Objective: In this paper we investigated patients with advanced Parkinson’s disease (PD) operated at our center with subthalamic nucleus deep brain stimulation (STN-DBS) for at least 15 years ago, in respect to key clinical milestones reflecting their overall function in daily living.

Background: STN-DBS is an effective treatment for motor fluctuations in PD, but does not halt disease progression. The long-term deterioration of key functions such as cognition, speech, ability to swallow, gait, urinary bladder control, orientation and reality perception is decisive for patients’ independency in daily life.

Methods: Retrospective analysis of clinical data concerning key clinical milestones including death in PD-patients, 15 years or more after they underwent STN-DBS surgery. All PD-patients implanted with STN-DBS at Sahlgrenska University Hospital (in Göteborg, Sweden) before January 1, 2001, were regularly assessed until death, drop-out, or January 11, 2016.

Results: Sixteen men and seven women with a median (range) disease duration of 18 (10 – 28) years were operated with STN-DBS. The median (range) follow-up time post-surgery was 12 (2-18) years and 692 person-years of disease duration were observed. In January 2016, nine PD-patients (39 %) were still alive (eight with active STN-DBS) [Figure 1]. Initially, motor symptoms improved in all patients. Sustained benefit (implying active stimulation at the last follow up) was maintained in 19 of them (83 %) but STN-DBS was inactivated in four (17 %) due to inefficacy. Over time, all patients deteriorated slowly, and a majority developed severe non-motor and motor axial symptoms such as dementia, inability to talk, swallow and walk, urinary incontinence, psychosis, and need for nursing home care [Figure 2 a-g]. At the last follow up, 16/23 (70 %) patients were treated with antidepressants.

Conclusions: A majority of PD-patients experience sustained motor benefit with continuous STN-DBS even after more than 15 years post surgery. However, over time, non-motor and axial symptoms slowly and severely restrict PD-patients’ function in their daily living.

References: 1. Hely MA, Morris JG, Reid WG, Trafficante R. Sydney Multicenter Study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years. Movement disorders : official journal of the Movement Disorder Society. 2005;20(2):190-9.

2. Rizzone MG, Fasano A, Daniele A, Zibetti M, Merola A, Rizzi L, Piano C, Piccininni C, Romito LM, Lopiano L, Albanese A. Long-term outcome of subthalamic nucleus DBS in Parkinson’s disease: from the advanced phase towards the late stage of the disease? Parkinsonism & related disorders. 2014;20(4):376-81.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/key-clinical-milestones-15-years-and-onwards-after-dbs-stn-surgery-a-retrospective-analysis-of-patients-that-underwent-surgery-between-1993-and-2001/