Naarding, K.J. (2015) The use of the UPDRS part III score in four conditions as part of usual care in Parkinson’s Disease patients treated with deep brain stimulation. thesis, Medicine.
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Abstract
Objective: This study revolves around the use of the Unified Parkinson’s Disease Rating Scale (UPDRS) part III score in four conditions (assessment in four conditions, AFC) as part of usual care in Parkinson’s Disease (PD) patients treated with deep brain stimulation (DBS) and dopaminergic medication. The objective was to evaluate whether AFC led to an improvement in PD symptoms and/or to a greater degree of patient satisfaction with their PD treatment. The four previously mentioned conditions are: ‘medication off/ DBS on’, ‘medication off/ DBS off’, ‘medication on/ DBS off’, and ‘medication on/ DBS on’. Methods: All patients undergoing an AFC at the Academic Medical Centre (AMC) in Amsterdam between November 2012 and March 2015 were included in this retrospective cohort study. A control group was selected primarily based on the age at DBS surgery and the moment of DBS surgery. Medical records were reviewed. Amongst other data, the indication for AFC, changes in treatment policy and the number of consultations with the AMC neurology department were recorded. Additionally, patients without proven dementia who underwent an AFC between November 2012 and January 2015 were asked to participate in a retrospective questionnaire and those who underwent AFC in February or March 2015 were asked to participate in a pilot of two prospective questionnaires. Four major Dutch DBS centres participated in a questionnaire about the use of AFC in their hospital. Results: All 42 patients who met the inclusion criteria were included in the study and 39 controls could be matched to them. Retrospective questionnaires were completed by 36 participants and prospective questionnaires by three. There were no significant differences between the baseline characteristics of the study and control group. There was a median time of 1.5 years between DBS surgery and AFC. Most study participants did not experience a change in their PD symptoms or level of functioning in the six months following AFC. Levodopa Equivalent Daily Dose was higher in the study group at each moment in time and decreased less from pre-operative screening to AFC compared to the control group (37% versus 49%). The number of consultations was significantly higher in the study group in the six months before and after AFC compared to the control group, but normalized in the consecutive six months (1.5 versus 1 per six months). 48% of study participants were referred back to their original neurologist compared to 22% controls. The benefits of AFC exceeded disadvantages according to 91% of study participants. A gait disorder was the most common indication (26%) for AFC. Dopaminergic medication had been adjusted more often in the study group compared to the control group in the year following AFC (93% versus 58%). In the two other DBS centres conducting AFC as part of usual care, the two last conditions of AFC are switched compared to the AMC protocol. Conclusion: PD patients treated with DBS and dopaminergic medication do not clearly benefit from AFC used as part of usual care. The reason for this is that AFC did not lead to a clear improvement in PD symptoms and the result that patients were satisfied to have undergone AFC was prone to bias. Although, in certain cases AFC could provide useful information, it is possible that a less time-consuming or demanding method, such as a clear explanation or only turning DBS off, could have the same effect. Based on this study, it is not advised to perform AFC on a larger scale.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Dorresteijn, Dr. L.D.A. neurologist and Department of Neurology, Medisch Spectrum Twente |
| Supervisor name: | Local supervisor: and Dijk, Dr. J.M. neurologist and Department of Neurology, Academic Medical Centre |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/622 |
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