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Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus

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Abstract

While deep brain stimulation (DBS) surgery is a well-accepted treatment for Parkinson disease (PD) that improves overall quality of life (QoL), its effects across different domains of QoL are unclear. The study reported here directly compared the effects of unilateral DBS in subthalamic nucleus (STN) or globus pallidus (GPi) on QoL in 42 non-demented patients with medication-refractory PD. Patients were enrolled in the COMPARE trial, a randomized clinical trial of cognitive and mood effects of STN versus GPi DBS conducted at the University of Florida Movement Disorders Center. Patients underwent motor, mood, verbal fluency and QoL (Parkinson disease questionnaire: PDQ-39) measures before and 6 months following surgery. Groups experienced motor and mood improvements that did not differ by target. Patients with STN DBS evidenced a slight decrement on letter fluency. On average, all patients endorsed better overall QoL after surgery. However, despite similar motor and mood improvements, GPi patients improved more than STN patients (38 vs. 14%, respectively; P = 0.03). Patients reported better QoL on subscales of mobility, activities of daily living (ADLs), emotional well-being, stigma, cognition and discomfort, but not on those of social support and communication. Improvements on the mobility, ADLs, stigma and social support subscales were greater amongst GPi patients. In regression analyses, only depression changes independently predicted changes in overall QoL as well as emotional well-being and social support changes. Within the STN group only, declining category fluency scores correlated with poorer QoL on the communication subscale. Unilateral DBS in both STN and GPi improved QoL overall and in disparate domains 6 months after surgery. Patients receiving GPi DBS reported greater improvements that cannot be explained by differential mood or motor effects; however, verbal fluency changes may have partially contributed to lesser QoL improvements amongst STN patients.

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Acknowledgments

This work was supported by the National Institutes of Health (K-23 NS50633 to MSO; R- 01 NS044997 to DB) and The National Parkinson Foundation Center of Excellence. The work of Michele Suelter in coordinating the COMPARE trial is gratefully acknowledged. Approval for this study was obtained from the University of Florida Institutional Review Board prior to beginning the project. Informed consent was obtained from all study participants prior to enrollment. This study follows guidelines outlined in the Declaration of Helsinki.

Conflict of interest statement

Drs. Okun and Foote have received honoraria for speaking for the Medtronic Corporation and also fellowship training grants. The NIH was involved in study design through the grants peer review process but was not involved in the collection, analysis or interpretation of data, writing of this report, or the decision to submit the paper for publication. The study was industry independent.

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Authors and Affiliations

  1. Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA

    Laura B. Zahodne, Lindsey Kirsch-Darrow & Dawn Bowers

  2. Department of Neurology, University of Florida, PO Box 100236, Gainesville, FL, 32610-0236, USA

    Michael S. Okun, Hubert H. Fernandez, Ramon L. Rodriguez, Charles E. Jacobson IV & Christian Rosado

  3. Department of Neurosurgery, University of Florida, PO Box 100265, Gainesville, FL, 32610-0265, USA

    Michael S. Okun & Kelly D. Foote

  4. Department of Epidemiology and Health Policy Research, University of Florida, PO Box 100177, Gainesville, FL, 32610-0177, USA

    Samuel S. Wu

Authors
  1. Laura B. Zahodne
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  2. Michael S. Okun
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  3. Kelly D. Foote
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  4. Hubert H. Fernandez
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  6. Samuel S. Wu
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  7. Lindsey Kirsch-Darrow
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  10. Dawn Bowers
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Correspondence to Laura B. Zahodne.

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Zahodne, L.B., Okun, M.S., Foote, K.D. et al. Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus. J Neurol 256, 1321–1329 (2009). https://doi.org/10.1007/s00415-009-5121-7

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  • DOI: https://doi.org/10.1007/s00415-009-5121-7

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