Effect of Subthalamic Nucleus Deep Brain Stimulation Treatment on Non-motor Symptoms and Sleep Quality in Parkinson’s Disease Patients

Year 2023, Volume: 7 Issue: 1, 59 - 65, 21.06.2023

Nazan Şimşek Erdem , Gokce Yagmur Gunes Gencer , Sehür Sibel Özkaynak , Tanju Uçar

https://doi.org/10.30565/medalanya.1221314

Cited By: 1

Abstract

Aim: To evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on non-motor symptoms (NMS), sleep quality, and excessive daytime sleepiness in patients with Parkinson’s Disease (PD).

Method: Sixteen PD patients, who had undergone bilateral STN-DBS surgery were enrolled. The patients were assessed at the baseline and 12 months after surgery using the Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire (PDQ-39), Beck Depression Inventory-II (BDI), Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Non-Motor Symptom Questionnaire (NMS-Quest).

Results: The mean age of the patients at the time of surgery was 53.5±3.6 years. There were significant improvements in the levodopa-equivalent daily dose, UPDRS-part-II, UPDRS-part-III, and UPDRS-part-IV at 12 months post-DBS surgery. The NMS-Quest total score at baseline was correlated with the disease duration of the patients (p=0.005 R:0.66). The PSQI score at baseline was significantly associated with a high total UPDRS and HADS score (p=0.03, p=0.004 respectively). There were no significant differences in terms of NMS-Quest total and subdomains thereof and PSQI total score and subdomains thereof, UPDRS-part I, BDI-II and HADS scores between baseline and 12 months post-DBS surgery (p>0.05 for all of them).

Conclusion: STN-DBS surgery did not change subjective sleep quality, excessive daytime sleepiness, and NMS although it improved motor symptoms, motor fluctuations, and the health-related quality of life

Keywords

subthalamic nucleus deep brain stimulation (STN-DBS), sleep quality, non-motor symptoms, excessive daytime sleepiness

Parkinson Hastalarında Subtalamik Çekirdek Derin Beyin Stimülasyonu Tedavisinin Non-motor Semptomlara ve Uyku Kalitesine Etkisi

Abstract

Amaç: Parkinson Hastalığı (PH) olan hastalarda subtalamik nukleus derin beyin stimülasyonunun (STN-DBS) non- motor semptomlar (NMS), uyku kalitesi ve gündüz aşırı uykululuk üzerine etkisini değerlendirmek.

Yöntem: Bilateral STN-DBS cerrahisi geçirmiş 16 PH hastası çalışmaya alındı. Hastalar ameliyat öncesi ve ameliyattan 12 ay sonra Birleşik Parkinson Hastalığı Derecelendirme Ölçeği (BPHDÖ), Parkinson Hastalığı Anketi (PDQ-39), Beck Depresyon Envanteri-II (BDI), Hastane Anksiyete ve Depresyon Ölçeği (HADS), Pittsburgh Uyku Kalitesi İndeksi (PSQI), Epworth Uykululuk Ölçeği (ESS) ve Non-motor Semptom Anketi (NMS-Quest) kullanılarak değerlendirildi.

Bulgular: Hastaların ameliyat anındaki ortalama yaşı 53,5±3,6 idi. DBS ameliyatından 12 ay sonra levodopa eşdeğeri günlük dozunda, BPHDÖ-bölüm-II, BPHDÖ-bölüm-III ve BPHDÖ-bölüm-IV'te anlamlı iyileşmeler oldu. Başlangıçtaki NMS-Quest toplam puanı, hastaların hastalık süresi ile koreleydi (p=0,005 R:0,66). Başlangıçtaki PSQI skoru, yüksek BPHDÖ toplam skor ve HADS skoru ile anlamlı şekilde ilişkiliydi (sırasıyla p=0.03, p=0.004). Başlangıçtaki ve DBS cerrahisinden 12 ay sonraki NMS-Quest toplam ve alt alanları, PSQI toplam puanı ve alt alanları, BPHDÖ-bölüm-I, BDI-II ve HADS puanları arasında anlamlı fark yoktu (p>0,05 tümü için ).

Sonuç: STN-DBS cerrahisi motor semptomları, motor dalgalanmaları ve sağlıkla ilişkili yaşam kalitesini iyileştirmesine rağmen gündüz aşırı uykululuk halini, subjektif uyku kalitesini ve NMS'yi değiştirmedi.

Keywords

subtalamik nukleus derin beyin stimülasyonu (STN-DBS), uyku kalitesi, non- semptomlar, gündüz aşırı uykululuk hali

References

• 1. Pfeiffer RF. Non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord. 2016;22 Suppl 1:S119-22. doi: 10.1016/j.parkreldis.2015.09.004.
• 2. Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015. Sleep Med Rev. 2017;35:33-50. doi: 10.1016/j.smrv.2016.08.001.
• 3. Frizon LA, Hogue O, Achey R, Floden DP, Nagel S, Machado AG, et al. Quality of Life Improvement Following Deep Brain Stimulation for Parkinson Disease: Development of a Prognostic Model. Neurosurgery. 2019;85(3):343-349. doi: 10.1093/neuros/nyy287.
• 4. Nazzaro JM, Pahwa R, Lyons KE. The impact of bilateral subthalamic stimulation on non-motor symptoms of Parkinson's disease. Parkinsonism Relat Disord. 2011;17(8):606-9. doi: 10.1016/j.parkreldis.2011.05.009.
• 5. Jost ST, Sauerbier A, Visser-Vandewalle V, Ashkan K, Silverdale M, Evans J, et al. EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group. A prospective, controlled study of non-motor effects of subthalamic stimulation in Parkinson's disease: results at the 36-month follow-up. J Neurol Neurosurg Psychiatry. 2020;91(7):687-694. doi: 10.1136/jnnp-2019-322614.
• 6. Eghlidos Z, Rahimian Z, Vadiee G, Jahangiri S. Effects of subthalamic deep brain stimulation on non-motor symptoms of Parkinson's disease: A meta-analysis. Acta Neurol Scand. 2022;146(2):115-125. doi: 10.1111/ane.13652.
• 7. Volkmann J, Daniels C, Witt K. Neuropsychiatric effects of subthalamic neurostimulation in Parkinson disease. Nat Rev Neurol. 2010;6(9):487-98. doi: 10.1038/nrneurol.2010.111.
• 8. Bjerknes S, Toft M. Subthalamic Nucleus Stimulation in Parkinson's Disease: 5-Year Extension Study of a Randomized Trial. Mov Disord Clin Pract. 2021;9(1):48-59. doi: 10.1002/mdc3.
• 9. Baumann-Vogel H, Imbach LL, Sürücü O, Stieglitz L, Waldvogel D, Baumann CR, et al. The Impact of Subthalamic Deep Brain Stimulation on Sleep-Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients. Sleep. 2017;40(5). doi: 10.1093/sleep/zsx033.
• 10. Yin Z, Bai Y, Guan B, Jiang Y, Wang Z, Meng F, et al. A quantitative analysis of the effect of bilateral subthalamic nucleus-deep brain stimulation on subjective and objective sleep parameters in Parkinson's disease. Sleep Med. 2021;79:195-204. doi: 10.1016/j.sleep.2020.10.021.
• 11. Dulski J, Schinwelski M, Konkel A, Grabowski K, Libionka W, Wąż P, et al. The impact of subthalamic deep brain stimulation on sleep and other non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord. 2019;64:138-144. doi: 10.1016/j.parkreldis.2019.04.001.
• 12. Choi JH, Kim HJ, Lee JY, Yoo D, Im JH, Paek SH, et al. Long-term effects of bilateral subthalamic nucleus stimulation on sleep in patients with Parkinson's disease. PLoS One. 2019;14(8):e0221219. doi: 10.1371/journal.pone.0221219.
• 13. Kharkar S, Ellenbogen JR, Samuel M, Rizos A, Silverdale M, Chaudhuri KR, et al. Changes in Parkinson's disease sleep symptoms and daytime somnolence after bilateral subthalamic deep brain stimulation in Parkinson's disease. NPJ Parkinsons Dis. 2018;4:16. doi: 10.1038/s41531-018-0053-5.
• 14. Jung YJ, Kim HJ, Lee WW, Ehm G, Jeon B. A 3-year observation of excessive daytime sleepiness after subthalamic deep brain stimulation in patients with Parkinson's disease. Clin Neurol Neurosurg. 2020;192:105721. doi: 10.1016/j.clineuro.2020.105721.
• 15. Cicolin A, Lopiano L, Zibetti M, Torre E, Tavella A, Guastamacchia G, et al. Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med. 2004 Mar;5(2):207-10. doi: 10.1016/j.sleep.2003.10.010.
• 16. Bargiotas P, Eugster L, Oberholzer M, Debove I, Lachenmayer ML, Mathis J, et al. Sleep-wake functions and quality of life in patients with subthalamic deep brain stimulation for Parkinson's disease. PLoS One. 2017;12(12):e0190027. doi: 10.1371/journal.pone.0190027.
• 17. Oner OG, Sunter G, Jafarova S, Agan K, Seker A, Gunal DI. Assessment of the Effect of Subthalamic Deep Brain Stimulation on Sleep Quality of Parkinson's Disease Patients. Turk Neurosurg. 2022;32(3):398-405. doi: 10.5137/1019-5149.JTN.33808-21.2.
• 18. Amara AW, Standaert DG, Guthrie S, Cutter G, Watts RL, Walker HC. Unilateral subthalamic nucleus deep brain stimulation improves sleep quality in Parkinson's disease. Parkinsonism Relat Disord. 2012;18(1):63-8. doi: 10.1016/j.parkreldis.2011.09.001.
• 19. Liu KD, Shan DE, Kuo TB, Yang CC. The effects of bilateral stimulation of the subthalamic nucleus on heart rate variability in patients with Parkinson's disease. J Neurol. 2013;260(7):1714-23. doi: 10.1007/s00415-013-6849-7.
• 20. Torun NA, Senel GB, Gunduz A, Karadeniz D, Kiziltan G, Ertan S, et al. Sleep parameters associated with long-term outcome following subthalamic deep brain stimulation in Parkinson's disease. Rev Neurol (Paris). 2020 May;176(4):277-284. doi: 10.1016/j.neurol.2019.07.020.
• 21. Jung YJ, Kim HJ, Paek SH, Jeon B. Effects of Deep Brain Stimulation on Sleep-Wake Disturbances in Patients with Parkinson's Disease: A Narrative Review. Curr Neuropharmacol. 2021;19(10):1716-1727. doi: 10.2174/1570159X19666210215115718.
• 22. Chahine LM, Ahmed A, Sun Z. Effects of STN DBS for Parkinson's disease on restless legs syndrome and other sleep-related measures. Parkinsonism Relat Disord. 2011;17(3):208-11. doi: 10.1016/j.parkreldis.2010.11.017.
• 23. Hjort N, Østergaard K, Dupont E. Improvement of sleep quality in patients with advanced Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus. Mov Disord. 2004 Feb;19(2):196-9. doi: 10.1002/mds.10639.
• 24. Lyons KE, Pahwa R. Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease. J Neurosurg. 2006 Apr;104(4):502-5. doi: 10.3171/jns.2006.104.4.502.