REM sleep behavior disorder not related to poorer surgery outcomes in PD
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Preoperative presence of REM sleep behavior disorder in patients with Parkinson’s disease did not correlate with different clinical outcome 1 year after subthalamic deep brain stimulation, according to a study published in Neurology.
“Altogether, our results suggest that the presence of probable [REM sleep behavior disorder (RBD)] preoperatively is not associated with different motor, cognitive and global quality of life outcomes 1 year after [subthalamic deep brain stimulation (STN-DBS)],” Elsa Besse-Pinot, MD, faculty of medicine at Université Clermont Auvergne, and colleagues wrote. “Thus, although the presence of RBD has been previously reported to be associated with a more severe phenotype of PD, it does not seem to constitute a marker of risk of poor outcome after surgery in PD patients eligible to STN-DBS.”
Besse-Pinot and colleagues analyzed the preoperative clinical profile of 448 patients (67% men; mean age, 63.3 years; mean disease duration: 11 years) diagnosed with PD from an ongoing multicentric prospective study. The study included patients across 17 specialized PD centers in France who were indicated STN-DBS. Researchers used the RBD Single Question and RBD Screening Questionnaire to determine the presence of probable RBD preoperatively.
Clinical assessment was performed at baseline and at 12 months after surgery and included collection of demographic data, neuropsychological testing, quality-of-life questionnaires, medical and treatment history and also assessment of parkinsonism, which was evaluated using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Of the 448 patients, 215 (66% men; mean age, 60.3 years; mean disease duration, 11.4 years) underwent postoperative assessment, of which 57% (n = 122) had preoperative RBD.
Researchers noted that although RBD-positive patients had a worse global quality of life preoperatively, 12 months after STN-DBS, their global quality of life did not differ from patients without RBD.
The study found that 12 months after STN-DBS, both preoperative RBD-positive patients and RBD-negative patients had significant MDS-UPDRS IV (motor complication) score decreases of 37% (P < .01) and 33%, respectively (P < .01), MDS-UPDRS III (motor score) off medication score decreases of 52% (P < .01) and 54% (P < .001), respectively and dopaminergic treatment decreases of 52% (P < .01) and 49% (P < .01), respectively after surgery, with no between-group difference.
Researchers also observed no between-group difference for cognitive, psycho-behavioral and global quality-of-life outcomes.
“Further studies assessing long-term outcomes associated with the presence of RBD preoperatively 3 years and 5 years after surgery will improve our comprehension of the specific prognosis associated with the presence of RBD in PD candidates to STN-DBS,” they concluded.