CLINICAL ARTICLE J Neurosurg 131:807–812, 2019 P arkinson’s disease (PD) is one of the most common age-related neurodegenerative diseases. 18,21 PD is treated both medically and surgically, with medi- cal management attempting to supplement dopaminergic activity, as well as balancing dopaminergic and choliner- gic pathways. Although medical management can provide long-term functional mobility, it is associated with adverse side effects 3 such as “wearing off” symptoms, and dyski- nesia with levodopa therapy. 20,35 The alternative to medi- cal management is deep brain stimulation (DBS), which ABBREVIATIONS DBS = deep brain stimulation; HY = Hoehn and Yahr; LEDD = levodopa-equivalent daily dose; MoCA = Montreal Cognitive Assessment; PD = Parkin- son’s disease; STN = subthalamic nucleus; UPDRS III = Unified Parkinson’s Disease Rating Scale part III. SUBMITTED August 7, 2017. ACCEPTED April 17, 2018. INCLUDE WHEN CITING Published online September 28, 2018; DOI: 10.3171/2018.4.JNS171909. Comparison of elderly and young patient populations treated with deep brain stimulation for Parkinson’s disease: long-term outcomes with up to 7 years of follow-up Joshua A. Hanna, MD, 1,2 Tyler Scullen, MD, 1,2 Lora Kahn, MD, 1,2 Mansour Mathkour, MD, 1,2 Edna E. Gouveia, MD, 1 Juanita Garces, MD, 1,2 Leah M. Evans, MS, 1 Georgia Lea, MD, 3 David J. Houghton, MD, MPH, 3 Erin Biro, MD, 1,2 Cuong J. Bui, MD, 1,2 Olawale A. Sulaiman, MD, PhD, 1,2 and Roger D. Smith, MD 1,2 Departments of 1 Neurosurgery and 3 Movement Disorders, Ochsner Clinic Foundation, New Orleans; and 2 Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana OBJECTIVE Deep brain stimulation (DBS) is the procedure of choice for Parkinson’s disease (PD). It has been used in PD patients younger than 70 years because of better perceived intra- and postoperative outcomes than in patients 70 years or older. However, previous studies with limited follow-up have demonstrated benefts associated with the treat- ment of elderly patients. This study aims to evaluate the long-term outcomes in elderly PD patients treated with DBS in comparison with a younger population. METHODS PD patients treated with DBS at the authors’ institution from 2008 to 2014 were divided into 2 groups: 1) elderly patients, defned as having an age at surgery ≥ 70 years, and 2) young patients, defned as those < 70 years at surgery. Functional and medical treatment outcomes were evaluated using the Unifed Parkinson’s Disease Rating Scale part III (UPDRS III), levodopa-equivalent daily dose (LEDD), number of daily doses, and number of anti-PD medications. Study outcomes were compared using univariate analyses, 1-sample paired t-tests, and 2-sample t-tests. RESULTS A total of 151 patients were studied, of whom 24.5% were ≥ 70 years. The most common preoperative Hoehn and Yahr stages for both groups were 2 and 3. On average, elderly patients had more comorbidities at the time of surgery than their younger counterparts (1 vs 0, p = 0.0001) as well as a higher average LEDD (891 mg vs 665 mg, p = 0.008). Both groups experienced signifcant decreases in LEDD following surgery (elderly 331.38 mg, p = 0.0001; and young 108.6 mg, p = 0.0439), with a more signifcant decrease seen in elderly patients (young 108.6 mg vs elderly 331.38 mg, p = 0.0153). Elderly patients also experienced more signifcant reductions in daily doses (young 0.65 vs el- derly 3.567, p = 0.0344). Both groups experienced signifcant improvements in motor function determined by reductions in UPDRS III scores (elderly 16.29 vs young 12.85, p < 0.0001); however, reductions in motor score between groups were not signifcant. Improvement in motor function was present for a mean follow-up of 3.383 years postsurgery for the young group and 3.51 years for the elderly group. The average follow-up was 40.6 months in the young group and 42.2 months in the elderly group. CONCLUSIONS This study found long-term improvements in motor function and medication requirements in both elder- ly and young PD patients treated with DBS. These outcomes suggest that DBS can be successfully used in PD patients ≥ 70 years. Further studies will expand on these fndings. https://thejns.org/doi/abs/10.3171/2018.4.JNS171909 KEYWORDS deep brain stimulation; Parkinson’s disease; outcome measures; functional neurosurgery J Neurosurg Volume 131 • September 2019 807 ©AANS 2019, except where prohibited by US copyright law Unauthenticated | Downloaded 05/18/22 04:30 PM UTC