Effects of deep brain stimulation in relatively young-onset multiple system atrophy Parkinsonism

Objective: The aim of this study was to analyze outcomes after 1 year of bilateral STN deep brain stimulation (DBS) in relatively young-onset patients with multiple system atrophy-Parkinsonism (MSA-P). Background: The efficacy of DBS has been demonstrated in idiopathic Parkinson's disease. However, the experience with DBS in relatively young-onset MSA-P is limited and controversial. Methods: Information about the demographic and clinical data from five MSA patients treated with STN DBS was entered into a database and analyzed. Results: Five patients with relatively young-onset MSA (mean age at onset 42.2 ± 2.2 years, 3 women, 2 men) have been treated with bilateral STN stimulators, the mean duration between DBS surgery and disease onset was 7.0 ± 3.5 years. All of the patients had dyskinesia and postural instability, and subjective benefit from levodopa. During the 6 months after surgery, the clinical status of three patients improved with a decrease of dyskinesia. However, by 1 year, the symptoms reappeared and progressed in all patients. Overall, the mean "off" medication UPDRS-III score worsened 23.5 ± 15.3 1 year after surgery and the levodopa dosage was not reduced. Conclusions: This data does not support the use of STN DBS for relatively young-onset MSA-P.