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Effects of bilateral stimulation of the subthalamic nucleus in Parkinson's disease with and without REM sleep behaviour disorder
  1. Panagiotis Bargiotas1,2,
  2. Ines Debove3,
  3. Ioannis Bargiotas4,
  4. Martin Lenard Lachenmayer3,
  5. Maria Ntafouli1,
  6. Nicolas Vayatis4,
  7. Michael WM Schüpbach3,
  8. Paul Krack3,
  9. Claudio L Bassetti1
  1. 1 Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
  2. 2 Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
  3. 3 Movement Disorders Center, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
  4. 4 Center of Applied Mathematics, ENS Cachan, CNRS, Paris, France
  1. Correspondence to Dr Panagiotis Bargiotas, Sleep-Wake-Epilepsy Center, Department of Neurology, Inselspital University Hospital Bern, Bern, BE 3010, Switzerland; pabargio{at}


Background Although rapid eye movement sleep behaviour disorder (RBD) in Parkinson’s disease (PD) is associated with increased non-motor symptoms, its impact on the deep brain stimulation (DBS) outcome remains unclear. This is the first study to compare the post-DBS outcome between PD patients with RBD (PD-RBD+) and without (PD-RBD-).

Methods We analysed data from PD patients who were treated with bilateral DBS in the nucleus subthalamicus. Assessments included night-polysomnography (only pre-DBS), and motor and non-motor assessments pre-DBS and post-DBS.

Results Among 50 PD patients (29 males, mean age 62.5 years, 11.8 mean PD years), 24 (48%) had RBD. Pre-DBS, the two groups were equal in respect to sociodemographic features, disease duration and PD medications. A multivariate analysis showed that the clinical profile linked to motor, non-motor and quality of life features differed significantly between PD patients with and without RBD. The most discriminative elements were Unified Parkinson’s Disease Rating Scale (UPDRS)-III, apathy and depression scores. Post-DBS, UPDRS-III, Epworth sleepiness scale and PD questionnaire improved significantly in both groups. UPDRS-II scores significantly improved in the PD-RBD+ group (−45%) but remained unchanged in the PD-RBD- group (−14%). The depression score improved significantly in the PD-RBD+ (−34%) and remained unchanged in the PD-RBD- group. The apathy score remained unchanged in the PD-RBD+ group but increased significantly in the PD-RBD- group (+33%).

Conclusion While pre-DBS, PD patients with and without RBD showed different clinical profiles, post-DBS, the clinical profiles were comparable between the two groups. In respect to depressive symptoms, apathy and activities of daily living, PD-RBD+ patients show favourable post-DBS outcome. These findings highlight the importance of RBD assessment prior to DBS surgery.

  • Parkinson’s disease
  • REM sleep behavior disorder (RBD)
  • quality of life
  • subthalamic deep brain stimulation
  • non-motor symptoms

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  • Contributors PB and CLB were responsible for study concept and design; PB, ID, MLL and WMMS were responsible for data acquisition; PB, IB and NV were responsible for data analysis; PB, ID, IB, MLL, MN, NV, WMMS, PK and CLB were responsible for drafting the manuscript and preparing figures.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Panagiotis Bargiotas has received an “Inselgrant” from Inselspital, Bern. He has also received congress fees and travel reimbursements from Lundbeck Foundation. Ines Debove, Ioannis Bargiotas, Lenard Lachenmayer, Maria Ntafouli and Nicolas Vayatis have nothing to declare. W.M. Michael Schuepbach reports receiving consulting fees from Medtronic and Aleva, and lecture honoraria from Zambon, Merz Pharma, as well as grant support from Boston Scientific, Ipsen, Actelion. Furthermore, he received congress fees and travel reimbursements from Boston Scientific and Zambon. Paul Krack has received funding for travel or speaker honoraria from UCB (personal fees), Medtronic (personal fees), Boston Scientific (personal fees). Furthermore, he did consultancies for Boston Scientific and received research support from UCB (grants), St Jude Medical France, Medtronic, St Jude, Boston Scientific, Orkyn, Homeperf, French Ministry of Health (PHRC), INSERM (French National Institute of Health and Research in Medicine), Swiss National Science Foundation, Centre National Recherche Scientifique, ROGER DE SPOELBERCH Foundation, CARIGEST, Edmond J & Lily, Bertarelli Foundation, Edmond J & Lily Safra Foundation, France Parkinson and Annemarie Opprecht Foundation, outside the submitted work. PK was member of Movement Disorders Editorial Board (2010-2013). Claudio Bassetti has received honoraria for consultancy, lectures, and board memberships from the following institutions/companies: Jazz, Servier, UCB, Zambon, Cephalon Lundbeck, Pfizer Bohringer Ingelheim. His research is currently supported by grants of the following institutions/companies: Swiss National Science Foundation (SNF), ResMed, Respironics, Vifor Pharma, UCB Pharma, Schweizerische Herzstiftung, Tropos Stiftung, Parkinson Schweiz.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the local ethics committee (2016-00369, Kantonale Ethikkommission Bern).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.