Objective: To characterize retrospectively the long-term survival of 109 PD patients after 8 years of STN-DBS and to identify the incidence of the milestones of freezing, falls, hallucinations, dementia and nursing home institutionalization.

Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) provides significant improvement of motor and nonmotor symptoms and quality-of-life in Parkinson’s disease (PD) patients in the short- and medium-term. However, studies on long-term survival and incidence of disability milestones outcomes after STN-DBS are rather limited

Method: 255 patients underwent surgery between 2006-2021. The clinical files from the 109 patients operated between 2006-2012 were reviewed since baseline up to 8 years (or death). For mortality, Cox proportional hazards regression analysis was performed. For disability milestones, competing risk analysis was performed and cumulative incidence functions calculated. Multivariable regression analysis in the presence of competing risks was done based on the Gray’s test of sub-distribution hazards of cumulative incidence functions.

Results: Survival rate was 83%, with a mean disease duration of 22 years. Mortality was significantly associated with age at surgery (HR 1.12, p = 0.019) and UPDRS III OFF (HR 0.94, p = 0.037). Milestones incidence was: falls 73%, freezing 47%, dementia 34%, hallucinations 32% and institutionalization 7%.  The average time from surgery to death was 62.1 ± 21.3 months, to freezing 39.6 ± 28.4 months, to falls 40.4 ± 25.4 months, to dementia 56.2 ± 21.2 months, to hallucinations 60.0 ± 20.7 months and to institutionalization 62.3 ± 22.0 months.  Age at surgery predicted falls (HR 1.284, p <0,004); age at surgery and UPDRS II OFF predicted freezing (HR 1.896, p = 0.006; HR 1.024, p < 0.001, respectively). Age at surgery and UPDRS II OFF and ON were significantly associated with dementia (HR 1.029, p=0.05; HR 1.026,  <0.001, HR 0.996, p= 0.014 respectively); and age at surgery and UPDRS II OFF predicted institutionalization (HR 1.190, p=0.001; HR 1.010, p <0.001, respectively).  

Conclusion: Disability milestones cluster together at the very late stages of disease progression and are soon followed by institutionalization and death. Age at surgery and baseline severity of the motor aspects of daily living activities appear to be the best predictors of gait and cortical milestones outcomes.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/long-term-follow-up-of-subthalamic-nucleus-deep-brain-stimulation-for-parkinsons-disease-survival-and-disability-milestones/