An approach to acute clinical deterioration in patients with late-stage Parkinson’s disease

Waller, Sophie; Williams, Laura; Fung, Victor S.C.; Qiu, Jessica; Tsui, David; Griffith, Jane

doi:10.31128/ajgp-03-22-6363

Cited by 2 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Very advanced stages of PD and advanced age are considered contra‐indications for DBS due to several reasons—the levodopa‐resistant axial motor and non‐motor symptoms seen in such patients are generally refractory to neuro‐stimulation and surgical risks outweigh benefits 10,24,25 ; moreover, surgical planning becomes difficult due to cerebral atrophy 10 . PD is known to have an accelerated progression with advancing age 26,27 and non‐motor manifestations, importantly, cognitive changes tend to dominate the clinical picture in advanced stages 25,28 . DBS is associated with cognitive risks, and albeit being small, 29,30 these may become relevant in patients whose cognitive functions are already significantly compromised by the disease.…”

Section: Discussionmentioning

confidence: 99%

“…21 For patients to enjoy its benefits for a maximum period, this intervention needs to be done when motor complications start interfering with QoL 6 because the positive effects of DBS on QoL tend to wane off over years with the natural progression of the disease and emergence of DBS refractory motor and nonmotor manifestations. 3,13,22,23 Very advanced stages of PD and advanced age are considered contra-indications for DBS due to several reasonsthe levodopa-resistant axial motor and non-motor symptoms seen in such patients are generally refractory to neuro-stimulation and surgical risks outweigh benefits 10,24,25 ; moreover, surgical planning becomes difficult due to cerebral atrophy. 10 PD is known to have an accelerated progression with advancing age 26,27 and non-motor manifestations, importantly, cognitive changes tend to dominate the clinical picture in advanced stages.…”

Section: Discussionmentioning

confidence: 99%

“…10 PD is known to have an accelerated progression with advancing age 26,27 and non-motor manifestations, importantly, cognitive changes tend to dominate the clinical picture in advanced stages. 25,28 DBS is associated with cognitive risks, and albeit being small, 29,30 these may become relevant in patients whose cognitive functions are already significantly compromised by the disease. Increased surgical risks due to comorbidities of advancing age is another concern.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Deep Brain Stimulation for Parkinson's Disease‐the Developing World's Perspective

Patel,

Kalikavil Puthanveedu,

Vijayaraghavan

et al. 2023

Movement Disord Clin Pract

View full text Add to dashboard Cite

BackgroundDeep brain stimulation (DBS) is the most widely used device‐assisted therapy in patients with moderately advanced stages of Parkinson's disease (PD) experiencing motor complications. Only a minority of eligible patients get the opportunity to undergo DBS in the developing world.ObjectivesTo examine the proportion and characteristics of patients with motor complications of PD who are willing for DBS and who undergo surgery.MethodsPatients with motor complications of PD eligible for DBS over a five‐year study period (2016–2020) were included. The demographic, clinical and socio‐economic characteristics and information on their status in 2021 were collected and analyzed.ResultsAmong 1017 patients, 223 had motor symptoms qualifying for DBS and follow‐up information available. Only 78 (35%) opted for surgery. The willing patients had higher socioeconomic status, were older and had longer duration of PD and motor complications, more freezing of gait, cognitive symptoms, and neuropsychiatric disturbances. 37 of them were found unfit during pre‐operative work‐up; only 41 (18%) with motor complications were finally taken up for DBS. Age, duration or severity of motor symptoms did not differ between patients who were finally selected for surgery and those who were not.ConclusionsLess than one‐fifth of our patients with motor complications of PD finally underwent DBS. The patients appeared to wait till the late stages of PD, before making a decision on availing surgical treatment. The delay resulted in nearly half of them being found unfit in pre‐operative work‐up. Our findings may enable clinicians to counsel eligible patients more efficiently.

show abstract