Objective: This study aims to identify the complications of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with advanced Parkinson’s disease (PD) to direct future considerations and improve outcomes.

Background: STN DBS is widely used for the treatment of advanced PD. Most studies have reviewed the short-term (<5 year) complications of DBS. Long-term complications have not been well-studied.

Method: We conducted a review of patients in a single centre who underwent STN DBS from 2008 to 2023 for the treatment of advanced PD with complex motor features. Data on complications was extracted from neurology and neurosurgery clinic letters.

Results: We included 84 patients (165 electrodes). The study was composed of 27 female and 57 male patients. Mean age was 59.3±7.82 (41-71). There was no perioperative mortality. Infections that resolved with antibiotics occurred in 2.35% of patients, 1 required surgical intervention but still has the stimulator in place 3 years later. Intracerebral haematoma occurred in 1 patient, though this was noted to have occurred >48h post-DBS surgery and presented with a seizure. There was 1 reported lead migration requiring repositioning. 2 patients had 1 lead repositioned for better symptom control. Interestingly, eyelid apraxia (12.94%) was noted to mainly occur >1 year post-DBS and a significant number were >5 years post DBS. No patients reported significant cognitive impairment in the first 6 months post-DBS, rather, if reported, this occurred later, in line with PD progression. No new hallucinations or impulse control disorders were reported outside of the context of late cognitive decline. There was 1 reported suicide 2 years post-DBS in the context of other medical problems. Only 1 patient was commenced on another advanced treatment (Apomorphine) and this was >10 years post DBS. Patients developing worsening gait and falls mostly occurred >5 years post-DBS and were likely secondary to PD progression.

Conclusion: Our findings are similar to results reported by other sites, suggesting that the overall risk of DBS complications is low. Eyelid apraxia and suicide occurred predominantly >1 year post-DBS, in contrast to previous reviews. Differentiating complications due to stimulation, the device or PD progression can be challenging in a progressive neurodegenerative disorder. DBS has proven to be an effective long term advanced treatment for PD with few complications.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-complications-in-parkinsons-disease-patients-a-15-year-single-centre-review/