La estimulación subtalámica mejora la calidad de vida en pacientes de 61 años o más con Enfermedad de Parkinson de corta duración.: Publicado originalmente en la Revista Neuromodulation 2018; 21: 532-540.  Traducción: Neurotarget.

Haidar Salimi Dafsari; Paul Reker; Monty Silverdale; Prashanth Reddy; Manuela Pilleri; Pablo Martínez-Martin; Alexandra Rizos; Estelle Perrier; Luisa Weiß; Keyoumars Ashkan; Michael Samuel; Julian Evans; Veerle Visser-Vandewalle; Angelo Antonini; Kallol Ray-Chaudhuri; Lars Timmermann

doi:10.47924/neurotarget201954

Authors

Haidar Salimi Dafsari Department of Neurology, University Hospital Cologne, Cologne, Germany.
Paul Reker Department of Neurology, University Hospital Cologne, Cologne, Germany.
Monty Silverdale Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Prashanth Reddy National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
Manuela Pilleri Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy.
Pablo Martínez-Martin National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain.
Alexandra Rizos National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
Estelle Perrier Department of Neurology, University Hospital Cologne, Cologne, Germany.
Luisa Weiß Department of Neurology, University Hospital Cologne, Cologne, Germany.
Keyoumars Ashkan National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
Michael Samuel National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
Julian Evans Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Veerle Visser-Vandewalle Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany.
Angelo Antonini Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy.
Kallol Ray-Chaudhuri National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.
Lars Timmermann Department of Neurology, University Hospital Cologne, Cologne, Germany.

DOI:

https://doi.org/10.47924/neurotarget201954

Keywords:

Age, EARLYSTIM, Parkinson's disease questionnaire, deep brain stimulation, subthalamic nucleus

Abstract

Objective: The optimal timing of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) is a topic of ongoing debate. In patients with short disease duration an improvement of quality of life (QoL) has been demonstrated for patients aged younger than 61 years. However, this has not been systematically investigated in older patients yet. We hypothesized that patients aged 61 years or older experience a significant QoL improvement after STN-DBS with no difference in effect sizes for groups of patients with short and longer disease duration.

Materials and methods: From four centers (Cologne, London, Manchester, Venice) we identified "older patients" aged 61 years or older with short (≤8 years) or longer disease duration and compared QoL, motor impairment, complications, medication requirements, and Mini-Mental State Examination (MMSE) on baseline and five months after surgery.

Results: Mean age/disease duration in 21 subjects with shorter disease duration were 65.5/6.3 years compared to 66.8/14.6 in 33 subjects with longer disease duration. The short disease duration group was affected by less baseline motor complications (p = 0.002). QoL in the short/longer disease duration group improved by 35/20% (p = 0.010/p = 0.006), motor complications by 40/44% (p = 0.018/p < 0.001), and medication requirements by 51/49% (both p < 0.001). MMSE remained unchanged in both groups.

Conclusion: Patients aged 61 years or older benefited from STN-DBS regardless of short (≤8 years) or longer (>8 years) disease duration. Our results contribute to the debate about DBS selection criteria and timing and call for prospective confirmation in a larger cohort.

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References

Krack P, Batir A, Van Blercom N et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003;349:1925–1934.

Deuschl G, Schade-Brittinger C, Krack P et al. A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006;355:896–908.

Kleiner-Fisman G, Herzog J, Fisman DN et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 2006;21(Suppl 14): S290–S304.

Okun MS, Gallo BV, Mandybur G et al. Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 2012;11:140–149.

Follett KA, Weaver FM, Stern M et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease. N Engl J Med 2010;362:2077–2091.

Schuepbach WM, Rau J, Knudsen K et al. Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 2013;368:610–622.

Schupbach WM, Rau J, Houeto JL et al. Myths and facts about the EARLYSTIM study. Mov Disord 2014;29:1742–1750. Charles D, Konrad PE, Davis TL, Neimat JS, Hacker ML, Finder SG. Deep brain stimulation in early stage Parkinson’s disease. Parkinsonism Relat Disord 2015;21:347–348.

Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2014;29:1583–1590.

Derost PP, Ouchchane L, Morand D et al. Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population? Neurology 2007;68:1345–1355.

Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181–184.

Dembek TA, Reker P, Visser-Vandewalle V et al. Directional DBS increases side-effect thresholds-A prospective, double-blind trial. Mov Disord 2017;32:1380–1388.

Dafsari HS, Reddy P, Herchenbach C et al. Beneficial effects of bilateral subthalamicstimulation on non-motor symptoms in Parkinson’s disease. Brain Stimul 2016;9:78–85.

Storch A, Schneider CB, Wolz M et al. Nonmotor fluctuations in Parkinson disease: severity and correlation with motor complications. Neurology 2013;80:800–809.

Martinez-Martin P, Jeukens-Visser M, Lyons KE et al. Health-related quality-of-life scales in Parkinson’s disease: critique and recommendations. Mov Disord 2011;26:2371–2380.

Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N. The PDQ-8: development and validation of a short-form Parkinson’s disease questionnaire. Psychol Health 1997;12:805–814.

Goetz CG, Tilley BC, Shaftman SR et al. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008;23:2129–2170.

Marinus J, Visser M, Stiggelbout AM et al. A short scale for the assessment of motor impairments and disabilities in Parkinson’s disease: the SPES/SCOPA. J Neurol Neurosurg Psychiatry 2004;75:388–395.

Martinez-Martin P, Benito-Leon J, Burguera JA et al. The SCOPA-Motor Scale for assessment of Parkinson’s disease is a consistent and valid measure. J Clin Epidemiol 2005;58:674–679.

Verbaan D, van Rooden SM, Benit CP, van Zwet EW, Marinus J, van Hilten JJ. SPES/ SCOPA and MDS-UPDRS: formulas for converting scores of two motor scales in Parkinson’s disease. Parkinsonism Relat Disord 2011;17:632–634.

Hentz JG, Mehta SH, Shill HA, Driver-Dunckley E, Beach TG, Adler CH. Simplified conversion method for unified Parkinson’s disease rating scale motor examinations. Mov Disord 2015;30:1967–1970.

Tomlinson CL, Stowe R, Patel S, Rick C, Gray R, Clarke CE. Systematic review of levodopa dose equivalency reporting in Parkinson’s disease. Mov Disord 2010;25:2649–2653.

Martinez-Martin P, Kurtis MM. Health-related quality of life as an outcome variable in Parkinson’s disease. Ther Adv Neurol Disord 2012;5:105–117.

Luo N, Tan LC, Zhao Y, Lau PN, Au WL, Li SC. Determination of the longitudinal validity and minimally important difference of the 8-item Parkinson’s Disease Questionnaire (PDQ-8). Mov Disord 2009;24:183–187.

Dafsari HS, Reker P, Stalinski L et al. Quality of life outcome after subthalamic stimulation in Parkinson’s disease depends on age. Mov Disord 2017. doi: 10.1002/ mds.27222.

Daniels C, Krack P, Volkmann J et al. Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson’s disease predictable? Mov Disord 2011; 26:2516–2521.

Ory-Magne F, Brefel-Courbon C, Simonetta-Moreau M et al. Does ageing influence deep brain stimulation outcomes in Parkinson’s disease? Mov Disord 2007;22:1457– 1463.

Schupbach WM, Maltete D, Houeto JL et al. Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial. Neurology 2007;68:267–271.

Fenoy AJ, Simpson RK. Jr. Risks of common complications in deep brain stimulation surgery: management and avoidance. J Neurosurg 2014;120:132–139.

Mestre TA, Espay AJ, Marras C, Eckman MH, Pollak P, Lang AE. Subthalamic nucleus-deep brain stimulation for early motor complications in Parkinson’s disease-the EARLYSTIM trial: early is not always better. Mov Disord 2014;29:1751–1756.

Sperens M, Hamberg K, Hariz GM. Are patients ready for “EARLYSTIM”? Attitudes towards deep brain stimulation among female and male patients with moderately advanced Parkinson’s disease. Parkinsons Dis 2017;2017:1939831.

Fundament T, Eldridge PR, Green AL et al. Deep brain stimulation for Parkinson’s disease with early motor complications: a UK cost-effectiveness analysis. PLoS One 2016;11:e0159340.

DeLong MR, Huang KT, Gallis J et al. Effect of advancing age on outcomes of deep brain stimulation for Parkinson disease. JAMA Neurol 2014; 71:1290–1295.

Charles PD, Van Blercom N, Krack P et al. Predictors of effective bilateral subthalamic nucleus stimulation for PD. Neurology 2002;59:932–934.

Umemura A, Oka Y, Okita K, Toyoda T, Matsukawa N, Yamada K. Predictive factors affecting early deterioration of axial symptoms after subthalamic nucleus stimulation in Parkinson’s disease. Parkinsonism Relat Disord 2010;16:582–584.

Weaver FM, Follett K, Stern M et al. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 2009;301:63–73.

Rughani AI, Hodaie M, Lozano AM. Acute complications of movement disorders surgery: effects of age and comorbidities. Mov Disord 2013;28:1661–1667.

Shalash A, Alexoudi A, Knudsen K, Volkmann J, Mehdorn M, Deuschl G. The impact of age and disease duration on the long term outcome of neurostimulation of the subthalamic nucleus. Parkinsonism Relat Disord 2014;20:47–52.

Fasano A, Romito LM, Daniele A et al. Motor and cognitive outcome in patients with Parkinson’s disease 8 years after subthalamic implants. Brain 2010;133:2664–2676.

Kurtis MM, Rajah T, Delgado LF, Dafsari HS. The effect of deep brain stimulation the non-motor symptoms of Parkinson’s disease: a critical review of the current evidence. NPJ Parkinsons Dis 2017;3:16024.

Hariz GM, Lindberg M, Hariz MI, Bergenheim AT. Gender differences in disability and health-related quality of life in patients with Parkinson’s disease treated with stereotactic surgery. Acta Neurol Scand 2003;108:28–37.

Hamberg K, Hariz GM. The decision-making process leading to deep brain stimulation in men and women with parkinson’s disease - an interview study. BMC Neurol 2014;14:89.

Setiawan M, Kraft S, Doig K et al. Referrals for movement disorder surgery: under-representation of females and reasons for refusal. Can J Neurol Sci 2006; 33:53–57.

Schrag A, Quinn N. Dyskinesias and motor fluctuations in Parkinson’s disease. A community-based study. Brain 2000;123:2297–2305.