Can Deep Brain Stimulation Improve Social, Occupational Functioning in Patients With Parkinson Disease?

Among patients with Parkinson disease (PD) aged 60 years and younger with early motor complications, deep brain stimulation (DBS) was found to provide significant improvements in social, occupational, and psychosocial function, according to study findings published in Movement Disorders Clinical Practice.

As the researchers noted, DBS has been shown to improve motor symptoms and quality of life in patients with PD (PwP) and early motor complications. Moreover, the safety of DBS has been indicated in a prior study, with previous concerns of dementia risk found not to be higher than the general PD population who did not undergo the procedure.

The implications of these benefits led researchers of the current study to examine whether DBS could be prescribed in the working-age PD population. While characterized as a condition typically occurring later in life, early-onset PD can significantly impact the prime earning years of PwP as they are more likely to report early retirement and economic burden than the general population.

Named the EARLYSTIM study, researchers evaluated the impact of DBS (n = 124) compared with best medical therapy (BMT) (n = 127) on the primary end point of quality of life and secondary end points of social, psychosocial, and occupational functioning in patients with PD ≤60 years of age with early motor complications. Participants were assessed at baseline and 5, 12, and 24 months after randomization.

Researchers utilized several measurement scales for analyses, including the Social and Occupational Functioning Assessment Scale (SOFAS), Scales for Outcomes for Parkinson’s–Psychosocial (SCOPA-PS), professional fitness, Starkstein Apathy Scale, and Schwab and England Activities of Daily Living Scale.

In the study findings, social and occupational functioning, determined by the SOFAS score, improved by 11% in the DBS group from baseline to 24 months (P < .05), translating to a mean category change from “some difficulty” to “slight impairment.” Conversely, the BMT group experienced a 3% decrease (P < .05) in social and occupational functioning at 24 months, although its mean category remained unchanged as “some difficulty.”

The increased benefits of DBS were additionally exhibited in psychological functioning, measured via SCOPA-PS, as those who underwent the procedure exhibited improvements of 28% from baseline to 24 months (mean ± SE, −2.5 ± 0.5; P < .05), compared with 3% for those of the BMT group (mean ± SE, −0.5 ± 0.5; P > .05).

While promising, work status, characterized as unemployed or full-time employed, was not significantly different between the DBS (44.2%) and BMT (40.2%) groups. One significant issue related with the inability to work was the prevalence of apathy.

“During postoperative management of DBS in PD, subjective inability to work may be positively influenced by management of dopaminergic medications, potentially resulting in a “happy doctor with a happy patient,” concluded the study authors.

Reference

Stoker V, Krack P, Tonder L, et al. Deep brain stimulation impact on social and occupational functioning in Parkinson’s disease with early motor complications. Mov Disord Clin Pract. Published online August 3, 2020. doi:10.1002/mdc3.13015