Objective: To evaluate whether implantation of deep brain stimulation (DBS) could lead to multiple system atrophy (MSA).

Background: Recent studies regarding the transmissibility of alpha-synuclein prions have warned against the possibility of human-to-human transmission of MSA through DBS implantation.

Methods: We retrospectively reviewed all cases with the final clinical diagnosis of MSA evaluated at Mayo Clinic, Rochester who had undergone DBS for parkinsonism. The timeline of each patient was determined, including symptom onset of motor and autonomic symptoms, DBS implantation, diagnosis of MSA, and date of death when available. Clinical documentation was reviewed to determine whether there was evidence of atypical parkinsonism suggestive of MSA prior to DBS implantation or whether signs and symptoms of MSA followed implantation.

Results: Of 594 patients ultimately fulfilling diagnostic criteria for probable MSA, there were 5 patients that underwent DBS. All patients had DBS implantation at other institutions. The median time from onset of Parkinsonian symptoms to DBS implantation was 8.0 years (range 4 to 14 years). Of the 5 patients, 4 had symptoms and signs of atypical parkinsonism prior to DBS implantation (including autonomic dysfunction of orthostatic hypotension or urinary incontinence, upper motor neuron signs, severe dystonia, atypical tremor or loss of levodopa responsiveness). However 1 patient had a 13 year history of levodopa responsive parkinsonism prior to DBS implantation. The patient had neurologic decline after implantation with autonomic failure shown on autonomic function testing, dysarthria and dysphagia, and ultimately died at age 57, 6 years after DBS implantation.

Conclusions: An exceedingly low number of MSA cases in our cohort had DBS implantation for parkinsonism. The majority of those had signs and symptoms of atypical parkinsonism prior to DBS implantation. Our data therefore do not support transmissibility of MSA through DBS, but further neuropathological studies are needed to answer that question with added certainty. Autonomic function testing prior to DBS implantation is useful to determine if features of MSA are present prior to DBS implantation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-deep-brain-stimulation-implantation-cause-multiple-system-atrophy-a-retrospective-review-of-msa-patients/