Mortality of advanced Parkinson's disease patients treated with deep brain stimulation surgery

Abstract

Objective: Despite the widespread use of deep brain stimulation (DBS) for patients with Parkinson's disease (PD), long-term outcomes remain unclear. We aimed to analyze the mortality of advanced PD patients who received DBS surgery.

Methods: We assessed the survival rate of 158 consecutive advanced PD patients who underwent DBS surgery between April 2002 and May 2014. Kaplan-Meier survival curves were constructed using death as the endpoint. Cox proportional hazards regression models were used to assess the association of clinical risk factors with survival.

Results: Twenty-seven (17.1%) PD patients (13 men and 14 women) died during the mean follow-up period of 5.3±3.1years. The survival rate was 97% at 3years and 85% at 5years after DBS surgery. Pneumonia (n=7) was the most common specific cause of death. Orthostatic hypotension was more frequent in deceased patients than in survivors (P=0.026). In a step-wise Cox regression analysis, male sex (hazard ratio (HR) = 2.58; 95% confidence interval (CI) = 1.19–5.60; P = 0.016), visual hallucination (HR = 9.53; 95% CI = 3.50–26.01; P < 0.001), and nursing home admission (HR = 6.76; 95% CI = 2.40–18.99; P < 0.001) predicted poor survival.

Conclusion: The poor survival of advanced PD patients who underwent DBS surgery was associated with male sex, orthostatic hypotension, visual hallucination, and nursing home admission.

Keywords: Deep brain stimulation; Mortality; Outcome; Parkinson's disease.