Deep brain stimulation improves survival in severe Parkinson’s disease

Research output: Contribution to journalArticle

Authors

  • Rosalind Mitchell
  • Jamilla Kausar
  • James Hodson
  • Anwen Harries

Colleges, School and Institutes

External organisations

  • Queen Elizabeth Hosp
  • UNIVERSITY HOSPITAL BIRMINGHAM NHS FOUNDATION TRUST

Abstract

Objectives
Levodopa and other dopaminergic treatments have not had the expected effect on survival in Parkinson disease. Bilateral sub-thalamic nucleus deep brain stimulation (STN-DBS) has been shown to improve motor function, motor fluctuations, health-related quality of life (HRQoL) and to reduce medication usage and drug-induced dyskinesia in patients with severe Parkinson’s disease refractory to medical therapy. Little however, has been described on the impact of STN-DBS on the survival of these patients.
We aim in this study to examine the impact of sub-thalamic nucleus deep brain stimulation on the survival of patients with severe Parkinson’s disease.

Methods
Patients who were eligible for STN-DBS were given the choice of undergoing surgery or continuing on medical treatment. Those that exercised patient choice and preferred to continue with medical treatment formed a control population. All eligible patients seen in a 10-year period are included in this study. Our primary outcome measure is a difference in mortality between the two groups with a secondary measure of admission rates to residential (nursing home) care.

Results
106 patients underwent STN-DBS and 41 patients exercised patient choice and declined the procedure. The two groups were matched for age, gender, ethnicity, duration of disease, rates of pre-existing depression, and Levodopa Equivalent Doses (LED) of anti-Parkinson’s medications taken.

Patients undergoing STN-DBS had significantly longer survival and were significantly less likely to be admitted to a residential care home than those managed purely medically. The statistical significance of these findings persisted after adjusting for potential confounding factors (Survival: p=0·002, Hazard ratio 0·29 (0·13-0·64) (Residential care home admission: Odds ratio: 0·1 (95% CI: 0·0-0·3; p<0·001).

Interpretation
We show for the first time that there is a survival advantage of DBS surgery in advanced PD. The effect of potential bias factors is examined. The survival advantage may arise for several postulated reasons, ranging from improvement in axial functions such as swallowing to some as yet unrecognized benefit of reduction in dopaminergic

Details

Original languageEnglish
Pages (from-to)17-22
Number of pages6
JournalJournal of Neurology Neurosurgery and Psychiatry
Volume85
Issue number1
Early online date10 Jul 2013
Publication statusPublished - 2014

Keywords

  • Movement Disorders, Parkinson's Disease, DBS

ASJC Scopus subject areas