Objective: The aim of this study is to examine the long-term effects of deep brain stimulation of the subthalamic nucleus (STN DBS) in Parkinson’s disease (PD).

Background: STN DBS has become a well-established, symptomatic treatment for advanced PD and is the most effective therapy for fluctuating PD. As the surgical procedure is still quite new, only little is known of the long-term effects.

Methods: 82 patients underwent surgery in Copenhagen between 2001 and 2008 and are potential candidates for this follow-up study more than nine years after surgery. The follow-up proceeds like the pre-surgical examination. Patients are shortly hospitalized, and rated by the UPDRS with and without stimulation and medicine. Neuropsychological testing is performed. In addition, data from patients’ medical records are collected. 43 patients are still alive and possible candidates for long-term follow-up. This study is ongoing. 16 patients have finished the long-term follow-up and 69 patients are included so far. The mean [SD] (range) age at surgery was 60.4 [15.3] (41.9-77.6) years and the duration of disease was 13 [10] (5-25) years. 59 % of the patients are men and 41 % are women.

Results: Data from the first 16 patients included for follow-up show that the effect of medication on the motor UPDRS 3 before surgery was an improvement of 55.8 [36.0] %. The OFF UPDRS 3 score (with neither stimulation nor medicine) was 50.0 [24.8] before surgery, 54.3 [24.5] after one year and 59.5 [27.9] at the 9-15 (mean 12.1) years follow-up. This corresponds to a progression of 18.9 [56.3] % after 12 years. The improvement of UPDRS 3 with stimulation alone compared to the OFF UPDRS 3 was 67.4 [13.3] % after one year and 39.9 [27.3] % at follow-up 9-15 years after surgery. Data from the medical records for the 69 included patients show that compared to before surgery, medication was reduced by 52.6 [77.4] % after one year, and 44.4 [100] % after 9-15 years; 53.4 % of these patients developed dementia and 37.7 % moved to a nursing home.

Conclusions: STN DBS is an efficient and safe treatment in advanced PD. It remains effective after more than 9 years, however, the effect seems to decrease through the years. Disease progression evaluated by motor symptoms OFF treatment is modest and the number of patients who developed dementia is not higher than would be expected from a PD population.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-in-parkinsons-disease-outcome-after-more-than-nine-years/