Weaver FM (Center for Management of Complex Chronic Care), Hur K
(Hines VA Hospital), Follett K
(University of Nebraska), Stern M
(Philadelphia VAMC), Harris C
(Alburquerque VAMC), Reda D
(Hines VA Hospital)
Although deep-brain stimulation (DBS) for Parkinson’s disease (PD) has gained acceptance for treatment of PD, questions remain regarding which patients are appropriate candidates. In a randomized, controlled, blinded-evaluator multi-center trial of DBS in PD, patients stratified by study site and age ( < 70 vs. 70+ years old) were compared between best medical therapy (BMT) and DBS.
255 persons with idiopathic PD, Hoehn and Yahr stage 2 or worse off medications were recruited from seven VA and six university hospitals. Study subjects were randomized to DBS or BMT and followed for six months. The primary outcome was time spent in the on-state without troubling dyskinesia, using motor diaries. Other outcomes included functional status, quality of life, and medication use. Comparisons were made by age.
The intention-to-treat analysis included 187 subjects < 70 and 68 subjects 70+ years old. Time spent in the on-state improved significantly over baseline for DBS compared to BMT in both age groups. Older DBS patients gained an average of 4.7 hours in on time, while older BMT patients lost 0.6 hours of on time at six months (p < 0.001). A similar result was observed in younger patients (gained 5.2 hours vs. lost 0.3 hours, p < 0.001). Quality of life on most Parkinson’s Disease Questionnaire-39 subscales and motor function scores on UPDRS improved significantly for the DBS group, with some variation by age, but there was little change in BMT patients. DBS patients experienced a higher rate of serious adverse events (SAEs) than BMT patients, but no difference in SAE rate was found between older (26%) and younger (25%) patients. Also, there were no differences in types of SAEs (e.g., site infection, fall, etc.) between the two age groups.
DBS was superior to BMT in improving on time, motor function, and quality of life in both older and younger patients. Age greater or less than 70 does not impact response to DBS.
Age is not a limiting factor in consideration of DBS for PD. However, older patients may have a greater number or more severe comorbidities that should be considered when making the decision to offer surgery.