Objective: To analyze the features of very late stage Parkinson’s disease (PD) in a selected group of patients treated with bilateral subthalamic nucleus DBS (STN-DBS), with a disease history of more than 30 years.

Background: The improvement in the treatment of PD motor symptoms obtained in the last decades through surgical or infusion therapies highlighted issues related to the multi-systemic nature of the disease.

Methods: Five STN-DBS treated patients (age 70.6±5.1 ys; DBS duration 13.7±1.4 ys) with disease duration of 35.6±5.8 ys were evaluated with the Unified PD Rating Scale (UPDRS), the PD Questionnaire-39 (PDQ-39) and a complete neuropsychological battery. A clinical interview was collected to investigate the presence of non-motor symptoms. Moreover, patients underwent an electrophysiological study, an otorhinolaryngological evaluation, a comprehensive cardiologic assessment (clinical examination, echocardiography, Holter ECG and 24-hour blood pressure monitoring) and a complete battery of autonomic tests. Brain MRI, [¹²³I]FP-CIT SPECT and cardiac [131]I-MIBG scintigraphy were also obtained.

Results: All patients demonstrated a sustained motor response to STN-DBS, with an average UPDRS-III improvement of 45.6% (Med-ON/Stim-ON vs Med-ON/Stim-OFF). All patients had constipation and hyposmia. RBD was present in 4 subjects. Four patients reported speech impairment, and 3 complained drooling and mild dysphagia. Autonomic tests were altered in 3 subjects, only in one case accompanied by orthostatic symptoms. Urge-incontinence was reported by 3 patients. Two sensory and one sensory-motor axonal polyneuropathies were diagnosed. No significant alterations were found at the cardiological examinations. One patient was demented, one had a single domain PD-MCI, one had a multiple domain PD-MCI. [¹²³I]FP-CIT SPECT and [131]I-MIBG scintigraphy were severely altered in all patients. PDQ-39 showed a moderate impact of PD on quality of life in 3 cases, mainly due to mobility (balance problems and falls), cognition and communication impairment.

Conclusions: The sustained control of motor symptoms achieved with advanced therapies, especially when applied to young-onset PD patients, allows a better understanding of the disease evolution in its very advanced phases, and demonstrates as the disability is mainly due to the progressive worsening of levodopa-unresponsive and non-motor symptoms, and the presence of cognitive decline.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/beyond-30-years-of-parkinsons-disease-a-comprehensive-characterization-of-long-surviving-patients/