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Title: Lesser-Known Aspects of Deep Brain Stimulation for Parkinson's Disease: Programming Sessions, Hardware Surgeries, Residential Care Admissions, and Deaths.
Austin Authors: Xu, San San ;Malpas, Charles B;Bulluss, Kristian J ;McDermott, Hugh J;Kalincik, Tomas;Thevathasan, Wesley
Affiliation: Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
MS Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
Bionics Institute, East Melbourne, VIC, Australia
Department of Medical Bionics, The University of Melbourne, East Melbourne, VIC, Australia
CORe, Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
Issue Date: 2022
Date: 2021-06-10
Publication information: Neuromodulation 2022; 25(6): 836-845
Abstract: The long-term treatment burden, duration of community living, and survival of patients with Parkinson's disease (PD) after deep brain stimulation (DBS) implantation are unclear. This study aims to determine the frequency of programming, repeat hardware surgeries (of the intracranial electrode, implantable pulse generator [IPG], and extension-cable), and the timings of residential care and death in patients with PD treated with DBS. In this cross-sectional, population-based study, individual-level data were collected from the Australian government covering a 15-year period (2002-2016) on 1849 patients with PD followed from DBS implantation. The mean DBS implantation age was 62.6 years and mean follow-up 5.0 years. Mean annual programming rates were 6.9 in the first year and 2.8 in subsequent years. 51.4% of patients required repeat hardware surgery. 11.3% of patients had repeat intracranial electrode surgery (including an overall 1.1% of patients who were completely explanted). 47.6% of patients had repeat IPG/extension-cable surgery including for presumed battery depletion. 6.2% of patients had early repeat IPG/extension-cable surgery (within one year of any previous such surgery). Thirty-day postoperative mortality was 0.3% after initial DBS implantation and 0.6% after any repeat hardware surgery. 25.3% of patients were admitted into residential care and 17.4% died. The median interval to residential care and death was 10.2 years and 11.4 years, respectively. Age more than 65 years was associated with fewer repeat hardware surgeries for presumed complications (any repeat surgery of electrodes, extension-cables, and early IPG surgery) and greater rates of residential care admission and death. Data from a large cohort of patients with PD treated with DBS found that the median life span after surgery is ten years. Repeat hardware surgery, including of the intracranial electrodes, is common. These findings support development of technologies to reduce therapy burden such as enhanced surgical navigation, hardware miniaturization, and improved battery efficiency.
DOI: 10.1111/ner.13466
ORCID: 0000-0001-5338-5934
Journal: Neuromodulation
PubMed URL: 34114293
Type: Journal Article
Subjects: Complications
Parkinson's disease
deep brain stimulation
programming strategies
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