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Should We Consider Deep Brain Stimulation Discontinuation in Late‐Stage Parkinson's Disease?
Author(s) -
Fabbri Margherita,
Zibetti Maurizio,
Rizzone Mario Giorgio,
Giannini Giulia,
Borellini Linda,
Stefani Alessandro,
Bove Francesco,
Bruno Andrea,
CalandraBuonaura Giovanna,
Modugno Nicola,
Piano Carla,
Peppe Antonella,
Ardolino Gianluca,
Romagnolo Alberto,
Artusi Carlo Alberto,
Berchialla Paola,
Montanaro Elisa,
Cortelli Pietro,
Luigi Romito,
Eleopra Roberto,
Minafra Brigida,
Pacchetti Claudio,
Tufo Tommaso,
Cogiamanian Filippo,
Lopiano Leonardo
Publication year - 2020
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.28091
Subject(s) - deep brain stimulation , stimulation , discontinuation , medicine , parkinson's disease , adverse effect , parkinsonism , subthalamic nucleus , psychology , anesthesia , disease
Background Subthalamic deep brain stimulation (STN‐DBS) effects may decrease with Parkinson's disease (PD) progression. There is no indication if, when, and how to consider the interruption of DBS treatment in late‐stage PD. The objective of the current study was to investigate the percentage of “poor stimulation responders” among late‐stage PD patients for elaborating an algorithm to decide whether and when DBS discontinuation may be considered. Methods Late‐stage PD patients (Hoehn Yahr stage ≥4 and Schwab and England Scale <50 in medication on/stimulation on condition) treated with STN‐DBS for at least 5 years underwent a crossover, double‐blind, randomized evaluation of acute effects of stimulation. Physicians, caregivers, and patients were blinded to stimulation conditions. Poor stimulation responders (MDS‐UPDRS part III change <10% between stimulation on/medication off and stimulation off/medication off) maintained the stimulation off/medication on condition for 1 month for open‐label assessment. Results Thirty‐six patients were included. The acute effect of stimulation was significant (17% MDS‐UPDRS part III), with 80% of patients classified as “good responders.” Seven patients were classified as “poor stimulation responders,” and the stimulation was switched off, but in 4 cases the stimulation was switched back “on” because of worsening of parkinsonism and dysphagia with a variable time delay (up to 10 days). No serious adverse effects occurred. Conclusions The vast majority of late‐stage PD patients (92%) show a meaningful response to STN‐DBS. Effects of stimulation may take days to disappear after its discontinuation. We present a safe and effective decisional algorithm that could guide physicians and caregivers in making challenging therapeutic decisions in late‐stage PD. © 2020 International Parkinson and Movement Disorder Society