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

Background There are limited data on the long‐term survival of patients with Parkinson's disease (PD) undergoing subthalamic nucleus deep brain stimulation (STN‐DBS). Objectives The aim of the study was to estimate the long‐term survival and its predictors in patients who underwent STN‐DBS. Methods 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. Results 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). Conclusions 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.