Kyle T Mitchell1, John R Younce1, Scott A Norris1,2, Samer D Tabbal1,3, Joshua L Dowling4, Keith M Rich4, Joel S Perlmutter1,2,5,6,7, Mwiza Ushe1. 1. Department of Neurology, Washington University School of Medicine, St. Louis, Missouri. 2. Department of Radiology, Washington University School of Medicine, St. Louis, Missouri. 3. Department of Neurology, American University of Beirut, Beirut, Lebanon. 4. Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri. 5. Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri. 6. Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri. 7. Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri.
Abstract
BACKGROUND: Subthalamic nucleus deep brain stimulation (STN DBS) is an effective adjunctive therapy for Parkinson disease. Studies have shown improvement of motor function but often exclude patients older than 75 yr. OBJECTIVE: To determine the safety and effectiveness of STN DBS in patients 75 yr and older. METHODS: A total of 104 patients (52 patients >75 yr old, 52 patients <75 yr old) with STN DBS were paired and retrospectively analyzed. The primary outcome was change in Unified Parkinson Disease Rating Scale (UPDRS) subscale III at 1 yr postoperatively, OFF medication. Secondary outcomes were changes in UPDRS I, II, and IV subscales and levodopa equivalents. Complications and all-cause mortality were assessed at 30 d and 1 yr. RESULTS: Both cohorts had significant improvements in UPDRS III at 6 mo and 1 yr with no difference between cohorts. Change in UPDRS III was noninferior to the younger cohort. The cohorts had similar worsening in UPDRS I at 1 yr, no change in UPDRS II, similar improvement in UPDRS IV, and similar levodopa equivalent reduction. There were similar numbers of postoperative intracerebral hemorrhages (2/52 in each cohort, more severe in the older cohort) and surgical complications (4/52 in each cohort), and mortality in the older cohort was similar to an additional matched cohort not receiving DBS. CONCLUSION: STN DBS provides substantial motor benefit and reduction in levodopa equivalents with a low rate of complications in older patients, which is also noninferior to the benefit in younger patients. STN DBS remains an effective therapy for those over 75 yr.
BACKGROUND: Subthalamic nucleus deep brain stimulation (STN DBS) is an effective adjunctive therapy for Parkinson disease. Studies have shown improvement of motor function but often exclude patients older than 75 yr. OBJECTIVE: To determine the safety and effectiveness of STN DBS in patients 75 yr and older. METHODS: A total of 104 patients (52 patients >75 yr old, 52 patients <75 yr old) with STN DBS were paired and retrospectively analyzed. The primary outcome was change in Unified Parkinson Disease Rating Scale (UPDRS) subscale III at 1 yr postoperatively, OFF medication. Secondary outcomes were changes in UPDRS I, II, and IV subscales and levodopa equivalents. Complications and all-cause mortality were assessed at 30 d and 1 yr. RESULTS: Both cohorts had significant improvements in UPDRS III at 6 mo and 1 yr with no difference between cohorts. Change in UPDRS III was noninferior to the younger cohort. The cohorts had similar worsening in UPDRS I at 1 yr, no change in UPDRS II, similar improvement in UPDRS IV, and similar levodopa equivalent reduction. There were similar numbers of postoperative intracerebral hemorrhages (2/52 in each cohort, more severe in the older cohort) and surgical complications (4/52 in each cohort), and mortality in the older cohort was similar to an additional matched cohort not receiving DBS. CONCLUSION: STN DBS provides substantial motor benefit and reduction in levodopa equivalents with a low rate of complications in older patients, which is also noninferior to the benefit in younger patients. STN DBS remains an effective therapy for those over 75 yr.
Authors: Frances M Weaver; Kenneth A Follett; Matthew Stern; Ping Luo; Crystal L Harris; Kwan Hur; William J Marks; Johannes Rothlind; Oren Sagher; Claudia Moy; Rajesh Pahwa; Kim Burchiel; Penelope Hogarth; Eugene C Lai; John E Duda; Kathryn Holloway; Ali Samii; Stacy Horn; Jeff M Bronstein; Gatana Stoner; Philip A Starr; Richard Simpson; Gordon Baltuch; Antonio De Salles; Grant D Huang; Domenic J Reda Journal: Neurology Date: 2012-06-20 Impact factor: 9.910
Authors: G-M Hariz; P Limousin; L Zrinzo; E Tripoliti; I Aviles-Olmos; M Jahanshahi; K Hamberg; T Foltynie Journal: Acta Neurol Scand Date: 2013-04-01 Impact factor: 3.209
Authors: Frances M Weaver; Kenneth Follett; Matthew Stern; Kwan Hur; Crystal Harris; William J Marks; Johannes Rothlind; Oren Sagher; Domenic Reda; Claudia S Moy; Rajesh Pahwa; Kim Burchiel; Penelope Hogarth; Eugene C Lai; John E Duda; Kathryn Holloway; Ali Samii; Stacy Horn; Jeff Bronstein; Gatana Stoner; Jill Heemskerk; Grant D Huang Journal: JAMA Date: 2009-01-07 Impact factor: 56.272