MDS Virtual Congress 2020: Directional vs Omnidirectional DBS in Parkinson, and More

Loneliness May Play Key Role in Severity of Parkinson Disease

Quality of life and disease severity in Parkinson disease appear to be worsened by loneliness, according to new findings presented at the International Parkinson and Movement Disorder Society (MDS) Virtual Congress 2020.

These findings emerged from a cross‐sectional analysis of baseline data from 1746 patients who reported a diagnosis of idiopathic Parkinson disease (PD) from the CAM Care PD study. Quality of life and severity of PD were measured via Patient Reported Outcome Measurement Information System (PROMIS) and Patient Reported Outcomes in Parkinson Disease (PRO-PD), respectively.

Results of the study indicated that 354 patients reported feeling lonely. Patients who reported feelings of loneliness were found to have higher PRO-PD scores than those who reported smoking (n = 259) or feeling very stressed (n = 195).

“These data do not speak to causation. However, the results further support the need to keep people from becoming socially isolated and lonely as they age,” the authors of the study wrote.

Notably, exercising was found to confer as much benefit as feelings of loneliness conferred detriment. Having many friendships also appeared to be beneficial among patients with PD.

“By recognizing loneliness as a risk factor for worsened PD severity, health care providers can become more proactive in preventing social isolation. Counseling about the need to stay socially connected from time of diagnosis is essential,” the authors concluded.

Directional DBS Demonstrates Superiority Over Omnidirectional DBS in Parkinson Disease

The therapeutic window (TW) for directional deep brain stimulation (DBS) appears to be superior to omnidirectional DBS among patients with Parkinson disease (PD), according to new findings highlighted at the MDS Virtual Congress 2020.

The authors of the study wrote that this is the first time superiority of TW for directional over omnidirectional DBS has been demonstrated.

They arrived at their conclusion after evaluating the effects of omnidirectional vs directional subthalamic nucleus (STN) DBS among participants with PD (N = 234) who received implanted directional DBS systems. Participants were blinded to DBS type and underwent 3 months of omnidirectional subthalamic nucleus (STN) DBS and a subsequent 3 months of directional DBS. TW and motor symptoms were examined by a blinded evaluator. The primary endpoint was superiority.

The results of the study indicated that the TW was wider when directional DBS was used among 90.6% of participants, thus “satisfying the primary endpoint for superiority” of directional DBS over omnidirectional DBS, the authors wrote. For directional stimulation, the mean increase in TW was 41%.

At month 6, 102 (53%) of 193 participants expressed preference for the period with directional DBS compared with 50 (26%) participants who preferred the period with omnidirectional DBS and 41 (21%) participants who expressed no preference. Among 193 clinicians, 113 (59%) said they preferred the directional DBS period compared with 41 (21%) who expressed preference of the omnidirectional DBS period.

The authors noted that additional data, including findings at 12 months, will be made available.

—Christina Vogt

References:

  1. Subramanian I, Mischley L, Farahnik J. 1244: Loneliness/social isolation as a risk factor for worsened Parkinson disease severity. Movement Disorders. 2020;35(suppl. 1). doi:10.1002/mds.28268
  2. Schnitzler A, Mir P, Brodsky MA, et al. 942: Directional versus omnidirectional deep brain stimulation: results of a multicenter prospective blinded crossover study. Movement Disorders. 2020;35(suppl. 1). doi:10.1002/mds.28268