Evidence-based correlates and predictors of medication reduction after DBS in PD

Document Type

Conference Proceeding

Publication Date

8-1-2023

Publication Title

J Parkinsons Dis

Abstract

Objective: To explore predictors and correlates of LEDD reduction after DBS in a multi-center real-word registry of PD patients undergoing DBS. Methods: RAD-PD systematically characterizes PD patients undergoing DBS through patient-reported outcomes and clinicianadministered scales assessing disease features, medical/surgical treatments, motor/non-motor symptoms, quality of life, social determinants of health, stimulation parameters, and adverse effects. We analyzed 6-month outcomes according to LEDD change (decreased <75%/remained stable, decreased >/=75%, and increased LEDD). DBS outcomes, correlates of LEDD change at 6mos and predictors of LEDD change were investigated. Results: Amongst N=32 with 6mo outcomes (N=29 STN, N=3 GPi), mean baseline LEDD=1268mg (SD 659.7) and mean 6mo LEDD reduction = 565mg (SD 855). 27/32 (84.4%) had reduced/unchanged LEDD at 6mos, of which N=10 (37.0%) reduced >/=75% [mean reduction 87% (SD 8%)] and N=17 (62.9%) reduced <75%/remained stable [mean reduction 27% (SD 21%)]. 5/32 (15.6%) increased LEDD by mean 200% (SD 147%). 6mos post- DBS, MDS-UDPRS part 3, EQ5D, PDQ39 summary index, MDSUPDRS part 2, BDI, GAD-7, and NMSS significantly improved amongst all patients (Exact Wilcoxon signed rank test, p<0.05). When analyzed by degree of LEDD change, there were no statistically significant differences in PD motor phenotype or DBS target, but those who increased LEDD had significantly lower baseline LEDD (Table 1). Those who reduced LEDD>75% had significantly greater reductions in MDS-UPDRS 2, MoCA, and GAD- 7 (Fisher's exact test, Kruskal-Wallis rank sum test, Table 1). Correlates of LEDD change at 6mos included starting amantadine after DBS, and the %changes in MDS-UPDRS 3 OFF, PDQ39 summary index, MDS-UPDRS 2, GAD-7, and NMSS (linear regression, p<0.05). Amongst pre-op features, only baseline MoCA correlated with LEDD change (p=0.02) at 6mos. Patient satisfaction and QoL at 6mos were not influenced by LEDD change. Conclusions: A majority of patients reduced their LEDD 6mos after DBS with 31% reducing >/=75%, and 15% increasing. Motor phenotype and DBS target did not influence LEDD change. Those who increased had lower baseline LEDD but no clear baseline predictors of LEDD change were found. LEDD change at 6mos correlates with multiple motor and non-motor improvements, but does not influence patient satisfaction or quality of life. Long term follow-up and imaging are required.

PubMed ID

Not assigned.

Volume

13

First Page

284

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