials: K
authors.lastname: Berganzo
authors.affiliation: Neurology Department, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Molano
authors.affiliation: Neurosurgery Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Edurne Ruiz
authors.initials: ER
authors.lastname: de Gopegui
authors.affiliation: Neurosurgery Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Iñigo
authors.initials: I
authors.lastname: Pomposo
authors.affiliation: Neurodegenerative Diseases Group, BioCruces Health Research Institute, Barakaldo, Spain.|Neuropsychology of Severe Medical Conditions, Deusto University, Bilbao, Spain.
authors.forename: Iñigo
authors.initials: I
authors.lastname: Gabilondo
authors.affiliation: Neurology Department, Cruces University Hospital, Plaza de Cruces s/n, 48903, Barakaldo, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Zarranz
mesh_terms: D000203:Activities of Daily Living; D000978:Antiparkinson Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D003863:Depression / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000503:physiopathology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents
keywords: Deep brain stimulation; LEDD; Parkinson’s disease; Quality of life; Subthalamic nucleus