Predictors Of Outcome After Subthalamic Nucleus Deep Brain Stimulation

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Several studies have examined the factors predictive of a positive outcome after STN DBS (25,35,38-40). Charles et al. (38) examined 54 PD patients after bilateral STN DBS and found that age and preoperative levodopa response were the strongest predictors of outcome. In a study of 41 PD patients who had STN DBS, Welter et al. used regression analyses to identify age and disease duration as predictors of outcome. They found that patients 56 years of age or younger had a 71% improvement in UPDRS ADL and motor scores compared to improvements of 57% and 62% for those older than 56 years. Similarly, those with disease duration less than 16 years had significantly better responses to surgery than those with disease duration greater than 16 years. The authors concluded that in addition to age and disease duration, levodopa responsiveness was the strongest predictor of outcome after STN DBS. Kleiner-Fisman et al. (35) examined age, sex, disease duration, medication usage, dyskinesia, age of onset, and levodopa responsiveness in 25 PD patients who received bilateral STN DBS. Levodopa responsiveness was the only factor related to outcome. Jaggi et al. (39) examined 39 patients after STN DBS. They found that age, preoperative change in UPDRS motor scores with medication, and disease duration were the strongest predictors of outcome. Finally, Pahwa et al. (40) examined

45 patients after bilateral STN DBS and found that the preoperative change in UPDRS motor scores with medication was the strongest predictor of outcome. They found no relationship with age or disease duration. The American Academy of Neurology Practice Parameter: Treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review) (41) concluded that preoperative response to levodopa is probably predictive of postsurgical improvement and younger age and disease duration less than 16 years are possibly predictive of greater improvement after STN DBS. It was recommended that preoperative response to lev-odopa should be considered as a factor predictive of outcome after STN DBS, whereas, age and disease duration may be considered as predictive factors.

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