Predictors of short-term impulsive and compulsive behaviour after subthalamic stimulation in Parkinson disease

Background The effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson’s disease (PD) are understudied. Objective To investigate clinical predictors of STN-DBS effects on ICB. Methods In this prospective, open-label, multicentre study in patients with PD undergoing bilateral STN-DBS, we assessed patients preoperatively and at 6-month follow-up postoperatively. Clinical scales included the Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale (QUIP-RS), PD Questionnaire-8, Non-Motor Symptom Scale (NMSS), Unified PD Rating Scale in addition to levodopa-equivalent daily dose total (LEDD-total) and dopamine agonists (LEDD-DA). Changes at follow-up were analysed with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We explored predictors of QUIP-RS changes using correlations and linear regressions. Finally, we dichotomised patients into ‘QUIP-RS improvement or worsening’ and analysed between-group differences. Results We included 55 patients aged 61.7 years±8.4 with 9.8 years±4.6 PD duration. QUIP-RS cut-offs and psychiatric assessments identified patients with preoperative ICB. In patients with ICB, QUIP-RS improved significantly. However, we observed considerable interindividual variability of clinically relevant QUIP-RS outcomes as 27.3% experienced worsening and 29.1% an improvement. In post hoc analyses, higher baseline QUIP-RS and lower baseline LEDD-DA were associated with greater QUIP-RS improvements. Additionally, the ‘QUIP-RS worsening’ group had more severe baseline impairment in the NMSS attention/memory domain. Conclusions Our results show favourable ICB outcomes in patients with higher preoperative ICB severity and lower preoperative DA doses, and worse outcomes in patients with more severe baseline attention/memory deficits. These findings emphasise the need for comprehensive non-motor and motor symptoms assessments in patients undergoing STN-DBS. Trial registration number DRKS00006735.

[1]  L. Timmermann,et al.  Evaluation of the effect of bilateral subthalamic nucleus deep brain stimulation on fatigue in Parkinson’s Disease as measured by the non-motor symptoms scale , 2021, British journal of neurosurgery.

[2]  L. Timmermann,et al.  Personalised Advanced Therapies in Parkinson’s Disease: The Role of Non-Motor Symptoms Profile , 2021, Journal of personalized medicine.

[3]  G. Fink,et al.  Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease , 2021, NPJ Parkinson's disease.

[4]  G. Fink,et al.  Subthalamic Stimulation Improves Quality of Sleep in Parkinson Disease: A 36-Month Controlled Study. , 2020, Journal of Parkinson's disease.

[5]  G. Fink,et al.  Beneficial nonmotor effects of subthalamic and pallidal neurostimulation in Parkinson’s disease , 2020, Brain Stimulation.

[6]  O. Rascol,et al.  Impact of Subthalamic Deep Brain Stimulation on Impulse Control Disorders in Parkinson's Disease: A Prospective Study , 2020, Movement disorders : official journal of the Movement Disorder Society.

[7]  M. Breakspear,et al.  The structural connectivity of subthalamic deep brain stimulation correlates with impulsivity in Parkinson's. , 2020, Brain : a journal of neurology.

[8]  G. Fink,et al.  A prospective, controlled study of non-motor effects of subthalamic stimulation in Parkinson’s disease: results at the 36-month follow-up , 2020, Journal of Neurology, Neurosurgery, and Psychiatry.

[9]  H. Mayberg,et al.  Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson’s Disease , 2020, Frontiers in Behavioral Neuroscience.

[10]  V. Visser-Vandewalle,et al.  Beneficial effect of 24-month bilateral subthalamic stimulation on quality of sleep in Parkinson’s disease , 2020, Journal of Neurology.

[11]  P. Martínez-Martín,et al.  Impulse control and related behaviors in Parkinson’s disease with dementia , 2020, European journal of neurology.

[12]  Marios Politis,et al.  Non-motor outcomes depend on location of neurostimulation in Parkinson's disease. , 2019, Brain : a journal of neurology.

[13]  Eduardo A. Aponte,et al.  Subjective estimates of uncertainty during gambling and impulsivity after subthalamic deep brain stimulation for Parkinson’s disease , 2019, Scientific Reports.

[14]  M. Okun,et al.  Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease , 2019, Front. Neurol..

[15]  G. Deuschl,et al.  Quality of life predicts outcome of deep brain stimulation in early Parkinson disease , 2019, Neurology.

[16]  G. Fink,et al.  Beneficial effects of bilateral subthalamic stimulation on alexithymia in Parkinson's disease , 2018, European journal of neurology.

[17]  V. Visser-Vandewalle,et al.  Subthalamic Stimulation Improves Quality of Life of Patients Aged 61 Years or Older With Short Duration of Parkinson's Disease , 2018, Neuromodulation : journal of the International Neuromodulation Society.

[18]  V. Visser-Vandewalle,et al.  Short-term quality of life after subthalamic stimulation depends on non-motor symptoms in Parkinson's disease , 2018, Brain Stimulation.

[19]  M. Okun,et al.  Measures of impulsivity in Parkinson's disease decrease after DBS in the setting of stable dopamine therapy. , 2017, Parkinsonism & related disorders.

[20]  K. Chaudhuri,et al.  A European multicentre survey of impulse control behaviours in Parkinson's disease patients treated with short‐ and long‐acting dopamine agonists , 2016, European journal of neurology.

[21]  K. Chaudhuri,et al.  Impulse control disorder related behaviours during long‐term rotigotine treatment: a post hoc analysis , 2016, European journal of neurology.

[22]  G. Fink,et al.  Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease , 2016, Brain Stimulation.

[23]  J. Pilitsis,et al.  The Influence of Bilateral Subthalamic Nucleus Deep Brain Stimulation on Impulsivity and Prepulse Inhibition in Parkinson's Disease Patients , 2015, Stereotactic and Functional Neurosurgery.

[24]  A. Albanese,et al.  Impulse control behaviours in patients with Parkinson's disease after subthalamic deep brain stimulation: de novo cases and 3-year follow-up , 2014, Journal of Neurology, Neurosurgery & Psychiatry.

[25]  G. Deuschl,et al.  Validation of the questionnaire for impulsive-compulsive disorders in Parkinson’s disease (QUIP) and the QUIP-rating scale in a German speaking sample , 2014, Journal of Neurology.

[26]  M. Mata,et al.  Impulse control disorder in patients with Parkinson's disease under dopamine agonist therapy: a multicentre study , 2014, Journal of Neurology, Neurosurgery & Psychiatry.

[27]  M. T. Barbe,et al.  Modulation of local field potential power of the subthalamic nucleus during isometric force generation in patients with Parkinson’s disease , 2013, Neuroscience.

[28]  J. Régis,et al.  Subthalamic nucleus stimulation and compulsive use of dopaminergic medication in Parkinson's disease , 2013, Journal of Neurology, Neurosurgery & Psychiatry.

[29]  P. Martínez-Martín,et al.  Health-related quality of life as an outcome variable in Parkinson’s disease , 2012, Therapeutic advances in neurological disorders.

[30]  Daniel Weintraub,et al.  Questionnaire for impulsive‐compulsive disorders in Parkinson's Disease–Rating Scale , 2012, Movement disorders : official journal of the Movement Disorder Society.

[31]  Michael S. Okun,et al.  Effects of STN and GPi Deep Brain Stimulation on Impulse Control Disorders and Dopamine Dysregulation Syndrome , 2012, PloS one.

[32]  Anette Schrag,et al.  Health‐related quality‐of‐life scales in Parkinson's disease: Critique and recommendations , 2011, Movement disorders : official journal of the Movement Disorder Society.

[33]  Daniel Weintraub,et al.  Validation of the questionnaire for impulsive‐compulsive disorders in Parkinson's disease , 2009, Movement disorders : official journal of the Movement Disorder Society.

[34]  Daniel Weintraub,et al.  Dopamine and impulse control disorders in Parkinson's disease , 2008, Annals of neurology.

[35]  D. Grosset Dopamine agonists and therapy compliance , 2008, Neurological Sciences.

[36]  Paolo Barone,et al.  The metric properties of a novel non‐motor symptoms scale for Parkinson's disease: Results from an international pilot study , 2007, Movement disorders : official journal of the Movement Disorder Society.

[37]  G. Deuschl,et al.  A randomized trial of deep-brain stimulation for Parkinson's disease. , 2006, The New England journal of medicine.

[38]  The Unified Parkinson's Disease Rating Scale (UPDRS): Status and recommendations , 2003, Movement disorders : official journal of the Movement Disorder Society.

[39]  Ross D Crosby,et al.  Defining clinically meaningful change in health-related quality of life. , 2003, Journal of clinical epidemiology.

[40]  D. Beaton,et al.  Many faces of the minimal clinically important difference (MCID): a literature review and directions for future research. , 2002, Current opinion in rheumatology.

[41]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[42]  R. Fitzpatrick,et al.  The PDQ-8: Development and validation of a short-form parkinson's disease questionnaire , 1997 .

[43]  R. H. Myers Classical and modern regression with applications , 1986 .