Survival after Subthalamic Deep Brain Stimulation for Parkinson's Disease: 25-Year Experience from a Single Center

There are limited data on the long-term survival of patients with Parkinson's disease (PD) undergoing subthalamic nucleus deep brain stimulation (STN-DBS).

The aim of the study was to estimate the long-term survival and its predictors in patients who underwent STN-DBS.

The baseline demographic and clinical features of patients who underwent STN-DBS for PD at our center and had at least 5 years of follow-up were analyzed. Survival status, the date of demise, and the cause of death were obtained by telephonic interview with family members.

A total of 186 patients who underwent STN-DBS between 1999 and 2018 (age at surgery: 56.7 ± 9.3 years) and were contactable in 2024 were included; 85 had died by 2024. Progressive worsening of PD, intercurrent infections, and cardiovascular diseases were the leading causes of death. The median survival after surgery was 13.1 years (interquartile range [IQR]: 8.9-17.1). Baseline postural instability and gait dysfunction subtype (hazard ratio [HR]: 2.3; 95% confidence interval [CI]:1.4-3.8, P = 0.001), higher levodopa-equivalent daily dosage (HR: 2.5; 95%CI: 1.4-4.5; P = 0.002), and higher Unified Parkinson's Disease Rating Scale Part I (UPDRS I) score in the ON state (HR: 2.8; 95% CI: 1.8-4.9; P < 0.001) were independent predictors of shorter survival, whereas higher levodopa response was an independent predictor of longer survival (HR: 0.19; 95% CI: 0.07-0.48; P = 0.001).

STN-DBS offers a median survival of around 13 years; predominant axial features, neurocognitive changes, poor levodopa response, and higher medication requirement at baseline portend shorter survival. These findings could influence surgical candidate selection and long-term care strategies in resource-limited settings.