Effect of Advancing Age on Outcomes of Deep Brain Stimulation for Parkinson Disease

Abstract

IMPORTANCE Deep brain stimulation (DBS) is a well-established modality for the treatment of advanced Parkinson disease (PD). Recent studies have found DBS plus best medical therapy to be superior to best medical therapy alone for patients with PD and early motor complications. Although no specific age cutoff has been defined, most clinical studies have excluded patients older than 75 years of age. We hypothesize that increasing age would be associated with an increased number of postoperative complications.OBJECTIVE To evaluate the stepwise effect of increasing age (in 5-year epochs) on short-term complications following DBS surgery. DESIGN, SETTING, AND PARTICIPANTSA large, retrospective cohort study was performed using the Thomson Reuters MarketScan national database that examined 1757 patients who underwent DBS for PD during the period from 2000 to 2009.MAIN OUTCOMES AND MEASURES Primary measures examined included hospital length of stay and aggregate and individual complications within 90 days following surgery. Multivariate logistic regression analysis was used to calculate complication-related odds ratios (ORs) for each 5-year age epoch after controlling for covariates.RESULTS Overall, 132 of 1757 patients (7.5%) experienced at least 1 complication within 90 days, including wound infections (3.6%), pneumonia (2.3%), hemorrhage or hematoma (1.4%), or pulmonary embolism (0.6%). After adjusting for covariates, we found that increasing age (ranging from <50 to 90 years of age) did not significantly affect overall 90-day complication rates (OR, 1.10 per 5-year increase [95% CI, 0.96-1.25]; P = .17). The 2 most common procedure-related complications, hemorrhage (OR, 0.82 [95% CI, 0.63-1.07]; P = .14) and infection (OR, 1.04 [95% CI, 0.87-1.24]; P = .69), did not significantly increase with age. CONCLUSIONS AND RELEVANCEOlder patients with PD (>75 years) who were selected to undergo DBS surgery showed a similar 90-day complication risk (including postoperative hemorrhage or infection) compared with younger counterparts. Our findings suggest that age alone should not be a primary exclusion factor for determining candidacy for DBS. Instead, a clear focus on patients with medication-refractory and difficult to control on-off fluctuations with preserved cognition, regardless of age, may allow for an expansion of the traditional therapeutic window.

Novel Approach to Securing Deep Brain Stimulation Leads: Technique and Analysis of Lead Migration, Breakage, and Surgical Infection

“…The method of lead fixation described in this paper produces an excellent cosmetic result and provides low rates of complication consistent with published series [16,17,18,19]. While there were 5 cases of SSIs with the hydroxyapatite cement technique, the overall complication rate remained less than 1%, similar to 0% with the StimLoc™.…”

“…Our cement-clip method of securing the DBS leads produces excellent cosmetic results. In the series of 291 patients, complications were on par for both our own historical cohort of StimLoc™ cap fixations and with published series [16,17,18,19]. We find this technique is particularly well suited to use with the StarFix platform as it allows final fixation prior to disengaging the lead from the platform and therefore obviates the use of fluoroscopy.…”

Short- and Long-Term Outcomes of Deep Brain Stimulation in Patients 70 Years and Older with Parkinson Disease

“…In the literature, 'elderly' is generally acknowledged as an age greater than 68-70 years at the time of DBS surgery, and has traditionally served as a strong contraindication to DBS, resulting from the increased incidence of co-morbidities and surgery-related complications (27)(28)(29)(30) . Despite these reports, a small number of studies have demonstrated that elderly PD patients who underwent treatment with DBS show similar outcomes when compared to their younger counterparts (27)(28)(29)(30)(31)(32)(33)(34) , with one study even reporting a significantly decreased rate of infection (35) . As such, several authors suggest that advanced age should not be considered an absolute contraindication to DBS, and that such patients may simply require a more meticulous follow up (31)(32)(33)(34) .…”

What Do Medical Students Know about Deep Brain Stimulation

“…The estimations on how many PD patients would be suitable candidates for DBS in both groups were higher than what has been commonly stated in medical publications and what has been assumed by medical experts [9,31]. Nevertheless, it remains unclear indeed as to what the appropriate number would be, in particular with regard to concurrent therapies such as apomorphine pumps and duodenal levodopa infusion [24].…”