Patients' Expectations and Satisfaction in Subthalamic Nucleus Deep Brain Stimulation for Parkinson Disease: 6-Year Follow-up

OBJECTIVE: Patients' expectations are considered to play an important role in subthalamic nucleus (STN) deep brain stimulation (DBS). We explored the relationship among expectations, satisfaction, and outcome 6 years after surgery. METHODS: Fifteen patients with Parkinson disease (9 males, mean age 60.5 +/- 6.4 years) undergoing STN DBS completed a modified PDQ-39 questionnaire (incorporating an assessment of patients' expected changes in addition to the standard quality of life items) preoperatively and at 6 years postoperatively. A satisfaction questionnaire accompanied the postoperative questionnaire. RESULTS: At 6 years' follow-up, PDQ-39 scores were unchanged from preoperative scores except in the stigma domain, which showed significant improvement. There was no significant difference between the postoperatively rated expected PDQ-39 summary score and the postoperative actual PDQ-39 summary score. However, there was a significant difference between the preoperatively rated expected PDQ-39 summary score and the postoperative actual PDQ-39 summary score. Patients remained highly satisfied with the outcome of surgery (mean satisfaction score 83%). Satisfaction did not correlate with PDQ-39 summary scores, domain scores, or fulfilment of expectations. The more satisfied patients (satisfaction >= 80%) changed their expectations so that their postoperatively rated expectations reflected a less favorable condition, whereas no such change was seen in the less satisfied (satisfaction < 80%) patients. CONCLUSIONS: Patients remain highly satisfied with STN DBS 6 years after surgery, although quality of life assessed by the PDQ-39 may return to baseline levels. Patients' expectations change over time and may influence patient satisfaction. Managing expectations before and after surgery plays an essential role in STN DBS.