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TOPLINE:

In patients with advanced Parkinson's disease (PD), quality of life (QoL) remains stable at 5 years in those who receive deep brain stimulation of the subthalamic nucleus (STN-DBS) vs standard-of-care medical treatment (MED), results of a nonrandomized quasi-experimental trial showed.

METHODOLOGY:

• Researchers applied propensity score matching to 108 patients with advanced PD from the ongoing Non-Motor International Longitudinal Study, with disease duration, levodopa-equivalent daily dose (LEDD), and Scales for Outcomes in PD-motor scale (SCOPA-M) total score as baseline matching parameters, resulting in a sub-cohort of 50 patients (25 who received STN-DBS and 25 who received MED), mean age 65 years, and median disease duration 7.6 years.
• The primary outcome was QoL assessed with the Parkinson's Disease Questionnaire 8 (PDQ-8), reported as Summary Index (SI), which covers eight dimensions (mobility, activities of daily living [ADL], emotional well-being, social support, cognition, communication, bodily discomfort, and stigma), with scores ranging from 0 (no impairment) to 100 (maximum impairment).
• Secondary outcomes were motor examination, ADL, and motor complications assessed with the SCOPA-M, a validated short version of the Unified Parkinson's Disease Rating Scale, with subscales ranging from 0 (no impairment) to 42 (for motor examination), 21 (for ADL), and 12 (for motor complications).
• Researchers classified adverse events (AEs) as mild, moderate, severe, or serious and categorized them as neurologic, psychiatric, and other.

TAKEAWAY:

• In the MED group, QoL worsened significantly at the 5-year follow-up (PDQ-8 SI change, −10.9; 95% CI, −19.0 to −2.7; P = .01), while after significant improvement at 1 year, QoL remained stable but nonsignificant at 5 years in the STN-DBS group (PDQ-8 SI change, −4.3; 95% CI, −13.2 to 4.7; P = .34), for a between-group difference of 6.6 points and a moderate effect size.
• The SCOPA-M total score worsened significantly at 5 years in the MED group (total change, −4.5; 95% CI, −7.4 to −1.6; P = .008), whereas the STN-DBS group had a 6.4% statistically insignificant improvement (total change, 1.9; 95% CI, −1.1 to 5.0; P = .20), for a between-group difference of 6.4 points in favor of DBS (difference, −6.4; 95% CI, −10.6 to −2.3; P = .003) and with a moderate effect size.
• In the MED group, worsening of the SCOPA-M total score resulted from 25.4% worsening of ADL and 27.3% worsening of motor complications, while in the STN-DBS group, improvements were driven by favorable outcomes for motor complications (median between-group difference in change, −2.0; 95% CI, −4.0 to −1.0; P = .003), with this group also experiencing reductions in LEDD (STN-DBS vs MED, −821.4; 95% CI, −1111.9 to −530.8; P < .001).
• There were 39 serious AEs in 17 patients in the STN-DBS group, all but one of which resolved without major sequelae. Of these, 13 were deemed surgical- or device-related, eight as neurologic, seven as psychiatric, and 11 as other.

IN PRACTICE:

"These findings may provide helpful information when counseling patients on the efficacy of STN-DBS for PD and monitoring patients postoperatively in long-term follow-up," the researchers wrote.

SOURCE:

The study was conducted by Stefanie T. Jost, PhD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany, and colleagues. It was published online on January 18, 2024, in JAMA Network Open.

LIMITATIONS:

As use of propensity score matching can only be applied to known and measured parameters, the study could not account for other potentially relevant parameters. The study was small (108 subjects in the original cohort and 50 in the matched cohort). The preoperative PDQ-8 SI was higher at baseline in the STN-DBS group. Researchers did not conduct a motor examination in the medication-off state. As assessments could only take place via telephone during the COVID-19 pandemic, long-term follow-up data on motor outcomes was lacking for some patients.

DISCLOSURES:

Jost reported receiving grants from the Prof. Klaus Thiemann Foundation and Brandau-Laibach-Foundation; see paper for disclosures of other authors.