Effect of advancing age on outcomes of deep brain stimulation for Parkinson disease.
DeLong MR, Huang KT, Gallis J, Lokhnygina Y, Parente B, Hickey P, Turner DA, Lad SP. Effect of advancing age on outcomes of deep brain stimulation for Parkinson disease. , 2014 Oct;71(10):1290-5. doi: 10.1001/jamaneurol.2014.1272.
Introduction: Parkinson’s disease (PD) is a common neurological condition that typically strikes after age 60. PD is often successfully treated by deep brain stimulation (DBS) but there are known surgical risks even for those deemed “good candidates” for such treatment. In general, older adults also have a higher likelihood of surgical complications but there are few studies specifically looking at such risk factors in older adults with PD. Age quickly becomes an issue for this disease/treatment due to PD having older onset, mean duration of 14 years before DBS surgery, and a higher likelihood with advancing age of comorbid conditions that could affect surgical candidacy. Additionally, recent studies have found DBS plus medications are more efficacious than medications alone in a younger group of PD patients, suggesting that it may be beneficial to consider earlier surgical treatment to minimize adverse events and risks of DBS. As age is an important factor with this treatment, the stated goal of this study was to look at adverse events in older people with PD (PWP) that have undergone DBS.
Methods: A retrospective review of a national database of approximately 1700 PWP that underwent DBS (590 unilateral, 551 bilateral, 122 staged, 494 indeterminate) from 2000-2009 was evaluated. Neuroanatomical location of DBS placement was not known.
Results: Patient demographics included mean age of 61.2 years, 33% over age 65, 7% over 70, and 36% women. When looking at the entire group of PWP, the study found that 7% of the patients had one or more complication within ninety days of having surgery. The most common adverse events were “infection, pneumonia, hemorrhage, or pulmonary embolism.” Hardware or lead issues were few (2.9%) as were patient deaths (0.3%). When only the older PWP were reviewed the results did not significantly change at the 30 day or 5 year marks. They also found that older PWP did not have longer hospital stays.
Conclusion: Research over the last 10 years has been lacking on older PWP that have undergone DBS which is problematic as PD affects many older adults. This study found that older PWP did not have higher rates of adverse events which may be beneficial information for those considering such treatment. The authors highlight that the older PWP in this study benefited from multiple years of improved motor functioning and possibly improved quality of life. Limitations of this study include unknown selection criteria for those undergoing DBS (e.g. healthier individuals), possibility of inaccurate reporting to the database, and no additional but usually relevant clinical or demographic variables available due to the use of the database (e.g. duration of PD, age at onset, etc.). This study is informative however as it suggests that broadening the age range to those offered such treatment may be beneficial to the older PWP.