Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease

Maya Katz; Marta San Luciano; Kimberly Carlson; Ping Luo; William J Marks; Paul S Larson; Philip A Starr; Kenneth A Follett; Frances M Weaver; Matthew B Stern; Domenic J Reda; Jill L Ostrem; CSP 468 study group; Eugene Lai

doi:10.1002/ana.24374

Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease

Maya Katz, Marta San Luciano, Kimberly Carlson, Ping Luo, William J Marks, Paul S Larson, Philip A Starr, Kenneth A Follett, Frances M Weaver, Matthew B Stern, Domenic J Reda, Jill L Ostrem, CSP 468 study group, Eugene Lai

Research output: Contribution to journal › Article › peer-review

69 Scopus citations

Abstract

OBJECTIVE: The Veterans Administration Cooperative Studies Program #468, a multicenter study that randomized Parkinson's disease (PD) patients to either subthalamic nucleus (STN) or globus pallidus internus (GPi) deep brain stimulation (DBS), found that stimulation at either target provided similar overall motoric benefits. We conducted an additional analysis of this data set to evaluate whether PD motor subtypes responded differently to the 2 stimulation targets.

METHODS: We classified 235 subjects by motor subtype: tremor dominant (TD), intermediate (I), or postural instability gait difficulty (PIGD), based on pre-DBS baseline Unified Parkinson's Disease Rating Scale (UPDRS) scores off-medication. The primary outcome was change in UPDRS part III (UPDRS-III) off-medication scores from baseline to 24 months post-DBS, compared among subjects with particular PD motor subtypes and by DBS target (STN vs GPi). Changes in tremor, rigidity, akinesia, and gait scores were also assessed using the UPDRS.

RESULTS: TD patients had greater mean overall motor improvement, measured by UPDRS-III, after GPi DBS, compared to STN DBS (17.5 ± 13.0 vs 14.6 ± 14.9, p = 0.02), with improvement in gait accounting for this difference. Regardless of stimulation target, PIGD subjects had lower mean overall improvement in UPDRS-III scores compared with I or TD subjects (8.7 ± 12.2 vs 21.7 ± 11.2 vs 16.3 ± 13.8, p = 0.001).

INTERPRETATION: Our results suggest that responsiveness to both GPi and STN DBS is similar among different PD motor subtypes, although the TD motor subtype may have a greater response to GPi DBS with respect to gait. PIGD patients obtained less overall benefit from stimulation.

Original language	English (US)
Pages (from-to)	710-9
Number of pages	10
Journal	Annals of Neurology
Volume	77
Issue number	4
DOIs	https://doi.org/10.1002/ana.24374
State	Published - Apr 2015

Keywords

Aged
Deep Brain Stimulation
Female
Globus Pallidus
Humans
Male
Middle Aged
Parkinson Disease
Single-Blind Method
Subthalamic Nucleus
Treatment Outcome

Access to Document

10.1002/ana.24374

Cite this

@article{77e9c61baf5a4bcebfa2e00ebc1eaa8f,

title = "Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease",

abstract = "OBJECTIVE: The Veterans Administration Cooperative Studies Program #468, a multicenter study that randomized Parkinson's disease (PD) patients to either subthalamic nucleus (STN) or globus pallidus internus (GPi) deep brain stimulation (DBS), found that stimulation at either target provided similar overall motoric benefits. We conducted an additional analysis of this data set to evaluate whether PD motor subtypes responded differently to the 2 stimulation targets.METHODS: We classified 235 subjects by motor subtype: tremor dominant (TD), intermediate (I), or postural instability gait difficulty (PIGD), based on pre-DBS baseline Unified Parkinson's Disease Rating Scale (UPDRS) scores off-medication. The primary outcome was change in UPDRS part III (UPDRS-III) off-medication scores from baseline to 24 months post-DBS, compared among subjects with particular PD motor subtypes and by DBS target (STN vs GPi). Changes in tremor, rigidity, akinesia, and gait scores were also assessed using the UPDRS.RESULTS: TD patients had greater mean overall motor improvement, measured by UPDRS-III, after GPi DBS, compared to STN DBS (17.5 ± 13.0 vs 14.6 ± 14.9, p = 0.02), with improvement in gait accounting for this difference. Regardless of stimulation target, PIGD subjects had lower mean overall improvement in UPDRS-III scores compared with I or TD subjects (8.7 ± 12.2 vs 21.7 ± 11.2 vs 16.3 ± 13.8, p = 0.001).INTERPRETATION: Our results suggest that responsiveness to both GPi and STN DBS is similar among different PD motor subtypes, although the TD motor subtype may have a greater response to GPi DBS with respect to gait. PIGD patients obtained less overall benefit from stimulation.",

keywords = "Aged, Deep Brain Stimulation, Female, Globus Pallidus, Humans, Male, Middle Aged, Parkinson Disease, Single-Blind Method, Subthalamic Nucleus, Treatment Outcome",

author = "Maya Katz and Luciano, {Marta San} and Kimberly Carlson and Ping Luo and Marks, {William J} and Larson, {Paul S} and Starr, {Philip A} and Follett, {Kenneth A} and Weaver, {Frances M} and Stern, {Matthew B} and Reda, {Domenic J} and Ostrem, {Jill L} and {CSP 468 study group} and Eugene Lai",

note = "{\textcopyright} 2015 American Neurological Association.",

year = "2015",

month = apr,

doi = "10.1002/ana.24374",

language = "English (US)",

volume = "77",

pages = "710--9",

journal = "Annals of Neurology",

issn = "0364-5134",

publisher = "Wiley",

number = "4",

}

TY - JOUR

T1 - Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease

AU - Katz, Maya

AU - Luciano, Marta San

AU - Carlson, Kimberly

AU - Luo, Ping

AU - Marks, William J

AU - Larson, Paul S

AU - Starr, Philip A

AU - Follett, Kenneth A

AU - Weaver, Frances M

AU - Stern, Matthew B

AU - Reda, Domenic J

AU - Ostrem, Jill L

AU - CSP 468 study group

AU - Lai, Eugene

PY - 2015/4

Y1 - 2015/4

N2 - OBJECTIVE: The Veterans Administration Cooperative Studies Program #468, a multicenter study that randomized Parkinson's disease (PD) patients to either subthalamic nucleus (STN) or globus pallidus internus (GPi) deep brain stimulation (DBS), found that stimulation at either target provided similar overall motoric benefits. We conducted an additional analysis of this data set to evaluate whether PD motor subtypes responded differently to the 2 stimulation targets.METHODS: We classified 235 subjects by motor subtype: tremor dominant (TD), intermediate (I), or postural instability gait difficulty (PIGD), based on pre-DBS baseline Unified Parkinson's Disease Rating Scale (UPDRS) scores off-medication. The primary outcome was change in UPDRS part III (UPDRS-III) off-medication scores from baseline to 24 months post-DBS, compared among subjects with particular PD motor subtypes and by DBS target (STN vs GPi). Changes in tremor, rigidity, akinesia, and gait scores were also assessed using the UPDRS.RESULTS: TD patients had greater mean overall motor improvement, measured by UPDRS-III, after GPi DBS, compared to STN DBS (17.5 ± 13.0 vs 14.6 ± 14.9, p = 0.02), with improvement in gait accounting for this difference. Regardless of stimulation target, PIGD subjects had lower mean overall improvement in UPDRS-III scores compared with I or TD subjects (8.7 ± 12.2 vs 21.7 ± 11.2 vs 16.3 ± 13.8, p = 0.001).INTERPRETATION: Our results suggest that responsiveness to both GPi and STN DBS is similar among different PD motor subtypes, although the TD motor subtype may have a greater response to GPi DBS with respect to gait. PIGD patients obtained less overall benefit from stimulation.

AB - OBJECTIVE: The Veterans Administration Cooperative Studies Program #468, a multicenter study that randomized Parkinson's disease (PD) patients to either subthalamic nucleus (STN) or globus pallidus internus (GPi) deep brain stimulation (DBS), found that stimulation at either target provided similar overall motoric benefits. We conducted an additional analysis of this data set to evaluate whether PD motor subtypes responded differently to the 2 stimulation targets.METHODS: We classified 235 subjects by motor subtype: tremor dominant (TD), intermediate (I), or postural instability gait difficulty (PIGD), based on pre-DBS baseline Unified Parkinson's Disease Rating Scale (UPDRS) scores off-medication. The primary outcome was change in UPDRS part III (UPDRS-III) off-medication scores from baseline to 24 months post-DBS, compared among subjects with particular PD motor subtypes and by DBS target (STN vs GPi). Changes in tremor, rigidity, akinesia, and gait scores were also assessed using the UPDRS.RESULTS: TD patients had greater mean overall motor improvement, measured by UPDRS-III, after GPi DBS, compared to STN DBS (17.5 ± 13.0 vs 14.6 ± 14.9, p = 0.02), with improvement in gait accounting for this difference. Regardless of stimulation target, PIGD subjects had lower mean overall improvement in UPDRS-III scores compared with I or TD subjects (8.7 ± 12.2 vs 21.7 ± 11.2 vs 16.3 ± 13.8, p = 0.001).INTERPRETATION: Our results suggest that responsiveness to both GPi and STN DBS is similar among different PD motor subtypes, although the TD motor subtype may have a greater response to GPi DBS with respect to gait. PIGD patients obtained less overall benefit from stimulation.

KW - Aged

KW - Deep Brain Stimulation

KW - Female

KW - Globus Pallidus

KW - Humans

KW - Male

KW - Middle Aged

KW - Parkinson Disease

KW - Single-Blind Method

KW - Subthalamic Nucleus

KW - Treatment Outcome

U2 - 10.1002/ana.24374

DO - 10.1002/ana.24374

M3 - Article

C2 - 25627340

SN - 0364-5134

VL - 77

SP - 710

EP - 719

JO - Annals of Neurology

JF - Annals of Neurology

IS - 4

ER -

Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease

Abstract

Keywords

Access to Document

Fingerprint

Cite this