Should We Consider Deep Brain Stimulation Discontinuation in Late‐Stage Parkinson's Disease?

Abstract

Background: Subthalamic deep brain stimulation (STN-DBS) effects may decrease with Parkinson's disease (PD) progression. There is no indication if, when, and how to consider the interruption of DBS treatment in late-stage PD. The objective of the current study was to investigate the percentage of "poor stimulation responders" among late-stage PD patients for elaborating an algorithm to decide whether and when DBS discontinuation may be considered. Methods: Late-stage PD patients (Hoehn Yahr stage ≥4 and Schwab and England Scale <50 in medication on/stimulation on condition) treated with STN-DBS for at least 5 years underwent a crossover, double-blind, randomized evaluation of acute effects of stimulation. Physicians, caregivers, and patients were blinded to stimulation

Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: Preference and Satisfaction in Chinese Patients With Parkinson's Disease

“…Previous studies raised the challenging question of how device-aided treatment could be managed in late-stage PD patients ( 13 , 14 ). In our study, 92.8% of late-stage PD patients were satisfied with the choice of r-IPG.…”

Caregiver Burden in Partners of Parkinsonian Patients with Deep Brain Stimulation

“…Overall, patients’ satisfaction with DBS remains high at long-term follow-up of more than 6 years [ 7 , 59 ]. In a small cohort of late-stage PD patients (Hoehn and Yahr stage ≥4) with marked motor and cognitive impairment treated with STN-DBS for >14 years, patients still benefit partly from stimulation [ 60 ]. Interestingly, in this specific patient cohort, caregivers had mild to moderate stable caregiver burden.…”

“…Interestingly, in this specific patient cohort, caregivers had mild to moderate stable caregiver burden. When the medical decision was made to discontinue DBS stimulation due to the clinical impression of poor stimulation response in this advanced disease stage, PD patients’ global motor state and dysphagia declined with delayed onset, while caregivers’ QOL and CB worsened after DBS discontinuation slightly, but without statistical significance [ 60 ]. The observation of mild-moderate CB in this small cohort of very advanced PD patients with a long disease duration of up to 43 years is astonishing and could be due to acceptance of the CB and habituation to the caregiving situation.…”

Personalized Care in Late-Stage Parkinson’s Disease: Challenges and Opportunities

“…Regarding DBS, a common clinical question is the maintenance of this therapy at the time of replacement of the implantable pulse generator in patients no longer having clinically significant motor complications, and for whom the benefit of DBS may be doubtful. A small randomized, double-blind trial attempted to address this question, finding that DBS has a short and long-term benefit, similar to L-dopa, even in LSPD [ 18 ]. Worsening of dysphagia and Parkinsonism may occur after switching-off DBS and, at times, after a few days.…”

“…Worsening of dysphagia and Parkinsonism may occur after switching-off DBS and, at times, after a few days. An algorithm to evaluate the therapeutic benefit of DBS and criteria to discontinue DBS has been proposed [ 18 ]. A rule of thumb is to consider increasing neurostimulation with particular caution, especially for the most troublesome axial symptoms, as these likely are a manifestation of disease progression and will not be responsive to dopaminergic treatment [ 19 ] and thus to neurostimulation.…”