Preoperative RBD Not Linked to Altered Outcomes in Post DBS Parkinson Disease

Author(s):

Twelve months after subthalamic deep brain stimulation, patients with and without RBD had MDS-UPDRS IV score decrease, MDS-UPDRS III MedOff decrease, and total LEDD decrease, with no between group difference.

Ana Marques, MD

Data from a multicenter, prospective study (NCT02360683) in France showed no between-group differences for patients with Parkinson disease (PD) with or without preoperative REM sleep behavior disorder (RBD) on cognitive, psychobehavioral, and global quality of life outcomes, a year after undergoing subthalamic deep brain stimulation (STN-DBS).

A total of 215 patients with PD from the PREDISTIM cohort who had 12-month follow-up after STN-DBS were analyzed to answer whether RBD is a risk factor for poorer motor, nonmotor and quality of life outcomes. Of them, 122 (57%) had probable preoperative RBD (preopRBD+) while 93 (43%) were preopRBD-.

Senior author Ana Marques, MD, department of neurology, Clermont-Ferrard University Hospital, and colleagues found comparable mean decreases in Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III scores of 52% in preopRBD+ (P <.01) and by 54% in preopRBD- (P <.001). Additionally, they found decreases of 37% (P <.01) and 33% (P <.01) on MDS-UPDRS IV scores, further highlighting the lack of between group difference.

STN-DBS also led to a Levodopa Equivalent Daily Dose (LEDD) total reduction compared with baseline in both groups (preopRBD+: –52%; P <.01; preopRBD-: –49%; P <.01), with no between group difference observed. Despite significant decreases in both groups on MDS-UPDRS I and II, the 2 groups had no difference in variation. Furthermore, score decreases on Montreal Cognitive Assessment (MoCa) did not differ in the preopRBD- (P <.05) and preopRBD+ (P <.05) groups.

"Total psycho-behavioral symptoms were also similarly improved in both groups. STN-DBS improves quality of life in PD patients regardless of the presence of preopRBD,” Marques et al wrote. "Thus, although the presence of RBD has been previously reported to be associated with a more severe phenotype of PD, it does not seem to constitute a marker of risk of poor outcome after surgery in PD patients eligible to STN-DBS."

Prior to the operation, those with preopRBD+ were older (61 [±7.2] vs 59.5 [±7.7] years; P = .02), had less motor impairment (MDS-UPDRS III: 38.7 [±16.2] vs 43.4 [±7.1]; P = .03) compared with preopRBD-. However, these patients had more nonmotor symptoms on daily living activities (MDS-UPDRS I: 12.6 [±5.5] vs 10.7 [±5.3]; P <.001), more psychobehavioral manifestations (Ardouin Scale of Behavior in Parkinson’s Disease [ASBPD] total: 7.7 [±5.1] vs 5.1 [±0.4]; P = .003) and worse quality of life (Parkinson’s Disease Questionnaire [PDQ 39]: 33 [±12] vs 29 [±12]; P = .03).

Hyperdopaminergic total subscores, which significantly decreased in both groups, did not show a between group difference. Investigators noted that although there was significant worsened variation of the score in the preopRBD- group (P = .03), there were still not significant between group differences. Additionally, both groups experienced significant decreases in ASBPD total score and non-motor fluctuation subscores.

Those in the preopRBD- (–16%; P <.01) and preopRBD+ (–8%; P <.01) groups had significant decreases in PDQ39 SI scores, including both experiencing significant decreases on "Activities of Daily Living" and "Stigma" subscores. Decreases in “Cognition” and "communication" were only observed in the preopRBD+ group (P <.01), although none these variations significantly differed between groups. Despite significantly decreasing in both groups, "Bodily discomfort" was the only quality of life subscore that decreased more in the preopRBD+ group (P = .04).

At post operation evaluation, investigators continued to find no significant group difference between the 2 groups on variation of attentional, instrumental, and memory functions, as assessed by a combination of 11 cognitive tests.

"Further studies, assessing long-term outcomes associated with the presence of RBD preoperatively 3 years and 5 years after surgery, will improve our comprehension of the specific prognosis associated with the presence of RBD in PD candidates to STN-DBS,” the study authors wrote.

REFERENCE

Besse-Pinot E, Pereira B, Durif F, et al. Preoperative REM sleep behavior disorder and subthalamic deep brain stimulation outcome in Parkinson disease 1 year after surgery. Neurology. Published online October 19, 2021. doi:10.1212/WNL.0000000000012862