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.
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.
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.
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.
ABBREVIATIONSDBS = 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.
CozacVVEhrenspergerMMGschwandtnerUHatzFMeyerAMonschAU: Older candidates for subthalamic deep brain stimulation in Parkinson’s disease have a higher incidence of psychiatric serious adverse events. Front Aging Neurosci8:1322016
EskandarENFlahertyACosgroveGRShinobuLABarkerFGII: Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample. J Neurosurg99:863–8712003
LenzFASchniderSTaskerRRKwongRKwanHDostrovskyJO: The role of feedback in the tremor frequency activity of tremor cells in the ventral nuclear group of human thalamus. Acta Neurochir Suppl (Wien)39:54–561987
OkunMSGalloBVMandyburGJagidJFooteKDRevillaFJ: Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial. Lancet Neurol11:140–1492012
WilliamsAGillSVarmaTJenkinsonCQuinnNMitchellR: 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 Neurol9:581–5912010
ZhuXLChanDTLauCKPoonWSMokVCChanAY: Cost-effectiveness of subthalmic nucleus deep brain stimulation for the treatment of advanced Parkinson disease in Hong Kong: a prospective study. World Neurosurg82:987–9932014