Research articleImpact of subthalamic nucleus stimulation did not differ on young-onset and older-onset Parkinson's disease: A three-year follow up
Introduction
Parkinson's disease (PD) is a heterogeneous neurological disorder characterized by resting tremor, rigidity, bradykinesia, gait and postural disorders [1]. Based on the onset of the disease, PD can be classified into two subtypes: young-onset Parkinson's disease (YOPD) and older-onset Parkinson's disease (OOPD). YOPD has been typically defined as onset of PD signs between the ages of 21 and 40 [2]. For the present study, a somewhat less restrictive definition of YOPD was adopted; patients were considered eligible for study if they received a diagnosis of PD on or before the age of 50 [3,4].
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is a well-recognized treatment for motor complications in advanced PD, with well-documented improvements in PD motor symptoms in the short- and long-term [[5], [6], [7]]. Nevertheless, there are few data focusing on the role of PD onset age on the outcome of patients treated with STN-DBS.
In 2010, Otaka and colleagues first reported the results of a short-term comparison between 15 YOPD (21–40 years of onset age) and 113 late-onset PD (LOPD) (>40 years of onset age) patients 6 months after STN-DBS surgery; the authors observed greater improvement in the UPDRS-III score in the YOPD group than in the LOPD group [8]. In the same year, Young Seok Park and colleagues also compared the differences in response between 18 YOPD (<40 years of onset age) and 15 LOPD (≥56 years of onset age) patients at six months postoperatively and found that the age of onset does not influence the response to STN-DBS in PD patients [9]. In 2012, a study by Merola et al showed that STN DBS-treated YOPD patients (<40 years of onset age) were associated with a medium to long term lower incidence of stimulation resistant symptoms [10].
The studies above used a cut-off onset age of 40 years for YOPD and resulted in conflicting conclusions. Nevertheless, differences in response to STN-DBS treatment between YOPD (onset age <50 years) and OOPD (onset age ≥50 years) patients have not been assessed. We therefore investigated the short- and long-term impact of bilateral DBS-STN on the patients with disease onset before the age of 50 years compared with those with older age of onset.
Section snippets
Patients
This was a retrospective cohort study of 55 PD patients who underwent bilateral STN-DBS surgery between April 2013 and December 2016 in the Neurosurgery Department of Xiangya Hospital. All patients were operated on by the same surgeon and his team. Patients were divided into YOPD and OOPD groups based on their age at disease onset. The cut-off age of onset between two groups was 50 years. The inclusion criteria included (1) primary PD with a disease duration of five years or more, (2) sustained
Baseline differences between YOPD and OOPD
There were 25 YOPD patients and 30 OOPD patients in this study. Although the YOPD group showed a lower age at PD onset and a younger age at surgery compared with the OOPD group (p < 0.001), the disease duration of the two groups did not differ significantly (p = 0.149). Meanwhile, the two groups showed similar baseline UPDRS-III scores, axial sub-scores and ADL scores in both the OFF and ON conditions (p > 0.05, Table 1).
Motor symptoms: the beneficial effects of DBS gradually decreased
Motor control is the main treatment goal for STN-DBS in PD patients. As
Discussion
To our knowledge, this is the first retrospective cohort study focusing on the different outcomes and changes in response to STN-DBS treatment between YOPD and OOPD patients with an onset age cut-off of 50 years. In this study, we report a three-year follow-up evaluation of the effect of bilateral STN-DBS in 25 YOPD and 30 OOPD patients under DBS-OFF/Med-OFF and DBS-ON/Med-OFF conditions. We are now presenting the first data that the beneficial anti-parkinsonian effects of DBS are equally
Funding
This work was supported by the National Key Research and Development Program of China (grant number 2016YFC0105900).
Authorship statements
The corresponding author Zhiquan Yang designed the study and was fully responsible for this study. Junmei Zhang conducted programming DBS for patients, collected the data and prepared the manuscript. Ge Jia assisted with data acquisition and conducted the statistical analysis and interpretation. Zhuanyi Yang and Dingyang Liu contributes mainly to DBS surgery and provided technical support. Yonghong Hou and Yanjin Wang assisted in editing this manuscript for important intellectual content. All
Conflict of interest
The authors reported no conflicts of interest.
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Both authors contribute equally to this paper.