Article
Too late for deep brain stimulation surgery? A comprehensive analysis of early and late outcome in elderly versus younger patients with Parkinson’s disease
Wann ist es zu spät für die Tiefe Hirnstimulation? Eine ausführliche Analyse von Früh- und Spätresultaten bei Patienten über oder unter 70 Jahren mit Parkinson-Syndrom
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Authors
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Philipp Krauss
- UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
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Heide Baumann-Vogel
- UniversitätsSpital Zürich, Klinik für Neurologie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
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Markus F. Oertel
- UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
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Kuschan Afzaly
- UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
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Christian Baumann
- UniversitätsSpital Zürich, Klinik für Neurologie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
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Lennart H. Stieglitz
- UniversitätsSpital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland; UniversitätsSpital Zürich, Klinisches Neurozentrum, Zürich, Switzerland
| Published: | May 8, 2019 |
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Outline
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Objective: Increasing life expectancy will raise the prevalence of neurologic disorders including Parkinson’s disease (PD). Therefore, neurosurgeons will more and more have to select appropriate elderly candidates for deep brain stimulation (DBS). However, both harms and benefits of DBS, previously restrainedly offered due to reports of increased age related risks and side effects, need to be revaluated. To analyse the applicability of DBS in geriatric patients, we comprehensively compared preoperative risks and postoperative outcome in a large cohort of patients ≥70 and <70 years of age.
Methods: We performed a retrospective analysis of a single centre prospective clinical database of patients that underwent bilateral STN DBS for PD. We dichotomized patients into an elderly (≥70 y) and a young (<70y) age group at surgery. Outcome parameters included UPDRS I-IV, an axial symptoms sub score, LEDD, PDQ-39, MoCa and surgical adverse events (AE) corrected for the ASA score according to the Clavien-Dindo grading system before and 6 months after DBS. Moreover, we assessed the need for postoperative care including rehabilitation and follow up consultations. Long-term motor outcome was evaluated up to 8 years after surgery.
Results: We included 157 patients (young: n=121; elderly: n=36) in our final analysis. Elderly patients showed an impaired motor state compared to younger patients at all time points, including long term follow up. All other baseline characteristics despite MoCa did not vary between both groups. Relative to the baseline status, symptom reduction did not differ significantly between both groups. After stimulation, UPDRS I-IV, PDQ-39, LEDD and the axial sub score improved significantly in both groups whereas similar rates of surgery related AE could be observed. The need for postoperative care including duration of hospitalisation and rehabilitation or the number of follow up consultations did not differ significantly between both groups.
Conclusion: The present study shows comparable high efficacy of DBS regarding both motor and non-motor scores in elderly and young patients during short and long term follow up intervals. Patients age per se did not increase the risk for surgery related AE or the need for increased postoperative care. Our data suggest that DBS is also a safe, effective and relevant treatment option for elderly patients with PD.
