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LongâTerm Medication Profiles in Parkinson's Disease under Subthalamic Deep Brain Stimulation: A Controlled Study
Publication status: PublishedBackground: Subthalamic deep brain stimulation (STNâDBS) reduces antiparkinsonian medications in Parkinson's disease (PD) compared with the preoperative state. Longitudinal and comparative studies on this effect are lacking. Objective: To compare longitudinal trajectories of antiparkinsonian medication in STNâDBS treated patients to nonâsurgically treated control patients. Methods: We collected retrospective information on antiparkinsonian medication from PD patients that underwent subthalamic DBS between 1999 and 2010 and control PD patients similar in age at onset and baseline, sexâdistribution, and comorbidities. Results: In 74 DBS patients levodopaâequivalent daily dose (LEDD) were reduced by 33.9â56.0% in relation to the preoperative baseline over the 14âyear observational period. In 61 control patients LEDDs increased over approximately 10 years, causing a significant divergence between groups. The largest difference amongst single drugâclasses was observed for dopamine agonists. Conclusion: In PD patients, chronic STNâDBS was associated with a lower LEDD compared with control patients over 14 years
Development and Validation of a Prognostic Model to Predict Overall Survival in Multiple System Atrophy
BackgroundMultiple system atrophy (MSA) is a devastating disease characterized by a variable combination of motor and autonomic symptoms. Previous studies identified numerous clinical factors to be associated with shorter survival. ObjectiveTo enable personalized patient counseling, we aimed at developing a risk model of survival based on baseline clinical symptoms. MethodsMSA patients referred to the Movement Disorders Unit in Innsbruck, Austria, between 1999 and 2016 were retrospectively analyzed. Kaplan-Meier curves and multivariate Cox regression analysis with least absolute shrinkage and selection operator penalty for variable selection were performed to identify prognostic factors. A nomogram was developed to estimate the 7 years overall survival probability. The performance of the predictive model was validated and calibrated internally using bootstrap resampling and externally using data from the prospective European MSA Study Group Natural History Study. ResultsA total of 210 MSA patients were included in this analysis, of which 124 patients died. The median survival was 7 years. The following clinical variables were found to significantly affect overall survival and were included in the nomogram: age at symptom onset, falls within 3 years of onset, early autonomic failure including orthostatic hypotension and urogenital failure, and lacking levodopa response. The time-dependent area under curve for internal and external validation was >0.7 within the first 7 years of the disease course. The model was well calibrated showing good overlap between predicted and actual survival probability at 7 years. ConclusionThe nomogram is a simple tool to predict survival on an individual basis and may help to improve counseling and treatment of MSA patients