Artikel
Subthalamic Nucleus (STN) Deep Brain Stimulation (DBS) in elderly patients: a two year follow-up
Nucleus Subthalamicus (STN) Deep Brain Stimulation (DBS) bei älteren Patienten: ein 2 Jahres follow-up
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
There is an ongoing discussion regarding age limits of patients considered for Deep Brain Stimulation (DBS). Current indications are tremordominant disorders, Parkinson’s disease and dystonia. By using analgosedation, DBS surgery is more comfortable, especially for elderly patients. However, the value of DBS regarding the benefit-risk ratio in this patient population is still uncertain.
Methods
Bilateral electrode implantation in the STN was performed at two centers in a total of 73 patients, suffering from Parkinson‘s disease. Patients were analyzed retrospectively. For this study they were separated into two groups: Group I (age <65y, n=37) and group II (age ≥65y, n=36). Examinations were performed before the opration, at 6, 12 and 24 months follow-up. Age, UPDRS motor score (part III) on/off, Hoehn&Yahr scale, Activity of Daily Living (ADL), L-Dopa medication and complications were determined. SigmaStat (Jandel scientific) was used for statistical evaluation.
Results
Significant differences were found regarding the overall perfomance in the ADL score (group I: 48/71, group II: 41/62 points [preop/6 mo postop]) and in the rate of complications (group I: 4 intermittend psychosis, 4 infections in 8 patients, group II: 2 deaths [unrelated to surgery], 1 intracerebral hemorrhage, 7 intermittent psychosis, 3 infections, 2 pneumonia in 13 patients), (p<0,05). Interestingly changes in UPDRS score, Hoehn&Yahr scale, L-DOPA medication showed no statistic difference between the two groups.
Conclusions
DBS in the STN is as effective in elderly patients as it is in the younger ones. However, careful selection and follow-up is required because of the higher risk of complications found in the elderly patient population.