The impact of subthalamic deep-brain stimulation in restoring motor symmetry in Parkinson’s disease patients: a prospective study

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发表日期：

2024年2月9日

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Raquel Pinheiro Barbosa,
Caroline Moreau,
Anne Sophie Rolland,
Olivier Rascol,
Christine Brefel-Courbon,
Fabienne Ory-Magne,
Paulo Bastos,
Amaury de Barros,
Elodie Hainque,
Tiphaine Rouaud,
Ana Marques,
Alexandre Eusebio,
Isabelle Benatru,
Sophie Drapier,
Dominique Guehl,
David Maltete,
Christine Tranchant,
Thomas Wirth,
Caroline Giordana,
Melissa Tir,
Stephane Thobois,
Lucie Hopes,
Cecile Hubsch,
Bechir Jarraya,
Jean Christophe Corvol,
Matthieu Bereau,
David Devos,
Margherita Fabbri

摘要

Background and objectives

The impact of subthalamic deep-brain stimulation (STN-DBS) on motor asymmetry and its influence on both motor and non-motor outcomes remain unclear. The present study aims at assessing the role of STN-DBS on motor asymmetry and how its modulation translates into benefits in motor function, activities of daily living (ADLs) and quality of life (QoL).

Methods

Postoperative motor asymmetry has been assessed on the multicentric, prospective Predictive Factors and Subthalamic Stimulation in Parkinson’s Disease cohort. Asymmetry was evaluated at both baseline (pre-DBS) and 1 year after STN-DBS. A patient was considered asymmetric when the right-to-left MDS-UPDRS part III difference was ≥ 5. In parallel, analyses have been carried out using the absolute right-to-left difference. The proportion of asymmetric patients at baseline was compared to that in the post-surgery evaluation across different medication/stimulation conditions.

Results

537 PD patients have been included. The proportion of asymmetric patients was significantly reduced after both STN-DBS and medication administration (asymmetric patients: 50% in pre-DBS MedOFF, 35% in MedOFF/StimON, 26% in MedON/StimOFF, and 12% in MedON/StimON state). Older patients at surgery and with higher baseline UPDRS II scores were significantly less likely to benefit from STN-DBS at the level of motor asymmetry. No significant correlation between motor asymmetry and ADLs (UPDRS II) or overall QoL (PDQ-39) score was observed. Asymmetric patients had significantly higher mobility, communication, and daily living PDQ-39 sub-scores.

Conclusions

Both STN-DBS and levodopa lead to a reduction in motor asymmetry. Motor symmetry is associated with improvements in certain QoL sub-scores.