Abstract Details

Title Responsiveness of Parkinson's Disease Motor Subtypes to Subthalamic Nucleus (STN) Versus Globus Pallidus Internus (GPi) Deep Brain Stimulation (DBS): An Additional Analysis of the VA CSP #468 Study

Topic Movement Disorders

Presentation(s) S23 - (-)

Poster/Presentation
Number 006

Objective

Background The VA Cooperative Studies Program (CSP) #468, a large multicenter study that prospectively randomized PD patients to STN versus GPi DBS, found that stimulation at either target provided similar overall motor benefits. In order to further guide clinical decision-making, we conducted an additional analysis of this dataset to evaluate if different motor subtypes responded differently to the two stimulation targets.

Design/Methods 236 patients followed for 24 months were included in our analysis. Using patients' baseline Unified Parkinson's Disease Rating Scale (UPDRS) score in the off-medication state, we divided patients by motor subtype into: Tremor Dominant (TD), Intermediate (I), or Postural Instability Gait Difficulty (PIGD) (Jankovic et al. 1990). The primary outcome was improvement in motor function from baseline, defined as the difference in mean UPDRS III off medication/on stimulation score at 24 months.

Results Improvement from baseline motor function differed significantly based on motor subtype, regardless of target (p = 0.003), with PIGD patients having lower mean improvements in UPDRS III than I and TD groups. The I group had significantly fewer non-responders (3%) compared to TD (23%) and PIGD (36%) groups, defined as < 5 point decrease in UPDRS III score at 24 months (p = 0.001). TD patients had greater improvement in overall motor function after GPi DBS, compared to STN DBS (p = 0.02). Improvement in motor function for I (p = 0.56) and PIGD (p = 0.12) patients did not differ based on target.

Conclusions Our results suggest that patients with the TD motor subtype may have a greater response to GPi DBS compared to STN DBS, providing further support for the consideration of GPi DBS in treating PD.

Authors/Disclosures
Maya Katz, MD (Stanford University School of Medicine) PRESENTER	Dr. Katz has received research support from NIH.
Marta San Luciano, MD, FAAN (University of California San Francisco)	Dr. San Luciano has received research support from NIH (NINDS).
	No disclosure on file
	No disclosure on file
William J. Marks, Jr., MD, FAAN	Dr. Marks has received personal compensation for serving as an employee of Verily Life Sciences. Dr. Marks has received stock or an ownership interest from Verily Life Sciences. Dr. Marks has received publishing royalties from a publication relating to health care.
Paul Larson	No disclosure on file
	No disclosure on file
Kenneth Follett, MD (University of Nebraska Medical Center)	Dr. Follett has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic Neurological.
Frances Weaver	No disclosure on file
Matthew B. Stern, MD	Dr. Stern has received personal compensation for serving as an employee of Mediflix, Inc. Dr. Stern has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for biogen. Dr. Stern has received personal compensation in the range of $100,000-$499,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuroderm.
	No disclosure on file
Jill L. Ostrem, MD, FAAN (UCSF)	Dr. Ostrem has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz . Dr. Ostrem has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Superness. Dr. Ostrem has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AcureX. Dr. Ostrem has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Larimar. Dr. Ostrem has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Aspen. Dr. Ostrem has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Movement Disorders. The institution of Dr. Ostrem has received research support from Neuroderm. The institution of Dr. Ostrem has received research support from Boston Scientific. The institution of Dr. Ostrem has received research support from Medtronic. The institution of Dr. Ostrem has received research support from Rune.
Guy J. Buckle, MD (Biogen)	No disclosure on file

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