Objective: This is a descriptive study about consequences and management of unscheduled DBS disruption in 12 PD patients.

Background: Unscheduled DBS disruption may  occur mainly due to unanticipated battery depletion or to local infectious issues  needing rapid battery ablation. The management of oral therapies in this particular situation as well as clinical outcomes have not yet been clearly described.

Method: Unscheduled DBS disruption was retrospectively identified in 12 patients from our cohort of 282 PD patients with DBS . We report  clinical complications found in these patients, and compared  them to  disease  and  neurostimulation  history , equivalent levodopa daily doses (EDD) and unit dose (UD) before DBS instauration, after its unscheduled disruption and following  its replacement.

Results: An important increase of EDD (266%) and UD (36%) was necessary in all patients during the unscheduled DBS disruption. This increase remained noticeable following DBS replacement for both EDD (78%) and UD (21%). 7 patients developed serious clinical complications such as aspiration pneumonia, pulmonary embolism, psychiatric disorders and increased axial signs.  Patients with serious adverse events had a longer disease duration (20.14 versus 18 years) and a longer duration of neurostimulation (11 vs 1.84 years). They also required a greater increase of EDD (345.8 vs 153.8mg) and UD (143.55 vs 126.72) and had a longer hospital stay (33.71 days vs 12.2).

Conclusion: Sudden DBS disruption led to a major increase of EDD in our patients, correlated with the duration of PD progression and neurostimulation. A greater desensitization of dopaminergic receptors due to more advanced disease progression might be involved in these patients. Further multicenter studies with a larger number of patients are needed to confirm these data.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unscheduled-disruption-of-deep-brain-stimulation-dbs-in-parkinsons-disease-pd/