TY - JOUR
T1 - Multicenter Validation of Individual Preoperative Motor Outcome Prediction for Deep Brain Stimulation in Parkinson's Disease
AU - Habets, Jeroen G. V.
AU - Herff, Christian
AU - Fasano, Alfonso A.
AU - Beudel, Martijn
AU - Kocabicak, Ersoy
AU - Schnitzler, Alfons
AU - Snineh, Muneer Abu
AU - Kalia, Suneil K.
AU - Ramirez-Gómez, Carolina
AU - Hodaie, Mojgan
AU - Munhoz, Renato P.
AU - Rouleau, Eline
AU - Yildiz, Onur
AU - Linetsky, Eduard
AU - Schuurman, Rick
AU - Hartmann, Christian J.
AU - Lozano, Andres M.
AU - de Bie, Rob M. A.
AU - Temel, Yasin
AU - Janssen, Marcus L. F.
N1 - Funding Information: No direct funding is received and there is no conflict of interest due to the reported funding for this work. RMAB received research support from Netherlands Organization for Health Research and Development, Parkinson Vereniging, Stichting Parkinson Nederland, GE Health, Medtronic, Lysosomal Therapeutics, Neuroderm, all paid to the department. AAF received research support from Medtronic and Boston Scientific and honoraria from Abbvie, Abbott, Ceregare, Boston Scientific, and Medtronic. CJH received honoraria from Abbott. MH received honoraria from Medtronic. SKK is consultant for Medtronic for declaration. AML is consultant for Medtronic, Boston Scientific, and Abbott. MAS received consultation fees from Abbvie and research support from Medtronic and Boston Scientific. RS is consultant for Medtronic, Boston Scientific, and Elekta. YT received a research grant from Weijerhorst Foundation. CH received funding from Dutch Research Council (NWO). Publisher Copyright: © 2021 The Author(s) Published by S. Karger AG, Basel.
PY - 2021
Y1 - 2021
N2 - Background: Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for Parkinson's disease (PD) patients suffering from motor response fluctuations despite optimal medical treatment, or severe dopaminergic side effects. Despite careful clinical selection and surgical procedures, some patients do not benefit from STN DBS. Preoperative prediction models are suggested to better predict individual motor response after STN DBS. We validate a preregistered model, DBS-PREDICT, in an external multicenter validation cohort. Methods: DBS-PREDICT considered eleven, solely preoperative, clinical characteristics and applied a logistic regression to differentiate between weak and strong motor responders. Weak motor response was defined as no clinically relevant improvement on the Unified Parkinson's Disease Rating Scale (UPDRS) II, III, or IV, 1 year after surgery, defined as, respectively, 3, 5, and 3 points or more. Lower UPDRS III and IV scores and higher age at disease onset contributed most to weak response predictions. Individual predictions were compared with actual clinical outcomes. Results: 322 PD patients treated with STN DBS from 6 different centers were included. DBS-PREDICT differentiated between weak and strong motor responders with an area under the receiver operator curve of 0.76 and an accuracy up to 77%. Conclusion: Proving generalizability and feasibility of preoperative STN DBS outcome prediction in an external multicenter cohort is an important step in creating clinical impact in DBS with data-driven tools. Future prospective studies are required to overcome several inherent practical and statistical limitations of including clinical decision support systems in DBS care.
AB - Background: Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for Parkinson's disease (PD) patients suffering from motor response fluctuations despite optimal medical treatment, or severe dopaminergic side effects. Despite careful clinical selection and surgical procedures, some patients do not benefit from STN DBS. Preoperative prediction models are suggested to better predict individual motor response after STN DBS. We validate a preregistered model, DBS-PREDICT, in an external multicenter validation cohort. Methods: DBS-PREDICT considered eleven, solely preoperative, clinical characteristics and applied a logistic regression to differentiate between weak and strong motor responders. Weak motor response was defined as no clinically relevant improvement on the Unified Parkinson's Disease Rating Scale (UPDRS) II, III, or IV, 1 year after surgery, defined as, respectively, 3, 5, and 3 points or more. Lower UPDRS III and IV scores and higher age at disease onset contributed most to weak response predictions. Individual predictions were compared with actual clinical outcomes. Results: 322 PD patients treated with STN DBS from 6 different centers were included. DBS-PREDICT differentiated between weak and strong motor responders with an area under the receiver operator curve of 0.76 and an accuracy up to 77%. Conclusion: Proving generalizability and feasibility of preoperative STN DBS outcome prediction in an external multicenter cohort is an important step in creating clinical impact in DBS with data-driven tools. Future prospective studies are required to overcome several inherent practical and statistical limitations of including clinical decision support systems in DBS care.
KW - Clinical prediction models
KW - Deep brain stimulation
KW - Machine learning
KW - Motor response
KW - Outcome prediction
KW - Parkinson's disease
UR - http://www.scopus.com/inward/record.url?scp=85120611927&partnerID=8YFLogxK
U2 - https://doi.org/10.1159/000519960
DO - https://doi.org/10.1159/000519960
M3 - Article
C2 - 34823246
SN - 1011-6125
JO - Stereotactic and Functional Neurosurgery
JF - Stereotactic and Functional Neurosurgery
ER -