ORIGINAL RESEARCH article
Front. Neurol.
Sec. Movement Disorders
A Parsimonious Nomogram for Individualized Prediction of 1-Year Functional Outcome After STN-DBS in Parkinson's Disease: A Single-Center Retrospective Study
Yiming Zhang
Qiushi Zhu
Baojun Fang
Fengyang Geng
Liaocheng People's Hospital, Liaocheng, China
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Abstract
Background: In Parkinson's disease (PD), subthalamic nucleus deep brain stimulation (STN-DBS) alleviates motor symptoms; however, functional outcomes at follow-up remain heterogeneous. Identifying patients at higher risk of unsatisfactory functional recovery using a personalized risk stratification tool may help guide perioperative management. Methods: We retrospectively reviewed consecutive PD patients who underwent STN-DBS at the Department of Functional Neurosurgery, Liaocheng People's Hospital, between January 1, 2015 and August 1, 2024, with a 1-year follow-up. Functional outcome was defined by the medication-off Schwab and England Activities of Daily Living Scale (S&E) at 1 year as good (S&E >70) or poor (S&E ≤70). Candidate predictors were prespecified and collected from general clinical characteristics, perioperative indicators, and preoperative specialist assessments. Independent predictors of poor outcomes were identified using multivariable logistic regression, and a nomogram was constructed. Internal validation was performed using bootstrap resampling. Model discrimination was quantified by the area under the receiver operating characteristic curve [AUC (C-index)], calibration was assessed using calibration plots and the Hosmer–Lemeshow test, and clinical utility was evaluated using decision curve analysis (DCA). Results: A total of 184 patients were included, of whom 109 had a good outcome and 75 had a poor outcome; 11 of 195 eligible patients were lost to follow-up. Poor functional outcome was independently associated with older age (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.03–1.14), lower Mini-Mental State Examination (MMSE) scores (OR 0.66, 95% CI 0.56–0.79), and postoperative electrolyte disorder (OR 2.97, 95% CI 1.28–6.91). The nomogram demonstrated good discrimination (AUC 0.846; bootstrap 95% CI 0.781–0.905) with low optimism on internal validation (optimism-corrected C-index 0.841). Calibration analysis showed good agreement between predicted and observed risks. DCA indicated a positive net benefit across a wide range of threshold probabilities (0.20–0.99). Conclusion: We developed a parsimonious nomogram incorporating age, MMSE, and postoperative electrolyte imbalance to predict 1-year functional prognosis after STN-DBS in PD patients. With external validation, this model may support individualized perioperative risk assessment and shared decision-making.
Summary
Keywords
Calibration, Decision curve analysis, Deep Brain Stimulation, functional outcome, nomogram, Parkinson's disease, risk prediction, Subthalamic Nucleus
Received
03 January 2026
Accepted
30 January 2026
Copyright
© 2026 Zhang, Zhu, Fang and Geng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Qiushi Zhu
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