Survival and Health Care Use After Deep Brain Stimulation for Parkinson’s Disease

Abstract

Objectives: To compare long-term survival of Parkinson's disease (PD) patients with deep brain stimulation (DBS) to matched controls, and examine whether DBS was associated with differences in injurious falls, long-term care, and home care. Methods: Using administrative health data (Ontario, Canada), we examined DBS outcomes within a cohort of individuals diagnosed with PD between 1997 and 2012. Patients receiving DBS were matched with non-DBS controls by age, sex, PD diagnosis date, time with PD, and a propensity score. Survival between groups was compared using the log-rank test and marginal Cox proportional hazards regression. Cumulative incidence function curves and marginal subdistribution hazard models were used to assess effects of DBS on falls, long-term care admission, and home care use, with death as a competing risk. Results: There were 260 DBS recipients matched with 551 controls. Patients undergoing DBS did not experience a significant survival advantage compared to controls (log-rank test p = 0.50; HR: 0.89, 95% CI: 0.65-1.22). Among patients <65 years of age, DBS recipients had a significantly reduced risk of death (HR: 0.49, 95% CI: 0.28-0.84). Patients receiving DBS were more likely than controls to receive care for falls (HR: 1.56, 95% CI: 1.19-2.05) and home care (HR: 1.59, 95% CI: 1.32-1.90), while long-term care admission was similar between groups. Conclusions: Receiving DBS may increase survival for younger PD patients who undergo DBS. Future studies should examine whether survival benefits may be attributed to effects on PD or the absence of comorbidities that influence mortality. RÉSUMÉ : Taux de survie et utilisation des soins de santé dans le cas de patients atteints de la maladie de Parkinson ayant bénéficié de la stimulation cérébrale profonde. Objectifs : Comparer le taux de survie à long terme de patients atteints de la maladie de Parkinson (MP) qui ont bénéficié de la stimulation cérébrale profonde (SCP) à celui de témoins appariés ; analyser dans quelle mesure la SCP a été associée à des variations en ce qui concerne le nombre de chutes avec blessures et la nécessité de soins de longue durée et de soins à domicile. Méthodes : C'est au moyen de données administratives ontariennes du domaine de la santé, plus précisément une cohorte d'individus chez qui l'on a diagnostiqué la MP entre 1997 et 2012, que nous nous sommes attardés aux effets de la SCP. Des patients ayant bénéficiée de ce traitement ont ainsi été appariés en fonction de l'âge, du sexe, de la date du diagnostic de MP, de la durée de cette maladie et des scores de propension (propensity score) à des témoins qui n'en ont pas bénéficié. Les taux de survie de ces deux groupes ont été comparés au moyen du test de Mantel-Haenszel et du modèle de régression de Cox (MRC). Des courbes estimant la fonction d'incidence cumulée (cumulative incidence function curves) et des modèles de risque basés sur une sous-distribution marginale (marginal subdistribution hazard models) ont également été utilisés pour évaluer les effets de la SCP ...

Survival in patients with Parkinson’s disease: a ten-year follow-up study in northern China

“…However, many shortcomings or controversial areas remain to be further explored. First, studies of prognostic factors, such as sex, severity of motor symptoms, hallucinations, depression, autonomic dysfunction, smoking, and deep brain stimulation (DBS) treatment, have shown inconsistent results [ 2 , 5 – 14 ]. Furthermore, it remains unclear whether the presence of fatigue is an independent predictor of the decline in the survival of PD patients.…”

Long-term follow-up of subthalamic nucleus deep brain stimulation in patients with Parkinson’s disease: an analysis of survival and disability milestones

“…A time-depended deterioration of axials signs after surgery 10,11,14,16,37,41 has been suggested and can explain the lower incidence of falls (32% of 260 patients) in a study with shorter disease duration at surgery (6 ± 3.8 years) and shorter follow-up time (median 3.1 years). 42 Older age at STN-DBS was a strong driver of increase rates of both falls and freezing.…”

“…Several studies have shown an association between age and the occurrence of falls and freezing 33,34,42,43 . Besides age at DBS, only a worse baseline UPDRS II OFF score was an independent predictor of freezing, but not falls.…”

Deep brain stimulation in PD: risk of complications, morbidity, and hospitalizations: a systematic review

“…Any of these conditions may lead to hospitalization following DBS. Some symptoms of PD that lead to increased risks and may require specialized care within the hospitalized setting, such as dysphagia and falls, may also not be well-addressed by DBS (Nantel et al, 2012;Troche et al, 2013;Crispo et al, 2021). Given that DBS is most often used in the later stages of PD, both continuing symptom progression and complications from DBS itself may play a role in increasing rates of hospitalization.…”