Preoperative REM Sleep Behavior Disorder and Subthalamic Nucleus Deep Brain Stimulation Outcome in Parkinson Disease 1 Year After Surgery.

Abstract

BACKGROUND AND OBJECTIVES:

To determine whether patients with Parkinson disease (PD) eligible for subthalamic nucleus deep brain stimulation (STN-DBS) with probable REM sleep behavior disorder (RBD) preoperatively could be more at risk of poorer motor, nonmotor, and quality of life outcomes 12 months after surgery compared to those without RBD.

METHODS:

We analyzed the preoperative clinical profile of 448 patients with PD from a French multicentric prospective study (PREDISTIM) according to the presence or absence of probable RBD based on the RBD Single Question and RBD Screening Questionnaire. Among the 215 patients with PD with 12 months of follow-up after STN-DBS, we compared motor, cognitive, psycho-behavioral profile, and quality of life outcomes in patients with (pre-opRBD+) or without (pre-opRBD-) probable RBD preoperatively.

RESULTS:

At preoperative evaluation, pre-opRBD+ patients were older (61 ± 7.2 vs 59.5 ± 7.7 years; p = 0.02), had less motor impairment (Movement Disorder Society-sponsored version of the Unified Parkinson's Disease Rating Scale [MDS-UPDRS] III "off": 38.7 ± 16.2 vs 43.4 ± 7.1; p = 0.03) but more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; p < 0.001), had more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson's Disease total: 7.7 ± 5.1 vs 5.1 ± 0.4; p = 0.003), and had worse quality of life (Parkinson's Disease Questionnaire-39: 33 ± 12 vs 29 ± 12; p = 0.03), as compared to pre-opRBD- patients. Both pre-opRBD+ and pre-opRBD- patients had significant MDS-UPDRS IV score decrease (-37% and -33%, respectively), MDS-UPDRS III "med 'off'/stim 'on'" score decrease (-52% and -54%), and dopaminergic treatment decrease (-52% and -49%) after surgery, with no between-group difference. There was no between-group difference for cognitive and global quality of life outcomes.

CONCLUSIONS:

In patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with a different clinical outcome 1 year after neurosurgery.

TRIAL REGISTRATION INFORMATION:

NCT02360683.

CLASSIFICATION OF EVIDENCE:

This study provides Class II evidence that in patients with PD eligible for STN-DBS, the presence of probable RBD preoperatively is not associated with poorer outcomes 1 year post surgery.

• Authors: Elsa Besse-Pinot, Bruno Pereira, Franck Durif, Maria Livia Fantini, Elodie Durand, Bérengère Debilly, Philippe Derost, Caroline Moreau, Elodie Hainque, Tiphaine Rouaud, Alexandre Eusebio, Isabelle Benatru, Sophie Drapier, Dominique Guehl, Olivier Rascol, David Maltête, Ouhaïd Lagha-Boukbiza, Caroline Giordana, Melissa Tir, Stéphane Thobois, Lucie Hopes, Cécile Hubsch, Béchir Jarraya, Anne-Sophie Rolland, Jean-Christophe Corvol, David Devos, Ana Marques, Predistim Study Group
• Journal: Neurology (Neurology) Vol. 97 Issue 20 Pg. e1994-e2006 (11 16 2021) ISSN: 1526-632X [Electronic] United States
• PMID: 34667082 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 American Academy of Neurology.

Topics

• Deep Brain Stimulation
• Humans
• Parkinson Disease (surgery, therapy)
• Preoperative Period
• Prospective Studies
• REM Sleep Behavior Disorder (complications)
• Risk Assessment
• Subthalamic Nucleus (physiology)
• Treatment Outcome