Objective: To describe the clinical and non-clinical reasons leading to loss of surgical eligibility among patients initially considered candidates for Deep Brain Stimulation (DBS) in Parkinson’s disease (PD).

Background: DBS is a well-established surgical therapy for selected patients with PD1. Although DBS improves motor function and quality of life, access to this treatment remains limited in several regions, including Latin America. High costs and restricted availability in public health systems often result in prolonged waiting times for surgery2,3. During this period, some patients who initially met DBS criteria may lose their surgical indication. We aimed to describe these cases through a descriptive analysis of patients evaluated for DBS at a tertiary referral center in southern Brazil.

Method: We conducted a retrospective descriptive study of patients with PD who were indicated for DBS at a tertiary referral center but were later excluded from surgery. Demographic and clinical variables were collected. Reasons for exclusion were categorized and analyzed descriptively (Figure1).

Results: A total of 47 patients were identified(61% men). Thirty-three patients had one reason for exclusion, 11 had two, and 3 had three. The most frequent causes of loss of eligibility were loss to follow-up(29%), advanced PD(21%), psychiatric contraindications(17%), dementia(17%), and social vulnerability(14%). Other causes included lack of response to levodopa challenge (10%), poor functional status(8%), death(6%), and patient refusal of surgery(4.3%). Three additional cases(6.4%) were classified as other causes. Among the 17 patients with complete clinical data, mean age at symptom onset was 43.5 ± 13 years(range 4–66), mean age at diagnosis 43.9 ± 13 years, and mean age at loss of surgical eligibility 59.8 ± 13 years. The mean time between inclusion for surgery and exclusion was 2 ± 1.2 years. The main indication for DBS referral was dyskinesia(63%), followed by wearing-off fluctuations(31%).

Conclusion: Multiple factors contributed to loss of DBS eligibility in patients initially considered surgical candidates. Loss to follow-up, disease progression, and psychiatric or social factors were common reasons for exclusion. Prolonged waiting times may contribute to loss of surgical opportunity in PD patients.

Reasons for Loss of Surgical Eligibility for DBS

References: 1. Malek N. Deep brain stimulation in Parkinson’s disease. Neurol India. 2019;67(4):968-978.
2. Zorro-Guío ÓF, Ardila-Martínez MA, Bedoya-Gómez Á, et al. Estimulación cerebral profunda para enfermedad de Parkinson: experiencia, beneficios y limitaciones en un centro en Latinoamérica. Cir Cir. May 2023. doi:10.24875/ciru.22000438.
3. Lopez Rios AL, Piedimonte F, Arango GJ, et al. Deep brain stimulation in Latin America in comparison with the US and Europe in a real-world population: indications, demographics, techniques, technology, and adverse events. J Neurosurg. 2024;141(6):1587-1594.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/when-surgical-candidates-become-ineligible-loss-of-deep-brain-stimulation-eligibility-in-parkinsons-disease-a-descriptive-study-from-a-brazilian-referral-center/