Journal article
Effects of bilateral stimulation of the subthalamic nucleus in Parkinson's disease with and without REM sleep behaviour disorder.
- Bargiotas P Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland pabargio@yahoo.gr.
- Debove I Movement Disorders Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.
- Bargiotas I Center of Applied Mathematics, ENS Cachan, CNRS, Paris, France.
- Lachenmayer ML Movement Disorders Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.
- Ntafouli M Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.
- Vayatis N Center of Applied Mathematics, ENS Cachan, CNRS, Paris, France.
- Schüpbach MW Movement Disorders Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.
- Krack P Movement Disorders Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.
- Bassetti CL Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.
- 2019-08-19
Published in:
- Journal of neurology, neurosurgery, and psychiatry. - 2019
Parkinson’s disease
REM sleep behavior disorder (RBD)
non-motor symptoms
quality of life
subthalamic deep brain stimulation
Activities of Daily Living
Aged
Apathy
Deep Brain Stimulation
Depression
Female
Humans
Male
Mental Status and Dementia Tests
Middle Aged
Parkinson Disease
Polysomnography
Psychiatric Status Rating Scales
Quality of Life
REM Sleep Behavior Disorder
Retrospective Studies
Subthalamic Nucleus
Treatment Outcome
English
BACKGROUND
Although rapid eye movement sleep behaviour disorder (RBD) in Parkinson's disease (PD) is associated with increased non-motor symptoms, its impact on the deep brain stimulation (DBS) outcome remains unclear. This is the first study to compare the post-DBS outcome between PD patients with RBD (PD-RBD+) and without (PD-RBD-).
METHODS
We analysed data from PD patients who were treated with bilateral DBS in the nucleus subthalamicus. Assessments included night-polysomnography (only pre-DBS), and motor and non-motor assessments pre-DBS and post-DBS.
RESULTS
Among 50 PD patients (29 males, mean age 62.5 years, 11.8 mean PD years), 24 (48%) had RBD. Pre-DBS, the two groups were equal in respect to sociodemographic features, disease duration and PD medications. A multivariate analysis showed that the clinical profile linked to motor, non-motor and quality of life features differed significantly between PD patients with and without RBD. The most discriminative elements were Unified Parkinson's Disease Rating Scale (UPDRS)-III, apathy and depression scores. Post-DBS, UPDRS-III, Epworth sleepiness scale and PD questionnaire improved significantly in both groups. UPDRS-II scores significantly improved in the PD-RBD+ group (-45%) but remained unchanged in the PD-RBD- group (-14%). The depression score improved significantly in the PD-RBD+ (-34%) and remained unchanged in the PD-RBD- group. The apathy score remained unchanged in the PD-RBD+ group but increased significantly in the PD-RBD- group (+33%).
CONCLUSION
While pre-DBS, PD patients with and without RBD showed different clinical profiles, post-DBS, the clinical profiles were comparable between the two groups. In respect to depressive symptoms, apathy and activities of daily living, PD-RBD+ patients show favourable post-DBS outcome. These findings highlight the importance of RBD assessment prior to DBS surgery.
Although rapid eye movement sleep behaviour disorder (RBD) in Parkinson's disease (PD) is associated with increased non-motor symptoms, its impact on the deep brain stimulation (DBS) outcome remains unclear. This is the first study to compare the post-DBS outcome between PD patients with RBD (PD-RBD+) and without (PD-RBD-).
METHODS
We analysed data from PD patients who were treated with bilateral DBS in the nucleus subthalamicus. Assessments included night-polysomnography (only pre-DBS), and motor and non-motor assessments pre-DBS and post-DBS.
RESULTS
Among 50 PD patients (29 males, mean age 62.5 years, 11.8 mean PD years), 24 (48%) had RBD. Pre-DBS, the two groups were equal in respect to sociodemographic features, disease duration and PD medications. A multivariate analysis showed that the clinical profile linked to motor, non-motor and quality of life features differed significantly between PD patients with and without RBD. The most discriminative elements were Unified Parkinson's Disease Rating Scale (UPDRS)-III, apathy and depression scores. Post-DBS, UPDRS-III, Epworth sleepiness scale and PD questionnaire improved significantly in both groups. UPDRS-II scores significantly improved in the PD-RBD+ group (-45%) but remained unchanged in the PD-RBD- group (-14%). The depression score improved significantly in the PD-RBD+ (-34%) and remained unchanged in the PD-RBD- group. The apathy score remained unchanged in the PD-RBD+ group but increased significantly in the PD-RBD- group (+33%).
CONCLUSION
While pre-DBS, PD patients with and without RBD showed different clinical profiles, post-DBS, the clinical profiles were comparable between the two groups. In respect to depressive symptoms, apathy and activities of daily living, PD-RBD+ patients show favourable post-DBS outcome. These findings highlight the importance of RBD assessment prior to DBS surgery.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1136/jnnp-2019-320858
- PMID 31422368
- Persistent URL
- https://sonar.ch/global/documents/279096
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