Abstract Details

Title Longitudinal outcomes of LRRK2 gene mutation parkinsonism undergoing either Subthalamic Nucleus (STN) or Globus Pallidus Internus (GPi) Deep-Brain stimulation (DBS): a multi-group comparison

Topic Movement Disorders

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-029

Objective To improve our understanding of DBS in LRRK2 G2019S mutation carriers.

Background Data regarding DBS in LRRK2 PD are limited, and there are no published data comparing STN-DBS to GPi-DBS for LRRK2 mutation carriers.

Design/Methods Chart review for clinical, motor, and neuropsychiatric features was performed for 40 LRRK2 G2019S mutation PD (with or without DBS) and 15 non-LRRK2 PD with DBS who were part of genetics research at Mount Sinai Beth Israel. GBA mutation carriers were excluded.

Results

LRRK2 DBS patients had a significantly younger age of onset than LRRK2 PD without DBS, (50.11 years (range 26-70) vs 63.72 years (range 44-85); p=0.006), and were more likely to be male (77.8% vs 18.7%; p=0.002).

Among LRRK2 PD, 4 patients underwent GPi-DBS, and 5 patients underwent STN-DBS. There was a greater reduction in baseline to two-year levodopa equivalency dose (LED) for STN-DBS vs GPi-DBS (46% vs -1%, p=0.02). However, there was no difference in motor score or neuropsychological tests.

LRRK2 DBS did not differ from iPD DBS in age of onset and diagnosis, sex, disease duration, motor score or medication use at surgery. The average time to diagnosis was greater in LRRK2 DBS (0.67 years vs 1.67 years; p=0.03). LRRK2 PD DBS had a greater reduction in motor score than iPD DBS from baseline to two-year follow-up (69% vs. -11%; p=0.02). There was no difference in LED or neuropsychological tests.

Conclusions LRRK2 PD DBS are more likely male and have a younger age of onset than non-DBS LRRK2 PD. Both LRRK2 STN-DBS and GPi-DBS lead to reductions in motor scores, although STN-DBS may provide a greater reduction in LED. LRRK2 mutation carriers maintain a robust response to DBS at two-year follow-up. More data are needed as genotyping may be a consideration when identifying optimal patient and target for DBS.

Authors/Disclosures
Katherine E. Leaver, MD PRESENTER	Dr. Leaver has nothing to disclose.
Joan Miravite, DNP, RN, FNP-BC, FAAN, FAANP, DAAN (Mount Sinai West)	Dr. Miravite has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Dr. Miravite has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Miravite has a non-compensated relationship as a Board Member with Association of Movement Disorder Advanced Practice Providers that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
Roberto P. Ortega, MD	No disclosure on file
Eileen Moran, MD	No disclosure on file
Brian Kopell	No disclosure on file
Michael S. Okun, MD, FAAN (University of Florida)	Dr. Okun has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Okun has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Parkinson's Foundation. Dr. Okun has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for JAMA Neurology. Dr. Okun has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEJM Journal Watch. The institution of Dr. Okun has received research support from NIH. The institution of Dr. Okun has received research support from Parkinson's Foundation. The institution of Dr. Okun has received research support from Tourette Association of America. The institution of Dr. Okun has received research support from Michael J Fox. Dr. Okun has received publishing royalties from a publication relating to health care.
Kelly D. Foote, MD	Kelly D. Foote, MD has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Axio/Neurocrine Biosciences.
Vicki Shanker, MD, FAAN (Icahn School of Medicine at Mount Sinai)	Dr. Shanker has received personal compensation in the range of $0-$499 for serving as a Consultant for The Insighters.
Susan B. Bressman, MD, FAAN (Mount Sinai Health System)	The institution of Dr. Bressman has received research support from Michael J Fox Foundation . The institution of Dr. Bressman has received research support from NIH .
Rachel J. Saunders-Pullman, MD (Mount Sinai Beth Israel, Neurology, Downtown Union Square)	The institution of Dr. Saunders-Pullman has received research support from NIH, Bigglesworth Family Foundation, Empire Clinical Research Investigatory Program.

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