• Haidar S Dafsari, Dos Santos GhilardiMaria GabrielaMGDivision of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil., Veerle Visser-Vandewalle, Alexandra Rizos, Keyoumars Ashkan, Monty Silverdale, Julian Evans, Raquel C R Martinez, Rubens G Cury, Stefanie T Jost, Michael T Barbe, Gereon R Fink, Angelo Antonini, K Ray-Chaudhuri, Pablo Martinez-Martin, Erich Talamoni Fonoff, Lars Timmermann, and EUROPAR and the IPMDS Non Motor PD Study Group.
• University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom. Electronic address: haidar.dafsari@uk-koeln.de.
• Brain Stimul. 2020 Nov 1; 13 (6): 1697-1705.

BackgroundSubthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson's disease (PD). However, few studies have compared their nonmotor effects.ObjectiveTo compare nonmotor effects of STN-DBS and GPi-DBS.MethodsIn this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, -III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.ResultsIn both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.ConclusionsTo our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients' individual motor and nonmotor profiles.Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.

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