Long-term Follow-up of Unilateral Deep Brain Stimulation for Parkinson’s Disease
Anshul Daga1, Filipe Sarmento1, Anson Wang1, Joshua Wong1
1Norman Fixel Institute for Neurological Diseases, Department of Neurology, University of Florida
Objective:

To assess long-term effectiveness of unilateral deep brain stimulation (DBS) in Parkinson’s disease (PD) patients with up to one year of follow-up.

Background:

DBS is an established therapy for improving motor symptoms in select PD patients. Despite the common approach of simultaneous bilateral DBS implantation, there is value in a unilateral approach, with benefit up to 5 years. Considering the asymmetric phenomenology in PD, unilateral DBS may be a preferable initial option for select patients.

Design/Methods:
We conducted a retrospective study for PD patients who underwent subthalamic nucleus (STN) or globus pallidus interna (GPi) DBS surgery from January 2019 to September 2023. We extracted standardized motor assessments in the medication OFF state at preoperative baseline, 3-6 months, and 10-14 months postoperatively. Group-wise comparisons were conducted using the non-parametric Mann-Whitney test along with a Bonferroni correction (p=0.016).
Results:

We analyzed 180 patients (121 GPi / 59 STN) with unilateral DBS. The mean (SD) Unified Parkinson’s Disease Rating Scale part III motor scores (UPDRS-III) were: 35.7 (11.7) preoperatively, 25 (10.7) at 3-6 months postoperatively, and 26 (12) at 10-14 months postoperatively. The mean UPDRS-III at 3-6 and 10-14 months were significantly different from baseline (p = 0.000). A total of 66 patients with bilateral leads were selected for further comparison. Their mean (SD) UPDRS-III scores were: 37 (12) preoperatively, 24 (9) at 3-6 months postoperatively, and 27.3 (10.5) at 10-14 months postoperatively. The mean UPDRS-III at 3-6 and 10-14 months post-implantation were also significantly different from baseline. There was no significant difference in the percent improvement of UPDRS-III between unilateral and bilateral DBS at 3-6 and 10-14 months postoperatively (p= 0.208 and 0.762 respectively).

Conclusions:

Patients with unilateral DBS show significant improvement in motor symptoms at 3-6 and 10-14 months postoperatively. The degree of improvement is not significantly different from patients who underwent bilateral DBS.

10.1212/WNL.0000000000205870