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Determinants of Functional Independence or Its Loss following Subthalamic Nucleus Stimulation in Parkinson's Disease

Title
Determinants of Functional Independence or Its Loss following Subthalamic Nucleus Stimulation in Parkinson's Disease
Authors
Kim, RyulYoo, DallahJung, Yu JinLee, Woong-WooEhm, GwanheeYun, Ji YoungKim, Hee JinLee, Jee-YoungKim, Ji-YoungKim, Han-JoonPaek, Sun HaJeon, Beomseok
Ewha Authors
윤지영
Issue Date
2019
Journal Title
STEREOTACTIC AND FUNCTIONAL NEUROSURGERY
ISSN
1011-6125JCR Link

1423-0372JCR Link
Citation
STEREOTACTIC AND FUNCTIONAL NEUROSURGERY vol. 97, no. 2, pp. 106 - 112
Keywords
Parkinson's diseaseDeep brain stimulationActivities of daily livingDependenceIndependence
Publisher
KARGER
Indexed
SCIE; SCOPUS WOS
Document Type
Article
Abstract
Objective: This study aimed to describe the change in functional status following bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) and to identify predictors of postoperative functional dependence. Methods: We included PD patients with bilateral STN-DBS who had complete Schwab & England Activities of Daily Living (S&E ADL) Scale data at baseline and 6 months after surgery from our prospective registry. Functional dependence was defined as an S&E ADL score of less than 80%. All data were collected from the on-medication state and on-stimulation state (after surgery). Logistic regression analyses were performed to determine the factors predictive of functional dependence after surgery. Results: A total of 196 patients were included. At baseline, 41 patients were functionally dependent and the other 155 were functionally independent. Among the patients with preoperative dependence, 32 (78%) became functionally independent after surgery, and this conversion was associated with a lower baseline axial score (p = 0.012). Among the patients with preoperative independence, 21 (14%) developed postoperative dependence, and this conversion was associated with a higher baseline axial score (p = 0.013) and its smaller improvement (p < 0.001). Female sex (odds ratio [OR] 3.214; 95% confidence interval [CI] 1.210-8.542; p = 0.019) and a higher baseline axial score (OR 1.184; 95% CI 1.056-1.327; p = 0.004) significantly predicted the risk of postoperative functional dependence. Conclusions: We found that functional status following bilateral STN-DBS is closely related to preoperative axial symptoms. When loss of independence is a potential target for STN-DBS, clinicians should take into consideration the severity of axial impairment before surgery. (C) 2019 S. Karger AG, Basel
DOI
10.1159/000500277
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의과대학 > 의학과 > Journal papers
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