Comparison of elderly and young patient populations treated with deep brain stimulation for Parkinson’s disease: long-term outcomes with up to 7 years of follow-up

Restricted access

OBJECTIVE

Deep brain stimulation (DBS) is the procedure of choice for Parkinson’s disease (PD). It has been used in PD patients younger than 70 years because of better perceived intra- and postoperative outcomes than in patients 70 years or older. However, previous studies with limited follow-up have demonstrated benefits associated with the treatment of elderly patients. This study aims to evaluate the long-term outcomes in elderly PD patients treated with DBS in comparison with a younger population.

METHODS

PD patients treated with DBS at the authors’ institution from 2008 to 2014 were divided into 2 groups: 1) elderly patients, defined as having an age at surgery ≥ 70 years, and 2) young patients, defined as those < 70 years at surgery. Functional and medical treatment outcomes were evaluated using the Unified Parkinson’s Disease Rating Scale part III (UPDRS III), levodopa-equivalent daily dose (LEDD), number of daily doses, and number of anti-PD medications. Study outcomes were compared using univariate analyses, 1-sample paired t-tests, and 2-sample t-tests.

RESULTS

A total of 151 patients were studied, of whom 24.5% were ≥ 70 years. The most common preoperative Hoehn and Yahr stages for both groups were 2 and 3. On average, elderly patients had more comorbidities at the time of surgery than their younger counterparts (1 vs 0, p = 0.0001) as well as a higher average LEDD (891 mg vs 665 mg, p = 0.008). Both groups experienced significant decreases in LEDD following surgery (elderly 331.38 mg, p = 0.0001; and young 108.6 mg, p = 0.0439), with a more significant decrease seen in elderly patients (young 108.6 mg vs elderly 331.38 mg, p = 0.0153). Elderly patients also experienced more significant reductions in daily doses (young 0.65 vs elderly 3.567, p = 0.0344). Both groups experienced significant improvements in motor function determined by reductions in UPDRS III scores (elderly 16.29 vs young 12.85, p < 0.0001); however, reductions in motor score between groups were not significant. Improvement in motor function was present for a mean follow-up of 3.383 years postsurgery for the young group and 3.51 years for the elderly group. The average follow-up was 40.6 months in the young group and 42.2 months in the elderly group.

CONCLUSIONS

This study found long-term improvements in motor function and medication requirements in both elderly and young PD patients treated with DBS. These outcomes suggest that DBS can be successfully used in PD patients ≥ 70 years. Further studies will expand on these findings.

ABBREVIATIONS DBS = deep brain stimulation; HY = Hoehn and Yahr; LEDD = levodopa-equivalent daily dose; MoCA = Montreal Cognitive Assessment; PD = Parkinson’s disease; STN = subthalamic nucleus; UPDRS III = Unified Parkinson’s Disease Rating Scale part III.

Article Information

Correspondence Edna Gouveia: Ochsner Clinic Foundation, Jefferson, LA. v-egouveia@ochsner.org.

INCLUDE WHEN CITING Published online September 28, 2018; DOI: 10.3171/2018.4.JNS171909.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

References

1

Anderson VCBurchiel KJHogarth PFavre JHammerstad JP: Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease. Arch Neurol 62:5545602005

2

Benabid ALBenazzouz AHoffmann DLimousin PKrack PPollak P: Long-term electrical inhibition of deep brain targets in movement disorders. Mov Disord 13 (Suppl 3):1191251998

3

Beric AKelly PJRezai ASterio DMogilner AZonenshayn M: Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 77:73782001

4

Bronstein JMTagliati MAlterman RLLozano AMVolkmann JStefani A: Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol 68:1652011

5

Bronte-Stewart H: Parkinson’s disease: surgical options. Curr Treat Options Neurol 5:1311472003

6

Castrioto ALozano AMPoon YYLang AEFallis MMoro E: Ten-year outcome of subthalamic stimulation in Parkinson disease: a blinded evaluation. Arch Neurol 68:155015562011

7

Charles PDVan Blercom NKrack PLee SLXie JBesson G: Predictors of effective bilateral subthalamic nucleus stimulation for PD. Neurology 59:9329342002

8

Chiou SM: Benefits of subthalamic stimulation for elderly parkinsonian patients aged 70 years or older. Clin Neurol Neurosurg 149:81862016

9

Cozac VVEhrensperger MMGschwandtner UHatz FMeyer AMonsch AU: Older candidates for subthalamic deep brain stimulation in Parkinson’s disease have a higher incidence of psychiatric serious adverse events. Front Aging Neurosci 8:1322016

10

Dafsari HSReker PStalinski LSilverdale MRizos AAshkan K: Quality of life outcome after subthalamic stimulation in Parkinson’s disease depends on age. Mov Disord 33:991072018

11

DeLong MRHuang KTGallis JLokhnygina YParente BHickey P: Effect of advancing age on outcomes of deep brain stimulation for Parkinson disease. JAMA Neurol 71:129012952014

12

Derost PPOuchchane LMorand DUlla MLlorca PMBarget M: Is DBS-STN appropriate to treat severe Parkinson disease in an elderly population? Neurology 68:134513552007

13

Deuschl GSchade-Brittinger CKrack PVolkmann JSchäfer HBötzel K: A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 355:8969082006

14

Dorsey ERConstantinescu RThompson JPBiglan KMHolloway RGKieburtz K: Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 68:3843862007

15

Eskandar ENFlaherty ACosgrove GRShinobu LABarker FG II: Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample. J Neurosurg 99:8638712003

16

Fasano ARomito LMDaniele APiano CZinno MBentivoglio AR: Motor and cognitive outcome in patients with Parkinson’s disease 8 years after subthalamic implants. Brain 133:266426762010

17

Fraix VHoueto JLLagrange CLe Pen CKrystkowiak PGuehl D: Clinical and economic results of bilateral subthalamic nucleus stimulation in Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:4434492006

18

Fukaya CYamamoto T: Deep brain stimulation for Parkinson’s disease: recent trends and future direction. Neurol Med Chir (Tokyo) 55:4224312015

19

Goldenberg MM: Medical management of Parkinson’s disease. P&T 33:5906062008

20

Hauser RA: Long-term care of Parkinson’s disease. Strategies for managing “wearing off” symptom re-emergence and dyskinesias. Geriatrics 61:14202006

21

Kalia LVLang AE: Parkinson’s disease. Lancet 386:8969122015

22

Kim HYChang WSKang DWSohn YHLee MSChang JW: Factors related to outcomes of subthalamic deep brain stimulation in Parkinson’s disease. J Korean Neurosurg Soc 54:1181242013

23

Lenz FASchnider STasker RRKwong RKwan HDostrovsky JO: The role of feedback in the tremor frequency activity of tremor cells in the ventral nuclear group of human thalamus. Acta Neurochir Suppl (Wien) 39:54561987

24

Lewis SJFoltynie TBlackwell ADRobbins TWOwen AMBarker RA: Heterogeneity of Parkinson’s disease in the early clinical stages using a data driven approach. J Neurol Neurosurg Psychiatry 76:3433482005

25

Mathkour MGarces JScullen THanna JValle-Giler EKahn L: Short and long-term outcomes of deep brain stimulation in Parkinson’s disease patients 70-years and older. World Neurosurg 97:2472522017

26

Okun MSGallo BVMandybur GJagid JFoote KDRevilla FJ: Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol 11:1401492012

27

Ondo WJankovic JSchwartz KAlmaguer MSimpson RK: Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson’s disease tremor. Neurology 51:106310691998

28

Ory-Magne FBrefel-Courbon CSimonetta-Moreau MFabre NLotterie JAChaynes P: Does ageing influence deep brain stimulation outcomes in Parkinson’s disease? Mov Disord 22:145714632007

29

Pollak PFraix VKrack PMoro EMendes AChabardes S: Treatment results: Parkinson’s disease. Mov Disord 17 (Suppl 3):S75S832002

30

Pouratian NThakkar SKim WBronstein JM: Deep brain stimulation for the treatment of Parkinson’s disease: efficacy and safety. Degener Neurol Neuromuscul Dis 2012:S257502012

31

Puig-Junoy JPuig Peiró R: [Review of the economic evidence on the use of deep brain stimulation in late stage Parkinson’s disease.] Neurologia 24:2202292009 (Span)

32

Schuepbach WMRau JKnudsen KVolkmann JKrack PTimmermann L: Neurostimulation for Parkinson’s disease with early motor complications. N Engl J Med 368:6106222013

33

Shan DEWu HCChan LYLiu KD: Cost-utility analysis of Parkinson’s disease. Acta Neurol Taiwan 20:65722011

34

St George RJNutt JGBurchiel KJHorak FB: A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD. Neurology 75:129212992010

35

Stocchi F: The levodopa wearing-off phenomenon in Parkinson’s disease: pharmacokinetic considerations. Expert Opin Pharmacother 7:139914072006

36

Sugiyama KNozaki TAsakawa TKoizumi SSaitoh ONamba H: The present indication and future of deep brain stimulation. Neurol Med Chir (Tokyo) 55:4164212015

37

Vesper JHaak SOstertag CNikkhah G: Subthalamic nucleus deep brain stimulation in elderly patients—analysis of outcome and complications. BMC Neurol 7:72007

38

Voges JHilker RBötzel KKiening KLKloss MKupsch A: Thirty days complication rate following surgery performed for deep-brain-stimulation. Mov Disord 22:148614892007

39

Weaver FMFollett KStern MHur KHarris CMarks WJ Jr: Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 301:63732009

40

Williams AGill SVarma TJenkinson CQuinn NMitchell R: Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial. Lancet Neurol 9:5815912010

41

Zhu XLChan DTLau CKPoon WSMok VCChan AY: Cost-effectiveness of subthalmic nucleus deep brain stimulation for the treatment of advanced Parkinson disease in Hong Kong: a prospective study. World Neurosurg 82:9879932014

42

Zibetti MMerola ARizzi LRicchi VAngrisano SAzzaro C: Beyond nine years of continuous subthalamic nucleus deep brain stimulation in Parkinson’s disease. Mov Disord 26:232723342011

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 518 518 298
Full Text Views 3999 3999 91
PDF Downloads 207 207 34
EPUB Downloads 0 0 0

PubMed

Google Scholar