title: Subthalamic nucleus deep brain stimulation in elderly patients--analysis of outcome and complications.
abstract: BACKGROUND
  There is an ongoing discussion about age limits for deep brain stimulation (DBS). Current indications for DBS are tremor-dominant disorders, Parkinson's disease, and dystonia. Electrode implantation for DBS with analgesia and sedation makes surgery more comfortable, especially for elderly patients. However, the value of DBS in terms of benefit-risk ratio in this patient population is still uncertain.
  
  
  METHODS
  Bilateral electrode implantation into the subthalamic nucleus (STN) was performed in a total of 73 patients suffering from Parkinson's disease. Patients were analyzed retrospectively. For this study they were divided into two age groups: group I (age <65 years, n = 37) and group II (age > or = 65 years, n = 36). Examinations were performed preoperatively and at 6-month follow-up intervals for 24 months postoperatively. Age, UPDRS motor score (part III) on/off, Hoehn & Yahr score, Activity of Daily Living (ADL), L-dopa medication, and complications were determined.
  
  
  RESULTS
  Significant differences were found in overall performance determined as ADL scores (group I: 48/71 points, group II: 41/62 points [preoperatively/6-month postoperatively]) and in the rate of complications (group I: 4 transient psychosis, 4 infections in a total of 8 patients, group II: 2 deaths [unrelated to surgery], 1 intracerebral hemorrhage, 7 transient psychosis, 3 infections, 2 pneumonia in a total of 13 patients), (p < 0.05). Interestingly, changes in UPDRS scores, Hoehn & Yahr scores, and L-dopa medication were not statistically different between the two groups.
  
  
  CONCLUSIONS
  DBS of the STN is clinically as effective in elderly patients as it is in younger ones. However, a more careful selection and follow-up of the elderly patients are required because elderly patients have a higher risk of surgery-related complications and a higher morbidity rate.
authors: Department of Stereotactic Neurosurgery, Neurocenter, University of Freiburg, Germany. jan.vesper@uniklinik-freiburg.de
authors: Jan
authors: J
authors: Vesper
authors: Susanne
authors: S
authors: Haak
authors: Christoph
authors: C
authors: Ostertag
authors: Guido
authors: G
authors: Nikkhah
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000175:diagnosis* / Q000628:therapy*; D016459:Prosthesis-Related Infections / Q000209:etiology*; D020531:Subthalamic Nucleus; D016896:Treatment Outcome