Bilateral Subthalamic Nucleus Deep Brain Stimulation in Elderly Patients With Parkinson Disease: A Case-Control Study

Prevalence of Late-Stage Parkinson's Disease in the US Healthcare System: Insights from TriNetX

BACKGROUND

Patients in late-stage Parkinson's disease (PDLS) are caregiver-dependent, have low quality of life, and higher healthcare costs.

OBJECTIVE

To estimate the prevalence of PDLS patients in the current US healthcare system.

METHODS

We downloaded the 2010-2022 data from the TriNetX Diamond claims network that consists of 92 US healthcare sites. PD was identified using standard diagnosis codes, and PDLS was identified by the usage of wheelchair dependence, personal care assistance, and/or presence of diagnoses of dementia. Age of PDLS identification and survival information were obtained and stratified by demographic and the disability subgroups.

RESULTS

We identified 1,031,377 PD patients in the TriNetX database. Of these, 18.8% fitted our definition of PDLS (n = 194,297), and 10.2% met two or more late-stage criteria. Among all PDLS, the mean age of PDLS identification was 78.1 (±7.7) years, and 49% were already reported as deceased. PDLS patients were predominantly male (58.5%) with similar distribution across PDLS subgroups. The majority did not have race (71%) or ethnicity (69%) information, but for the available information >90% (n = 53,162) were White, 8.2% (n = 5121) Hispanic/Latino, 7.8% (n = 4557) Black, and <0.01% (n = 408) Asian. Of the PDLS cohort, 71.6% identified with dementia, 12.9% had personal care assistance, and 4.8% were wheelchair-bound.

CONCLUSIONS

Late-stage patients are a significant part of the PD landscape in the current US healthcare system, and largely missed by traditional motor-based disability staging. It is imperative to include this population as a clinical, social, and research priority. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Comparison of UPDRS III score between young and late onset Parkinson disease after deep brain stimulation: A meta-analysis

PURPOSE

Parkinson disease (PD) is a common age-related neurodegenerative disease. Subthalamic nucleus deep brain stimulation (DBS) is a safe and effective surgical treatment for medically resistant advanced PD. However, the relationship between the age at PD onset and the efficacy of subthalamic nucleus DBS surgery remains unclear. Thus, we conducted a meta-analysis to compare motor symptom improvements after DBS for the treatment of young-onset and late-onset PD.

METHODS

We systematically searched the Medline and Embase databases (from inception to March 2023) for English publications. All published studies comparing the outcomes (Unified Parkinson's Disease Rating Scale part III [UPDRS III] scores) of DBS between the young-onset Parkinson disease (YOPD) and late-onset Parkinson disease (LOPD) groups were identified. The effect size was defined as the standardized mean difference (Hedge g) with 95% confidence intervals. The standardized mean difference was calculated by dividing the difference in UPDRS III scores between old and young patients by the pooled and weighted standard deviations. The meta-analysis was performed using R Statistical Software version 4.2.2 (The R Foundation for Statistical Computing).

RESULTS

Six studies were eligible for inclusion. The standardized mean difference of UPDRS III score between young and old patients ranged from -0.54 to 1.43 with a pooled difference of 0.0932 (95% confidence intervals: - 0.4666 to 0.6530, I2 = 86.77%). Subgroup analyses were performed with a cutoff age of 65 years and did not show a significant difference in UPDRS III scores between patients with YOPD and LOPD (0.1877, -0.6663 to 1.0417).

CONCLUSIONS

The efficacy of DBS in patients with YOPD and LOPD showed similar improvements in the UPDRS score; hence, DBS should be considered, if necessary, regardless of the onset age of PD.

Safety of Deep Brain Stimulation Lead Placement on Patients Requiring Anticlotting Therapies

BACKGROUND

Limited studies exist to support the safety of performing neuromodulation surgeries in patients whose anticlotting medication has been held. Here, we assess the safety of performing deep brain stimulation (DBS) in this patient population.

METHODS

All consecutive DBS patients who underwent lead and battery placement/revision at our institution between 2011 and 2020 were included in this Institutional Review Board-approved prospective outcomes database. We retrospectively recorded adverse events occurring within 90 days of surgery.

RESULTS

The study included 226 patients who underwent 381 lead placements in 267 surgeries. Of the 267 surgeries included in this study, 176 (66%) were performed on patients not on anticoagulants and 89 (33%) cases were on patients on 1 drug. Two (0.7%) cases involved a patient taking 2 drugs. A total of 49 adverse events were seen. Thirteen occurred in patients taking anticoagulants. There was no difference in adverse event rate between patients on anticlotting medication and those not (χ² [1] = 1.523, P = 0.2171). No clot-related sequelae occurred in any patient. Three hemorrhages occurred, all in patients not on anticoagulants.

CONCLUSIONS

We found no increased risk of complications in patients routinely on anticlotting medication undergoing DBS lead placement. We show that our protocol was successful in balancing increased risks of bleeding and of thromboembolic events in this patient group.