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Movement Disorders, Parkinson's Disease
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Deep Brain Stimulation in Parkinson’s Disease – Impact on Quality of Life

Published Online: July 15th 2012 European Neurological Review, 2012;7(Suppl. 1):27–30 DOI: http://doi.org/10.17925/ENR.2012.07.S1.27
Authors: Mathias Toft
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Abstract:
Overview

Health-related quality of life (HRQoL) is reduced in Parkinson’s disease patients. Deep brain stimulation (DBS) is an established treatment for motor problems and motor fluctuations in advanced Parkinson’s disease. Three randomised trials were recently conducted to assess the effects of DBS on HRQoL. All studies found improvements in HRQoL after surgery. DBS of the subthalamic nucleus and the globus pallidus interna improved HRQoL to a similar degree. However, in the long-term, such improvements may not be maintained, perhaps because HRQoL is a subjective measure and subjective perceptions of disability may change over time. DBS has proven long-term efficacy on motor symptoms, and the decline in benefit over time may also be explained by progression in the non-motor symptoms of the disease. Several predictors of HRQoL improvements after DBS have been identified, including good levodopa response, young age and good cognitive function.

Keywords

Parkinson’s disease, continuous dopaminergic stimulation, deep brain stimulation, health-related quality of life, motor fluctuations

Article:

Health-related Quality of Life in Parkinson’s Disease
In general, measures of Parkinson’s disease (PD) symptoms, biomedical markers or survival do not cover every aspect of the disease relevant or important to the patient. Health-related quality of life (HRQoL) is defined as the perception and evaluation by the patient of the impact that the illness and its consequences has had on their life. Therefore, it is a subjective measurement, but one that helps in providing a more rounded picture of the effects of a disease on the patient. Several forms and questionnaires have been developed to measure HRQoL, including generic forms such as the Short-Form 36 Health Survey (SF-36), and disease-specific forms such as the 39-item Parkinson’s Disease Questionnaire (PDQ-39).

HRQoL is reduced in PD patients. In a study that measured HRQoL using the Nottingham Health Profile in 233 PD patients and 100 healthy elderly people, PD patients had lower HRQoL in all measured dimensions (emotional reactions, energy, pain, physical mobility, sleep, social isolation and total score of the Nottingham Health Profile) compared with the healthy elderly people.1

Many factors in PD could impact on HRQoL, such as motor symptoms, non-motor symptoms (NMS), disability, social functioning limitations and drug side-effects. A study showed that a decline in physical mobility was the most important single factor contributing to worsening HRQoL in people with PD during long-term follow-up.2 It also showed that a deterioration in NMS, when taken together, had a greater impact on overall HRQoL than a decrease in physical mobility. In addition, poor HRQoL was predicted by more advanced disease, greater severity of depressive symptoms and presence of insomnia.

Changes in Health-related Quality of Life after Deep Brain Stimulation
Thousands of patients have been treated with deep brain stimulation (DBS) since the first procedure in 1993, and clinical results on motor symptoms and motor complications have been reported in a large number of publications.3 In the last few years, there have been three randomised studies that used measurements of HRQoL as important endpoints.4–6

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Disclosure

Mathias Toft has received consulting and lecturing fees from Medtronic, Inc. and lecturing fees/travel support from Abbott, Lundbeck, Sanofi-Aventis, GlaxoSmithKline, Desitin, Orion and UCB.

Correspondence

Mathias Toft, Department of Neurology, Oslo University Hospital – Rikhospitalet, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway. E: mathias.toft@ous-hf.no

Support

The V International Forum on Parkinson’s Disease (Helsinki, Finland, 6–7 May 2011) was funded by an unrestricted educational grant from Abbott. Abbott funded the development of this supplement by ESP Bioscience (Crowthorne, UK). Emily Chu and Nicole Meinel of ESP Bioscience provided medical writing and editorial support to the author in the development of this publication. Abbott had the opportunity to review and comment on the publication’s content; however, all decisions regarding content were made by the author.

Received

2013-06-22T00:00:00

References

  1. Karlsen KH, Larsen JP, Tandberg E, et al., Influence of clinical and demographic variables on quality of life in patients with Parkinson’s disease, J Neurol Neurosurg Psychiatry, 1999;66:431–5.
  2. Forsaa EB, Larsen JP, Wentzel-Larsen T, et al., Predictors and course of health-related quality of life in Parkinson’s disease, Mov Disord, 2008;23:1420–7.
  3. Lyons MK, Deep brain stimulation: current and future clinical applications, Mayo Clin Proc, 2011;86:662–72.
  4. 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.
  5. Follett KA, Weaver FM, Stern M, et al., Pallidal versus subthalamic deep-brain stimulation for Parkinson’s disease, N Engl J Med, 2010;362:2077–91.
  6. Williams A, Gill S, Varma T, et al., Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial, Lancet Neurol, 2010;9:581–91.
  7. 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.
  8. Toft M, Lilleeng B, Ramm-Pettersen J, et al., Long-term efficacy and mortality in Parkinson’s disease patients treated with subthalamic stimulation, Mov Disord, 2011;26:1931–4.
  9. Volkmann J, Albanese A, Kulisevsky J, et al., Long-term effects of pallidal or subthalamic deep brain stimulation on quality of life in Parkinson’s disease, Mov Disord, 2009;24:1154–61.
  10. Smeding HM, Speelman JD, Huizenga HM, et al., Predictors of cognitive and psychosocial outcome after STN DBS in Parkinson’s Disease, J Neurol Neurosurg Psychiatry, 2011;82:754–60.
  11. Derost PP, Ouchchane L, Morand D, et al., Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population?, Neurology, 2007;68:1345–55.
  12. Schüpbach WM, Maltête D, Houeto JL, Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial, Neurology, 2007;68:267–71.

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