Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease

Medientyp: E-Artikel

Titel: Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease

Beteiligte: Sauerbier, Anna [VerfasserIn]; Loehrer, Philipp [VerfasserIn]; Baldermann, J. Carlos [VerfasserIn]; Huys, Daniel [VerfasserIn]; Nimsky, Christopher [VerfasserIn]; Barbe, Michael T. [VerfasserIn]; Fink, Gereon R. [VerfasserIn]; Martinez-Martin, Pablo [VerfasserIn]; Ray Chaudhuri, K. [VerfasserIn]; Visser-Vandewalle, Veerle [VerfasserIn]; Timmermann, Lars [VerfasserIn]; Weintraub, Daniel [VerfasserIn]; Jost, Stefanie T. [VerfasserIn]; Dafsari, Haidar S. [VerfasserIn]; Heil, Shania [VerfasserIn]; Petry-Schmelzer, Jan N. [VerfasserIn]; Herberg, Johanna [VerfasserIn]; Bachon, Pia [VerfasserIn]; Aloui, Salima [VerfasserIn]; Gronostay, Alexandra [VerfasserIn]; Klingelhoefer, Lisa [VerfasserIn]

Erschienen: BMJ Publishing Group, 2021

Sprache: Englisch

DOI: https://doi.org/10.1136/jnnp-2021-326131

ISSN: 0368-329X; 0266-8637; 1468-330X; 0022-3050

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Beschreibung: Background The effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson’s disease (PD) are understudied.Objective To investigate clinical predictors of STN-DBS effects on ICB.Methods In this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into ‘QUIP-RS improvement or worsening’ and analysed between-group differences.Results We included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the ‘QUIP-RS worsening’ group had more severe baseline impairment in the NMSS attention/memory domain.Conclusions Our results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS.

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