Determinants of Functional Independence or Its Loss following Subthalamic Nucleus Stimulation in Parkinson's Disease

Ryul Kim, Dallah Yoo, Yu Jin Jung, Woong Woo Lee, Gwanhee Ehm, Ji Young Yun, Hee Jin Kim, Jee Young Lee, Ji Young Kim, Han Joon Kim, Sun Ha Paek, Beomseok Jeon

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective: This study aimed to describe the change in functional status following bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) and to identify predictors of postoperative functional dependence. Methods: We included PD patients with bilateral STN-DBS who had complete Schwab & England Activities of Daily Living (S&E ADL) Scale data at baseline and 6 months after surgery from our prospective registry. Functional dependence was defined as an S&E ADL score of less than 80%. All data were collected from the on-medication state and on-stimulation state (after surgery). Logistic regression analyses were performed to determine the factors predictive of functional dependence after surgery. Results: A total of 196 patients were included. At baseline, 41 patients were functionally dependent and the other 155 were functionally independent. Among the patients with preoperative dependence, 32 (78%) became functionally independent after surgery, and this conversion was associated with a lower baseline axial score (p = 0.012). Among the patients with preoperative independence, 21 (14%) developed postoperative dependence, and this conversion was associated with a higher baseline axial score (p = 0.013) and its smaller improvement (p < 0.001). Female sex (odds ratio [OR] 3.214; 95% confidence interval [CI] 1.210-8.542; p = 0.019) and a higher baseline axial score (OR 1.184; 95% CI 1.056-1.327; p = 0.004) significantly predicted the risk of postoperative functional dependence. Conclusions: We found that functional status following bilateral STN-DBS is closely related to preoperative axial symptoms. When loss of independence is a potential target for STN-DBS, clinicians should take into consideration the severity of axial impairment before surgery.

Original languageEnglish
Pages (from-to)106-112
Number of pages7
JournalStereotactic and Functional Neurosurgery
Volume97
Issue number2
DOIs
StatePublished - 1 Aug 2019

Bibliographical note

Publisher Copyright:
© 2019 S. Karger AG, Basel.

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