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  • Toward Broadening Access to Deep Brain Stimulation in Parkinson’s Disease: Are Comorbidities an Absolute Contraindication?

    Final Number:
    1458

    Authors:
    Lora Kahn MD; Juanita Garces MD; Mansour Mathkour MD; Erin E. Biro MD; Cuong Bui MD; Olawale Sulaiman MD, PhD, FRCS(C); Roger D. Smith MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: The efficacy of deep brain stimulation (DBS) for Parkinson’s disease (PD) has been well demonstrated; however, there remain barriers to accessing DBS therapy for certain populations, including those with multiple medical comorbidities. Patients with multiple comorbidities have been excluded from the hallmark trials of DBS for PD. Here we seek to analyze whether these patients respond to DBS and whether they are more at risk for complications than those with few or no comorbidities.

    Methods: 151 patients were retrospectively reviewed and divided into three groups based on number of comorbidities at the time of DBS: zero, one to two, or three or more. Data were assessed using analysis of variance (ANOVA) and paired t-test. Treatment outcomes were evaluated using the unified Parkinson’s disease rating scale (UPDRSIII), number of doses of anti-PD medications daily, total number of anti-PD medications, and levodopa equivalence daily doses (LEDD).

    Results: 63 patients (41.72%) had no medical comorbidities, 75 (49.66%) had 1-2, and 13 (8.60%) had 3 or more. Patients without comorbidities were significantly younger at time of surgery. No significant difference was seen between groups for changes in all variables after surgery except a significant reduction in number of doses of anti-PD meds (p=0.04838) and a trend toward reduction of LEDD (p=0.0982). While all patients experienced significant improvement in UPDRS-III scores, only the groups with comorbidities experienced improvements in LEDD (p=0.006172 and p=0.01629). Four patients across all groups experienced infection that required removal of implants; three had 2 comorbidities (4%) and one had 3 (7.69 %).

    Conclusions: Our experience at a single center demonstrates that DBS is efficacious in patients with multiple medical comorbidities. Though these patients may be more prone to infection, these patients may benefit from DBS when performed at experienced centers. Further study is needed to assess optimal candidacy for DBS.

    Patient Care: To expand the window of patients selection who undergoing DBS surgery

    Learning Objectives: DBS is effective in patients with high comorbidities with good selection

    References:

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