Deep Brain Stimulation Improves Survival in Parkinson Disease
Deep brain stimulation may help to retain motor function, and in turn prolong life in patients with Parkinson disease.
The use of deep brain stimulation (DBS) in patients with Parkinson disease (PD) may result in a modest improvement in survival, according to a retrospective analysis of the Veterans Affairs and Medicare administrative data published in Movement Disorders.
Patient data were taken from claims files from the Veterans Affairs and the Center for Medicare and Medicaid Services. The researchers used propensity scoring to match veterans with PD undergoing DBS (n=611) vs veterans not undergoing DBS (n=611) during 2008 to 2013 to determine the effect of the therapy on mortality outcomes.
According to the findings, patients undergoing DBS experienced significantly longer survival than patients not receiving DBS (mean, 2291.1 [standard error = 46.4] days [6.3 years] vs 2063.8 [standard error = 47.7] days [5.7 years], respectively; P =.006; hazard ratio 0.69; 95% CI,0.56-0.85). During follow-up, significantly fewer patients in the DBS group vs the no DBS group had died (168 [27.5%] vs 214 [35.0%], respectively; P =.002).
There was no significant difference between DBS and no DBS with regard to the mean age at death (76.5 and 75.9, respectively; P =.67). In addition, patients managed with DBS had a 31% less chance of mortality compared with participants undergoing medical management (P =.0004).
Since this was a retrospective study of claims and administrative data, the researchers could not fully adjust for unobserved differences, which could have affected survival. In addition, this study is further limited in that the researchers did not take into account each the duration of each patient's PD, the types of medications used, and each individual's motor function or disease stage.
Although PD is progressive and continues to result in worsening of cognition, gait, and speech, the study's data on patients receiving DBS “suggests that there may be an advantage to maintaining motor function.”
Weaver FM, Stroupe KT, Smith B, et al. Survival in patients with Parkinson's disease after deep brain stimulation or medical management [published online November 18, 2017]. Mov Disord. doi:10.1002/mds.27235