Objective: to evaluate the long-term risk of wheelchair confinement and motor function in Parkinson’s disease (PD) patients undergoing subthalamic deep brain stimulation (STN-DBS), compared to a control group receiving medical therapy alone.

Background: STN-DBS is an established therapy for advanced-stage PD. However, long-term studies on STN-DBS remain limited, often lack control groups, and are typically based on small sample sizes.

Method: a retrospective multicenter analysis was conducted across five surgical centers, including PD patients with long-term STN-DBS and PD patients who were eligible for DBS but did not undergo surgery. Demographic variables included sex, age, age at disease diagnosis, PD phenotype, and disease duration. Clinical evaluations were conducted at baseline and at long-term follow-up (10 ± 2 years after the pre-operative evaluation). The outcomes were differences in MDS-UPDRS part III and Hoehn & Yahr (H&Y) scores in both ON-medication and OFF-medication states. Group matching was performed using propensity score matching for age, sex, age at disease diagnosis, disease duration and baseline levodopa equivalent daily dose (LEDD). Comparisons between categorical variables were made using the Chi-Square test. For continuous variables, comparisons were made using the Mann-Whitney test.

Results: Data were collected from 574 PD patients (381 STN-DBS, 193 on medical therapy alone) evaluated between 1993 and 2023. At baseline, the STN-DBS group had significantly lower age (p <0.001) and age at PD diagnosis (p < 0.001), but longer disease duration (p = 0.005) and higher total LEDD (p < 0.001). After 10 ± 2 years of follow-up and adjusting for potential baseline confounders, no significant differences were found in the progression of MDS-UPDRS III scores (p = 0.368) and H&Y staging (p = 0.681) in the ON-medication state between the two groups. However, in the OFF-medication state, STN-DBS patients showed significant improvements compared to controls in both H&Y (p < 0.001) and MDS-UPDRS III scores (p < 0.001).

Conclusion: In the long term, STN-DBS did not provide superior mobility compared to medical therapy alone in ON-medication state. However, it continued to deliver motor improvements in the OFF-medication state, highlighting the sustained therapeutic benefit of DBS in advanced stages of PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-10-year-stn-dbs-impact-the-natural-progression-of-parkinsons-disease-a-multicenter-retrospective-controlled-observational-study/