Analysis of the effectiveness of subthalamic nucleus deep brain stimulation in patients with advanced parkinson’s disease: one-year follow-up from ukrainian experience

Abstract

Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is a standard treatment for advanced Parkinson’s disease (PD); however, comprehensive data on the effectiveness of this method in Ukraine remain limited. Objective: to analyze changes in motor symptoms, medication burden, and quality of life in patients with advanced PD one year after bilateral STN-DBS. Materials and methods: A clinical and statistical analysis was performed in 59 patients (43 men and 16 women; mean age, 57.85 ± 8.49 years) who underwent bilateral STN-DBS in Ukraine between 2012 and 2024. Treatment efficacy was assessed using Parts II–IV of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the 39-item Parkinson’s Disease Questionnaire (PDQ-39), the Schwab and England Activities of Daily Living (SE-ADL) scale, and changes in the levodopa equivalent daily dose (LEDD). Statistical analyses were performed using the paired Student’s t-test, Wilcoxon signed-rank test, and Cohen’s d effect size. Results: One year after surgery, a highly significant reduction in motor impairment was observed in the medication-off state (med-OFF): the MDS-UPDRS Part III OFF score decreased by 58.4%, from 69.39 ± 19.39 to 28.85 ± 9.88 (p < 0.001). The severity of motor complications, assessed using MDS-UPDRS Part IV, decreased by 92.5%, from 9.82 ± 3.08 to 0.74 ± 1.25 (p < 0.001). Mean LEDD decreased by 37.1% (p < 0.001; d = 1.95). Quality of life, assessed using the PDQ-39, improved by 40.9%, with the score decreasing from 73.82 ± 18.35 to 43.63 ± 16.92 (p < 0.001; d = 1.68). The level of functional independence, assessed using the SE-ADL scale, increased from 58.52% to 80.00% (p < 0.001; d = 1.86). Conclusions: An analysis of the Ukrainian experience with STN-DBS demonstrates high clinical effectiveness consistent with international standards. The procedure enables substantial reduction of motor impairment and motor complications, significantly decreases dopaminergic medication burden, and markedly improves patients’ quality of life. Precise multidisciplinary candidate selection and the use of intraoperative neurophysiological monitoring are key factors contributing to treatment success.