title: The impact of age and disease duration on the long term outcome of neurostimulation of the subthalamic nucleus.
abstract: BACKGROUND
  Selection of patients with Parkinson's disease for neurostimulation of subthalamic nucleus (STN-DBS) is still poorly studied.
  
  
  OBJECTIVE
  To identify the impact of age and disease duration on the outcome of bilateral STN-DBS.
  
  
  METHODS
  110 operated patients in a single center covering a large range of age and disease duration were retrospectively included and followed for up-to 5 years. Standardized UPDRS assessments were obtained at 0.5-1 and 3-5 years. Patients were stratified into three age groups (≤ 55, 56-64 and ≥ 65 years) and the middle age group was further stratified into 2 disease duration subgroups (<15 years, ≥ 15 years).
  
  
  RESULTS
  The age groups had comparable baseline data except for the predefined differences. Compared to baseline early and late intra-group "Med Off-Stim On" motor scores were significantly improved for all groups (p < 0.001). Mood/cognition were significantly improved in younger two groups (p = 0.008, 0.019) at 0.5-1 year. Inter-group comparisons showed significantly worse early and late axial scores for older patients (p < 0.05). All groups had comparable postoperative improvement except for the older group which had significantly less improvement of early UPDRS-II, late UPDRS-I, and early and late PIGD/axial scores. Different disease durations had no effect on the outcome except for worse Schwab and England Off-score in longer duration group (p = 0.02). Side effects of surgery and long-term management were similar.
  
  
  CONCLUSIONS
  STN-DBS is an efficient treatment of advanced PD for all treated age-groups. Provided strict inclusion criteria are respected, older age and longer disease duration are associated with slightly worse effects mainly on L-dopa-resistant symptoms.
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Schittenhelmstr. 10, 24105 Kiel, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Shalash
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Schittenhelmstr. 10, 24105 Kiel, Germany.
authors.forename: Athanasia
authors.initials: A
authors.lastname: Alexoudi
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Schittenhelmstr. 10, 24105 Kiel, Germany.
authors.forename: Karina
authors.initials: K
authors.lastname: Knudsen
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Schittenhelmstr. 10, 24105 Kiel, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.affiliation: Department of Neurosurgery, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Mehdorn
authors.affiliation: Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel Campus, Christian-Albrechts University Kiel, Schittenhelmstr. 10, 24105 Kiel, Germany. Electronic address: g.deuschl@neurologie.uni-kiel.de.
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
keywords: Age; Duration; Neurostimulation; Parkinson's disease; Subthalamic nucleus