Session Information
Date: Monday, June 20, 2016
Session Title: Surgical therapy: Parkinson's disease
Session Time: 12:30pm-2:00pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To grasp real demand of deep brain stimulation (DBS) surgery in a substantial Parkinson’s disease (PD) population.
Background: DBS surgery has become frequently performed these days but its necessity to perform this procedure in a local neurological center where many PD patients are regularly treated (cross-sectionally, around 200 cases in our hospital) is not discussed.
Methods: Medical charts of patients who were treated as PD in our hospital between April 1995 and November 2015 and had disease history (from the onset of motor symptoms) of 15th year or more were retrospectively reviewed. As clinical landmarks, appearance of intractable motor fluctuation (IMF; with dyskinesia necessitating multiple adjustment of medication), sustained (visual) hallucination (SH), cognitive disturbance (CD; impaired judgement), and swallowing problems (SP; ensuing aspiration or needing food modification) were checked.
Results: Of 658 patients (male 286/ female 372, age at onset (AO) 66.7±9.3 years old), 92 patients (15%, M 42/ F 50, AO 58.2±9.1, modified Hoehn & Yahr stage at 15th year at on 3.4±0.8, at off 4.1±0.8, levodopa equivalent daily dosage at 15th year (LEDD) 631±248 mg) have reached their 15th disease year or more. Clinical landmarks were observed as follows: IMF in 26 (28%) at 15±4th year, SH in 54 (59%) at 15±3, CD in 47 (51%) at 16±4, SP in 39 (42%) at 18±4. As plausible candidates for DBS, judged as those with IMF but without CD and SP, only 16 patients (17%, M 4/ F 12, AO 51.4±6.4, LEDD 810±287) were identified. This number decreases to 10 (11%) when those who already have or would soon have DBS resistant symptoms such as camptocormia, day time sleepiness, severe falling tendency, delusion, dysphagia, hypophonia, eyelid opening apraxia etc. are excluded. Of these 10 patients, two patients took pallidotomy and one patient received DBS.
Conclusions: Only small proportion of PD patients with long disease history need DBS (less than 20%) in their clinical course considering its unproven efficacy for prevention of disease progression. especially to CD and SP. Probable candidates are those with young onset (approximately <55 years old) and taking much dopaminergic medication for alleviating their motor symptoms. At present, the more young-onset patients we treat, the more we encounter necessity of DBS surgery.
To cite this abstract in AMA style:
H. Shibayama, T. Fukumoto, M. Tomura, K. Tokumoto, H. Yano, K. Tajima, F. Mitobe, F. Katada, S. Sato, T. Fukutake. How many and which kind of Parkinson’s disease patients need deep brain stimulation surgery? An evaluation based on clinical observation of patients with disease history of 15th year or more [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/how-many-and-which-kind-of-parkinsons-disease-patients-need-deep-brain-stimulation-surgery-an-evaluation-based-on-clinical-observation-of-patients-with-disease-history-of-15th-year-or-more/. Accessed June 14, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/how-many-and-which-kind-of-parkinsons-disease-patients-need-deep-brain-stimulation-surgery-an-evaluation-based-on-clinical-observation-of-patients-with-disease-history-of-15th-year-or-more/