gms | German Medical Science

Objective: Currently the deep brain stimulation is an accepted standart method for treatment of movement disorders. However, the implantation in older patients and the expectant benefit for them are discussed controversially.

Methods: We retrospectivly analysed all patients at the age of 70 years or older, which have undergone deep brain stimulation in our department, since we started the program in 1999 up to Juli 2007. We recorded indication for surgery, target point, number of microelectrodes, perioperative and late onset complications and compared complication rate and outcome with our previous data for the total patient collective.

Results: Out of the 360 patients which have undergone deep brain stimulation in this period, 42 were classified as geriatric patients with a mean age of 72,2 years (70-78 years). Indications for surgery were Parkinson's disease (n=27), essential tremor (n=10), dystonia (n=3), and other forms of tremor (n=2). For Parkinson's disease our main target was the STN (n=22), but also the GPI (n=1) and the VIM (n=4). The target for dystonia was the GPI, for tremor the VIM. For the microrecording 3 or more electrodes could be used in 41 patients. Looking at the perioperative complications we had one case of hemorrhage with the consequence of a permanent hemiparesis, one asymptomatic infarction, and one electrode had to be revised because of dislocation. On late onset complication there was one revision because of painful scaring. There was no infection and no hospital mortality. In summary we find no higher complicationrate than in younger patients and the outcome was also comparable.

Conclusions: We conclude that the deep brain stimulation is an effective method for movement disorders also in geriatric patients. They have a similarly benefit from the surgery. Nevertheless, a carefully patient selection and indication setting is necessary, and the complication rate and the mortality will not be higher than in younger patients.