Long-Term Mortality Analysis in Parkinson’s Disease Treated with Deep Brain Stimulation

Abstract

Background. Few data have been published regarding long-term mortality in patients with Parkinson's disease treated with DBS. Methods. This study analyzed long-term mortality rates, causes, and correlates in PD patients treated with DBS. Results. 184 consecutive patients were included; mean follow-up was 50 months. Fifteen deaths occurred (total 8.15%, annual mortality rate 1.94%). Mean age at disease onset and at surgery was 48 ± 2.4 and 63 ± 1.6 years, respectively. Mean disease duration until death was 21 ± 7.8 years. Most deaths related to stroke, myocardial infarction, other vascular/heart disorders, or severe infection; one suicide was recorded. Deceased PD patients were mostly male and had lower motor benefit after DBS, but univariate analysis failed to show significant differences regarding gender and motor benefit. Survival was 99% and 94% at 3 and 5 years. Conclusions. Long-term survival is to be expected in PD patients treated with DBS, possibly higher than previously expected. Death usually supervenes due to vascular events or infection.

Survival in patients with Parkinson's disease after deep brain stimulation or medical management

“…The age of the study cohort at the time of DBS was approximately 69 years, much older than other large studies of DBS in which the age at DBS was around 60 years old . The average age of patients at the time of DBS in 2 of the recent DBS survival papers were somewhat older: 63 years old in the Rocha cohort and 64 years old for the matched DBS and comparison groups in the Lilleeng study …”

“…The previous studies on survival following DBS have mixed results. Two studies did not have a comparison group, whereas the other 2 studies reported opposing findings. Lilleeng and colleagues reported a trend toward higher risk of death following DBS, whereas Ngoga and colleagues found a significant survival advantage for DBS.…”

“…Two studies examined survival in DBS patients without a comparison group. Rocha and colleagues followed 184 PD patients who underwent DBS at a single site between 2002 and 2012. The patients were followed for an average of 50 months.…”

“…Each of these studies is limited by either not having a nontreated comparison group, being conducted at a single center, and/or having small sample sizes . In the current study, we examined survival in a large national population‐based cohort of veterans with PD who received DBS at either a Department of Veterans Affairs (VA) hospital or Medicare‐reimbursed facility from October 1, 2007 through September 30, 2013 (fiscal years [FY] 2007‐2013) and a matched cohort of veterans with PD who did not undergo DBS during that timeframe.…”

The ethical, moral, and pragmatic rationale for brain augmentation

“…As an example, DBS produces damage during implantation, and can lead to bleeding, infection, and other issues that have resulted in the deaths of some patients (Rocha et al, 2014). However, most methods of neuroenhancement are unlikely to cause physical harm if used correctly.…”