Objective: Deep brain stimulation(DBS) of subthalamic nucleus(STN) is an established treatment for Parkinson’s disease(PD). DBS has been reserved for patients with long-standing disease and disabling motor complications. However, earlier surgical intervention may provide functional and motor advantages. Real-world evidence comparing early-vs-late DBS remains limited. This study aimed to evaluate outcomes of early-vs-late DBS in a single-center, real-world cohort.

Background: To compare outcomes.

Method: Study included 69 PD patients who underwent DBS between 2015-2024. Patients were selected age-sex-disease-severity-matched.  Patients were classified into two groups as time from symptom-onset to surgery: Early DBS, defined as<5years, Late DBS ≥5years. Clinical evaluations included H&Y,MDS-UPDRS-Part-III, levodopa equivalent daily dose. Assessments were performed preoperatively, postoperatively, at 3-year-follow-up.

Results: Mean age was 62.65±8.61years; 71%were male. STN was targeted in 94.2% of patients. Both groups demonstrated significant postoperative improvement in H&Y,UPDRS-Part-III scores(p<0.001). At 3-year-follow-up, worsening occurred for both groups, consistent with disease progression, but scores remained improved compared to baseline.

No significant group×time interaction was observed for H&Y or UPDRS-Part-III. However, total LEDD showed a significant group×time interaction(p=0.006). Early-DBS group achieved more pronounced reduction in medication requirement. Longer symptom duration correlated with worse long-term motor outcomes, particularly in late-DBS group. Five patients in early-DBS group and one patient in late-DBS group were later reclassified as PD-plus syndromes.

Conclusion: Both groups provided short-term motor improvement, with partial symptom progression at 3-year follow-up reflecting natural course of disease. However, early-surgery allowed for greater sustained reduction in dopaminergic-medication requirements. This finding may reflect improved motor stability, or reduced motor complications when surgery is performed earlier in disease course. Although early DBS appears safe and effective, this finding reminds us that careful patient selection remains essential, particularly when considering surgery at earlier stages of disease. Although early surgery does not appear to alter long-term course of disease progression, it may provide meaningful advantages.

References: 1. Hacker ML, Turchan M, Heusinkveld LE, et al. Deep brain stimulation in early-stage Parkinson disease: five year outcomes. Neurology. 2020;95(4):e393-e401.
2. Merola A, Romagnolo A, Rizzi L, et al. Earlier versus later subthalamic deep brain stimulation in Parkinson disease. Parkinsonism Relat Disord. 2015;21(9):972-975.
3. Hacker ML, Tonascia J, Turchan M, et al. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson’s disease. Parkinsonism Relat Disord. 2015;21(10):1177-1183.
4. Schüpbach WMM, Maltête D, Houeto JL, et al. Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial. Neurology. 2007;68(4):267-271.
5. Limousin P, Foltynie T. Long-term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol. 2019;15(4):234-242.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/challenging-traditional-paradigm-clinical-outcomes-of-early-vs-late-subthalamic-deep-brain-stimulation-in-parkinsons-disease/