Longitudinal Analysis of the Deep Brain Stimulation Impairment Scale for Subthalamic Nucleus Stimulation in Parkinson’s Disease

TL;DR

This study examines how deep brain stimulation affects quality of life in Parkinson’s patients, finding improvements in movement and cognition but also device-related issues impacting older individuals.

Contribution

The study longitudinally evaluates the Deep Brain Stimulation Impairment Scale (DBS-IS) to track post-surgical outcomes and device-related complications in Parkinson’s patients.

Findings

DBS improves postural instability, gait difficulty, and cognitive impairment in Parkinson’s patients.

Device-related problems affect 43% of patients and reduce quality of life improvements.

Older patients are more likely to experience device-related complications.

Abstract

•The DBS-IS was developed to assess quality of life-limiting impairments after surgery, yet their post-surgical development remains unclear.•Impairments evaluated by the DBS-IS improve after surgery in subscales postural instability and gait difficulty and cognitive impairment.•Device-related problems are related to reduced quality of life and are more common among older individuals.

The DBS-IS was developed to assess quality of life-limiting impairments after surgery, yet their post-surgical development remains unclear.

Impairments evaluated by the DBS-IS improve after surgery in subscales postural instability and gait difficulty and cognitive impairment.

Device-related problems are related to reduced quality of life and are more common among older individuals.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for people with Parkinson’s disease (PwP). However, some patients treated with DBS may still experience quality of life limiting impairments after surgery, e.g., concerning posture and gait, cognition, speech, apathy or impulsivity, as well as technical challenges in managing the implanted device. The Deep Brain Stimulation Impairment Scale (DBS-IS) was developed to assess these impairments, yet their postoperative development is underexplored.

We retrospectively analysed changes in the DBS-IS Total Score and subscales assessed in patients at baseline, three, six and twelve months post-DBS implantation (n = 33 PwP) using linear mixed models for repeated measurements. Furthermore, we investigated device-related issues within the first year after surgery and their impact on quality of life in a larger sample (n = 99 PwP) using DBS-IS Facility Scores.

After surgery we observed significant improvement in the DBS-IS Total Score (β = −1.93; p = 0.005), particularly in the subscales of postural instability, gait difficulty and cognitive impairment. 43 % of patients reported device-related problems within one year after surgery. Patients with device-related problems showed significantly less improvement in quality of life (z = −2.40; p = 0.017). Exploratory post-hoc tests suggested a higher propensity for device-related complications among older individuals (z = −2.19; p = 0.029).

The majority of impairments evaluated by the DBS-IS, such as postural instability, gait difficulty and cognitive impairments, appear amenable to STN-DBS intervention. Special attention is warranted for potential device issues, especially in older patients, to optimize patients’ quality of life outcomes.

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