• Anna Sauerbier, Philipp Loehrer, Stefanie T Jost, Shania Heil, Jan N Petry-Schmelzer, Johanna Herberg, Pia Bachon, Salima Aloui, Alexandra Gronostay, Lisa Klingelhoefer, J Carlos Baldermann, Daniel Huys, Christopher Nimsky, Michael T Barbe, Gereon R Fink, Pablo Martinez-Martin, Ray ChaudhuriKKInstitute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.Parkinson's Centre of Excellence, Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK.NIHR Mental Health Biomedical Resear, Veerle Visser-Vandewalle, Lars Timmermann, Daniel Weintraub, Haidar S Dafsari, and EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group.
• Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK anna.2.sauerbier@kcl.ac.uk haidar.dafsari@uk-koeln.de.
• J. Neurol. Neurosurg. Psychiatr. 2021 Dec 1; 92 (12): 1313-1318.

BackgroundThe effects of subthalamic stimulation (subthalamic nucleus-deep brain stimulation, STN-DBS) on impulsive and compulsive behaviours (ICB) in Parkinson's disease (PD) are understudied.ObjectiveTo investigate clinical predictors of STN-DBS effects on ICB.MethodsIn 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.ResultsWe 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.ConclusionsOur 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 NumberDRKS00006735.© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

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