• Alexandra Gronostay, Stefanie Theresa Jost, Monty Silverdale, Alexandra Rizos, Philipp Alexander Loehrer, Julian Evans, Anna Sauerbier, Donya Indi, Valentina Leta, Paul Reker, Gereon Rudolf Fink, Keyoumars Ashkan, Angelo Antonini, Christopher Nimsky, Veerle Visser-Vandewalle, Pablo Martinez-Martin, Ray ChaudhuriKKParkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK., Lars Timmermann, and Haidar S Dafsari.
• Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
• J. Neurol. Neurosurg. Psychiatr. 2024 Jun 17; 95 (7): 630638630-638.

BackgroundSubthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson's disease (PD) improves quality of life (QoL), motor and non-motor symptoms (NMS). However, in previous studies, 43%-49% of patients did not experience clinically relevant postoperative QoL improvement. To inform individualised prediction of postoperative QoL improvement, we developed a stratification analysis of QoL outcomes based on preoperative non-motor total burden, severity of motor progression and motor response in levodopa challenge tests.MethodsThis was a prospective, open-label, multicentre, international study with a 6-month follow-up. A distribution-based threshold identified 'QoL responders' in the PDQuestionnaire-8 Summary Index (PDQ-8 SI). After baseline stratification based on the NMS Scale, Hoehn and Yahr Scale and levodopa response assessed with the Unified PD Rating Scale-III, we compared postoperative QoL response between these strata. To assess the clinical usefulness and statistical feasibility of stratifications, we compared cumulative distribution function curves, respectively PDQ-8 within-stratum variation.ResultsAll main outcomes improved postoperatively. Based on the 8.1 points threshold for clinically meaningful PDQ-8 SI improvement, only 80/161 patients were classified as 'QoL responders'. The absolute risk reductions for QoL non-response among respective non-motor, motor progression and levodopa response strata were 23%, 8% and 3%, respectively. Only non-motor stratification reduced PDQ-8 within-stratum variation compared with the overall cohort.ConclusionsNon-motor stratification, but not motor progression or levodopa response stratification, is clinically useful and statistically feasible for personalised preoperative prediction of postoperative QoL outcome of STN-DBS for PD. Our findings highlight that non-motor assessments are necessary components of a case-based, holistic approach of DBS indication evaluations geared towards optimising postoperative QoL outcomes.Trial Registration NumberGermanClinicalTrialsRegister: #6735.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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