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Should We Consider Deep Brain Stimulation Discontinuation in Late-Stage Parkinson's Disease?
- Source :
- Movement Disorders; Aug2020, Vol. 35 Issue 8, p1379-1387, 9p
- Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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 conditions. Poor stimulation responders (MDS-UPDRS part III change <10% between stimulation on/medication off and stimulation off/medication off) maintained the stimulation off/medication on condition for 1 month for open-label assessment.<bold>Results: </bold>Thirty-six patients were included. The acute effect of stimulation was significant (17% MDS-UPDRS part III), with 80% of patients classified as "good responders." Seven patients were classified as "poor stimulation responders," and the stimulation was switched off, but in 4 cases the stimulation was switched back "on" because of worsening of parkinsonism and dysphagia with a variable time delay (up to 10 days). No serious adverse effects occurred.<bold>Conclusions: </bold>The vast majority of late-stage PD patients (92%) show a meaningful response to STN-DBS. Effects of stimulation may take days to disappear after its discontinuation. We present a safe and effective decisional algorithm that could guide physicians and caregivers in making challenging therapeutic decisions in late-stage PD. © 2020 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 08853185
- Volume :
- 35
- Issue :
- 8
- Database :
- Complementary Index
- Journal :
- Movement Disorders
- Publication Type :
- Academic Journal
- Accession number :
- 145052787
- Full Text :
- https://doi.org/10.1002/mds.28091