REM sleep behavior disorder has not been linked to poor outcomes after surgery for Parkinson’s disease

Probable REM sleep behavior disorder (RBD) before subthalamic deep brain stimulation (STN-DBS) is not associated with poorer quality of life (QoL) or poorer motor and non-motor outcomes associated with Parkinson’s disease (PD) in patients 1 year after surgery, suggest study results published in Neurology.

Patients with PD and RBD may have a more severe phenotype characterized by major motor disabilities, cognitive impairments, and axial symptoms. Despite the effectiveness of STN-DBS in severe Parkinson’s disease, the researchers found that some patients who undergo the procedure experience worsening of motor and non-motor symptoms.

In the study, the researchers performed a complementary analysis of the data collected from the ongoing French multicenter prospective study PREDISTIM. The aim of the study is to assess the predictive factors of treatment response to STN-DBS on long-term quality of life. For their analysis, the researchers focused on the preoperative clinical profile of 448 patients (mean age 63.3 ± 7.4 years) with PD (mean disease duration 11.0 ± 4.3 years) from the French study, corresponding to the absence or Presence of a probable RBD was assessed using the RBD individual question and the RBD screening questionnaire.

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All patients in the study had 12 months of follow-up after STN-DBS. The researchers compared patients with preoperative RBD (n = 242) with those without probable preoperative RBD (n = 206) in terms of motor, cognitive, psycho-behavioral profile and quality of life.

Patients with preoperative RBD were significantly older (61 ± 7.2 vs. 59.5 ± 7.7 years; P = 0.02) and had fewer motor impairments (Unified PD Rating Scale of the Society for Movement Disorders). [MDS-UPDRS] III Off: 38.7 ± 16.2 vs. 43.4 ± 7.1; P = .03), more non-motor symptoms in activities of daily living (MDS-UPDRS I: 12.6 ± 5.5 vs 10.7 ± 5.3; P <.001), more psycho-behavioral manifestations (Ardouin- Behavioral scale for PD total: 7.7 ± 5.1 vs 5.1 ± 0.4; P = 0.003) and significantly poorer quality of life (PD QoL 39 scale: 33 ± 12 vs 29 ± 12; P = 0, 03).

After the operation, both patients with vs without preoperative RBD had significant reductions in the MDS-UPDRS IV score (-37% and -33%; between group comparison of the variation: P = .43), MDS-UPDRS III “MedOff / StimOn” – Score (-52% and -54%; between group comparisons of the variation: P = .28) and dopaminergic treatment (-52% and -49%; between group comparisons of the variation: P = .22). In addition, the researchers reported no significant differences between the groups for cognitive and global QoL scores.

Both groups recorded a significant decrease in the subscores “activities of daily living” and “stigma”, while the subscores for “cognition” and “communication” only decreased significantly in patients with preoperative RBD (P <0.01). None of the variations in the cognitive and communication subscores differed significantly between the groups (P = .20 and P = .19). While the QoL subscore “physical complaints” decreased significantly more in patients with preoperative RBD (p = .04), this subscore decreased significantly in both groups.

The lack of polysomnographically confirmed RBD diagnoses in the study may have misclassified some patients with PD, the researchers said.

Despite this caveat, they noted, “The presence of RBD has previously been reported to be associated with a more severe Parkinson’s disease phenotype. ”

Long-term results require further evaluation in additional studies, particularly studies that include 3 to 5 year postoperative follow-up data, as this “increases our understanding of the specific prognosis associated with the presence of RBD in PD candidates for STN. can improve -DBS, ”the researchers concluded.


Besse-Pinot E, Pereira B, Durif F, et al. Preoperative REM sleep behavior disorder and subthalamic outcome of deep brain stimulation in Parkinson’s disease 1 year after surgery. Neurology. Published online October 19, 2021. doi: 10.1212 / WNL.000000000000012862

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