Risk-Benefit Considerations in Deep Brain Stimulation Discontinuation for Late-Stage Parkinson's Disease

Background: Management of deep brain stimulation (DBS) in late-stage Parkinson's disease (LSPD) remains challenging, particularly when deciding whether to continue or discontinue stimulation, and evidence on risk–benefit considerations is limited. Objectives: To identify key factors to improve decision-making in DBS management for LSPD patients. Methods: We retrospectively analyzed demographic, clinical and stimulation parameters in LSPD patients (Hoehn and Yahr ≥4; Schwab and England ≤50) who either maintained best medical therapy (BMT) or required unscheduled device-aided therapy (DAT) implantation up to 1 year after DBS discontinuation. Results: From 2005 to 2022, 94 patients with bilateral subthalamic nucleus DBS were reviewed and among the 31 patients who have transitioned to LSPD, 15 patients remained on BMT, while 10 required rescue DAT (6 unscheduled implantable pulse generator replacements and 4 Levodopa-Carbidopa Intestinal Gel) within 3 months after discontinuation. Significant differences were observed in years of DBS (12.4 vs. 8.5), modified Falls Efficacy Scale (12.5 vs. 21.2), and months since the last parameter adjustment (30.3 vs. 23.2), with a trend toward less ΔMDS-UPDRS III worsening after stimulation was switched off (7.6 vs. 10.9). Longer DBS duration was inversely associated with rescue DAT (OR 0.529; 95% CI, 0.284–0.986), with a cutoff of 10.5 years. Conclusion: In selected LSPD patients, a transition from DBS to BMT alone can be attempted with long-term stability, whereas in others a more conservative approach is advisable, and stimulation should be continued. Clinical, therapeutic, and care-related factors should guide decisions when discontinuation is being considered.