title: Surviving 10 years with deep brain stimulation for Parkinson's disease--a follow-up of 79 patients.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) for severe Parkinson's disease (PD) outperforms the best medical treatment in controlling motor symptoms and improving quality of life. Nevertheless disease progression cannot be controlled, and the development of dementia over time is nearly inevitable, often resulting in nursing home placement. Ten-year survival, development of hallucinations, dementia and nursing home placement were examined and adverse events were assessed.
  
  
  METHODS
  Patient files were scrutinized from baseline up to 10 years of treatment or death on all 79 PD patients treated with DBS of the subthalamic nucleus from 1998 to 2003 at Aarhus University Hospital.
  
  
  RESULTS
  Twenty-four patients died during the follow-up period of 10 years. Age above 60 years at surgery increased mortality 2.3-fold (P = 0.04). Of the 55 surviving patients 29 (53%) were demented and 19 (35%) were in nursing homes. Average time from operation to dementia was 5.6 ± 2.9 years. Hallucinations and nursing home placement were associated with increased mortality.
  
  
  CONCLUSIONS
  Survival of 70% after a mean of 25 years of PD including 10 years with DBS illustrates that this is a selected group of PD patients. The prevalence of dementia steadily increased after surgery as expected from disease progression and can be an early event. Compared with the few similar long-term studies, the present study presents a larger cohort followed at the same DBS center for a longer period of time and none was lost to follow-up, making conclusions more valid. The present findings are of significant prognostic help for the patient, caregiver and physician when treatment with DBS has to be decided.
authors.affiliation: Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Bang Henriksen
authors.affiliation: Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark.
authors.forename: E L
authors.initials: EL
authors.lastname: Johnsen
authors.affiliation: Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Sunde
authors.affiliation: Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Vase
authors.affiliation: Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark.
authors.forename: M C
authors.initials: MC
authors.lastname: Gjelstrup
authors.affiliation: Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Østergaard
mesh_terms: D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D003704:Dementia / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000628:therapy*; D020531:Subthalamic Nucleus
keywords: Parkinson's disease; deep brain stimulation; disease evolution; long-term follow-up; subthalamic nucleus