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Research paper
Patients’ expectations of deep brain stimulation, and subjective perceived outcome related to clinical measures in Parkinson's disease: a mixed-method approach
  1. Franziska Maier1,
  2. Catharine J Lewis1,
  3. Nina Horstkoetter2,
  4. Carsten Eggers1,
  5. Elke Kalbe1,3,
  6. Mohammad Maarouf4,
  7. Jens Kuhn5,
  8. Mateusz Zurowski6,
  9. Elena Moro7,
  10. Christiane Woopen2,
  11. Lars Timmermann1
  1. 1Department of Neurology, University of Cologne, Cologne, Germany
  2. 2Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
  3. 3Institute for Gerontology, University of Vechta, Vechta, Germany
  4. 4Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
  5. 5Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
  6. 6Department of Psychiatry, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
  7. 7Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France
  1. Correspondence to Franziska Maier, Department of Neurology, University Hospital Cologne, Kerpener Str. 62, Cologne D-50937, Germany; franziska.maier{at}uk-koeln.de

Abstract

Objective To study patients’ expectations of subthalamic deep brain stimulation (STN-DBS) and their subjective perceived outcome, by using qualitative and quantitative methods in Parkinson's disease (PD).

Methods PD patients were prospectively examined before and 3 months after surgery. Semistructured interviews regarding preoperative expectations and postsurgical subjective perceived outcome were conducted. These were analysed using content analysis. For statistical analyses, patients were classified according to their subjective perceived outcome, resulting in three different subjective outcome groups (negative, mixed, positive outcome). The groups were used for multiple comparisons between and within each group regarding motor impairment, quality of life (QoL), neuropsychiatric status and cognitive functioning, using standard instruments. A logistic regression analysis was conducted to find predictors of subjective negative outcome. Receiver operating characteristic curves were used to analyse cut-off scores for predictive tests.

Results Of the 30 PD patients participating, 8 had a subjective negative outcome, 8 a mixed and 14 a positive outcome. All groups significantly improved in motor functioning. Patients with subjective negative outcome were characterised by preoperative unrealistic expectations, no postsurgical improvement in QoL, and significantly higher presurgical and postsurgical apathy and depression scores. Higher preoperative apathy and depression scores were significant predictors of negative subjective outcome. Cut-off scores for apathy and depression were identified.

Conclusions The mixed-method approach proved useful in examining a patient's subjective perception of STN-DBS outcome. Our results show that significant motor improvement does not necessarily lead to a positive subjective outcome. Moreover, PD patients should be screened carefully before surgery regarding apathy and depression. (DRKS-ID: DRKS00003221).

  • Parkinson's Disease
  • Neuropsychiatry
  • Neuropsychology
  • Quality of Life
  • Stereotaxic Surgery

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