{ "abstract": "Background Motor asymmetry is a hallmark of Parkinson’s disease (PD), but ~20% of patients present with symmetric motor signs, which are associated with faster disease progression and poorer dopaminergic response. The impact of motor symmetry on activities of daily living (ADL) outcomes following subthalamic deep brain stimulation (STN-DBS) remains unclear. We hypothesised that patients with symmetric PD experience less ADL improvement post-STN-DBS than asymmetric PD patients.Methods This was a prospective, quasi-experimental, non-randomised, controlled, international multicentre study with a 6-month follow-up. The primary outcome was the Scales for Outcomes in Parkinson’s Disease-Motor ADL scale. Secondary outcomes included Unified Parkinson’s Disease Rating Scale motor examination and Parkinson’s Disease Questionnaire-8 (PDQ-8). We defined symmetric PD as a right-to-left hemibody motor score equalling 1. We analysed within-group longitudinal changes, between-group outcome differences, effect size and correlations between PDQ-8 and motor changes. We confirmed results in a propensity-score matched subcohort with well-balanced demographic and clinical parameters.Results We included 200 patients with asymmetric and 54 with symmetric PD. In symmetric PD, ADL remained stable, which was not associated with the observed PDQ-8 improvement. In contrast, in asymmetric PD, ADL improved with a moderate effect size, which correlated moderately with PDQ-8 improvement. In symmetric PD, the absolute risk of experiencing no clinically relevant postoperative ADL improvement was 23.8% higher.Conclusions This study provides class IIb evidence of worse ADL outcome of STN-DBS in patients with symmetric compared with asymmetric PD. Clinicians should counsel patients with symmetric PD on their elevated risk of ADL non-response when discussing STN-DBS as a treatment option.", "authors": [ { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany" ], "name": "Stefanie Theresa Jost" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany" ], "name": "Camilla Atwani" }, { "affiliations": [ "Department of Neurology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany" ], "name": "Philipp Alexander Loehrer" }, { "affiliations": [ "Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK" ], "name": "Keyoumars Ashkan" }, { "affiliations": [ "Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK" ], "name": "Alexandra Rizos" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany" ], "name": "Jan Niklas Petry-Schmelzer" }, { "affiliations": [ "Department of Parkinson, Sleep and Movement Disorders, University Hospital Bonn, Bonn, Germany" ], "name": "Jonas Krauss" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany" ], "name": "Jan F Krause" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany" ], "name": "Agni Maria Konitsioti" }, { "affiliations": [ "Department of General Psychology, University of Padua, Padua, Italy", "Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Center for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padua, Padua, Italy" ], "name": "Roberta Biundo" }, { "affiliations": [ "Department of Neurology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany" ], "name": "David J Pedrosa" }, { "affiliations": [ "Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK" ], "name": "Julian Evans" }, { "affiliations": [ "Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany" ], "name": "Veerle Visser-Vandewalle" }, { "affiliations": [ "Department of Neurosurgery, University of Marburg, Marburg, Germany" ], "name": "Christopher Nimsky" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany", "Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany" ], "name": "Gereon Rudolf Fink" }, { "affiliations": [ "Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK" ], "name": "Monty Silverdale" }, { "affiliations": [ "Krembil Research Institute, Toronto, Ontario, Canada", "Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada" ], "name": "Alfonso Fasano" }, { "affiliations": [ "Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain" ], "name": "Pablo Martinez-Martin" }, { "affiliations": [ "Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padua, Italy" ], "name": "Angelo Antonini" }, { "affiliations": [ "Department of Clinical Medicine, Aarhus University, Aarhus, Denmark", "Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark" ], "name": "Per Borghammer" }, { "affiliations": [ "Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK", "Dementech Neuroscience Academic Centre, London, UK", "Parkinson’s Centre of Excellence, Kings College Hospital, Dubai, UAE" ], "name": "K Ray Chaudhuri" }, { "affiliations": [ "Department of Neurology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany" ], "name": "Lars Timmermann" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany" ], "name": "Haidar S Dafsari" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany", "Department of Neurology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany", "Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK", "Department of Parkinson, Sleep and Movement Disorders, University Hospital Bonn, Bonn, Germany", "Department of General Psychology, University of Padua, Padua, Italy", "Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Center for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padua, Padua, Italy", "Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK", "Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany", "Department of Neurosurgery, University of Marburg, Marburg, Germany", "Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany", "Krembil Research Institute, Toronto, Ontario, Canada", "Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada", "Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain", "Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padua, Italy", "Department of Clinical Medicine, Aarhus University, Aarhus, Denmark", "Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark", "Dementech Neuroscience Academic Centre, London, UK", "Parkinson’s Centre of Excellence, Kings College Hospital, Dubai, UAE" ], "name": "The Non-Motor Parkinson’s Disease Research Group" }, { "affiliations": [ "Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany", "Department of Neurology, University Hospital of Giessen and Marburg, Campus Marburg, Marburg, Germany", "Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK", "Department of Parkinson, Sleep and Movement Disorders, University Hospital Bonn, Bonn, Germany", "Department of General Psychology, University of Padua, Padua, Italy", "Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Center for Rare Neurological Diseases (ERN-RND), Department of Neuroscience, University of Padua, Padua, Italy", "Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Greater Manchester, UK", "Department of Stereotactic and Functional Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany", "Department of Neurosurgery, University of Marburg, Marburg, Germany", "Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany", "Krembil Research Institute, Toronto, Ontario, Canada", "Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital - UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada", "Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain", "Parkinson and Movement Disorders Unit, Department of Neurosciences (DNS), University of Padua, Padua, Italy", "Department of Clinical Medicine, Aarhus University, Aarhus, Denmark", "Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark", "Dementech Neuroscience Academic Centre, London, UK", "Parkinson’s Centre of Excellence, Kings College Hospital, Dubai, UAE" ], "name": "The German Parkinson Society Non-Motor Symptoms Study Group" }, { "affiliations": [], "name": "The Movement Disorders Society Non-Motor Parkinson’s Disease Study Group" } ], "title": "Patients with symmetric Parkinson’s disease do poorly with subthalamic stimulation", "uid": "deb407b1-5b10-5c30-bbc4-2a56bfd8f963" }