Introduction: Deep brain stimulation (DBS) is a reversible adjustable proven therapy for movement disorders and other conditions. Therapy effectiveness is currently expressed to patients in terms of crudely measured success or failure rates. We aimed to examine long-term survival data of both DBS devices and therapy; more patient-centered parameters. Survival is defined as absence of failure and continuing use.
Methods: Retrospective chart review of patients with an implanted DBS device at a single institution between the years 1999-2014 was undertaken. Device history and longevity, as determined by the per annum incidence of device and/or therapy failure were evaluated. Kaplan-Meier analysis was applied to generate survival over time and hazard rates for failure. Predictors of survival were analyzed using log-rank comparisons for univariate analysis and Cox proportional hazards models for multivariate analysis.
Results: In 355 patients, the mean and median device survival time were 140.66 ± 5.31 months and 177 months, respectively. The 5 and 10 year survival rates were 90% and 75%, respectively while the mean survival of therapy was 204.9 ± 4.28 months, with 5 and 10 year survival rates of 95% and 90%, respectively.
For essential tremor patients 5 and 10 year survival rates were 85% and 60%, respectively. Mean therapy survival was 178.5 ± 8.55 months, with 5 and 10 year survival rates of 85%.
For Parkinson’s disease patients 5 and 10 years survival rates were 90% and 75%, respectively. Mean therapy survival was 209.93 ± 4.27 months, with 5 and 10 year survival rates of 95%.
Conclusions: DBS therapy is an effective long-term therapy with very high rates of survival of benefits despite infrequent device failures for which most patients undergo device re-implantation. There is a trend towards higher rates of DBS therapy survival in patients with Parkinson’s disease compared to patients with essential tremor.
Patient Care: Provide long-term survival data of both DBS devices and therapy; more patient-centered parameters
Learning Objectives: 1. Mean DBS device survival
2. Mean DBS therapy survival
3. Factors influencing DBS device survival
References: Weaver FM, Follett K, Stern M, et al. Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients With Advanced Parkinson Disease: A Randomized Controlled Trial. JAMA. 2009;301(1):63-73.