Panagiotis Bargiotas, 1 Ines Debove,2 Ioannis Bargiotas,3 Lenard Martin Lachenmayer,4 Maria Ntafouli,1 Nicolas Vayatis,3 Michael Schüpbach,2 Paul Krack,2 Claudio Bassetti1

1 Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland

2 Movement Disorders Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland

3 Center of Applied Mathematics, ENS Cachan, CNRS, Paris, France

4 Inselspital University Hospital Bern, Bern, Switzerland

Abstract

Background Although rapid eye movement sleep behaviour disorder (RBD) in Parkinson’s disease (PD) is associated with increased non-motor symptoms, its impact on the deep brain stimulation (DBS) outcome remains unclear. This is the first study to compare the post-DBS outcome between PD patients with RBD (PDRBD+) and without (PD-RBD-).

Methods: We analysed data from PD patients who were treated with DBS in the nucleus subthalamicus. Assessments included night-polysomnography (only preDBS), and motor and non-motor assessments pre-DBS and post-DBS.

Results: Among 50 PD patients (29 males, mean age 62.5 years, 11.8 mean PD years), 24 (48%) had RBD. Pre-DBS, the two groups were equal in respect to sociodemographic features, disease duration and PD medications. A multivariate analysis showed that the clinical profile linked to motor, non-motor and quality of life features differed significantly between PD patients with and without RBD. The most discriminative elements were Unified Parkinson’s Disease Rating Scale (UPDRS)- III, apathy and depression scores. Post-DBS, UPDRS-III, Epworth sleepiness scale and PD questionnaire improved significantly in both groups. UPDRS-II scores significantly improved in the PD-RBD+ group (−45%) but remained unchanged in the PD-RBD- group (−14%). The depression score improved significantly in the PD-RBD+ (−34%) and remained unchanged in the PD-RBD- group. The apathy score remained unchanged in the PD-RBD+ group but increased significantly in the PD-RBD- group (+33%).

Conclusion: While pre-DBS, PD with and without RBD showed different clinical profiles, post-DBS, the clinical profiles post-DBS were comparable. In respect to depressive symptoms, apathy and activities of daily living, PD-RBD+ patients show favourable post-DBS outcome. These findings highlight the importance of pre-DBS RBD assessment.

Μαίρη Ζ. Νταφούλη

Κλινική Ψυχολόγος

Πιστοποιημένη Γνωστική Συμπεριφορική Ψυχοθεραπεύτρια

ΜSc  Iατρική του Ύπνου

PhDc Uni Bern, Switzerland

Eξωτερική συνεργάτιδα, Aiγινήτειο Νοσoκομείο και Ερρίκος Ντυνάν ΗC