To assess outcomes of deep brain stimulator (DBS) implantable pulse generator (IPG) replacement surgery for patients with Parkinson’s disease (PD) who have undergone DBS IPG replacement in proximity to end of life.

Often, as Parkinson's disease advances, so does the burden of DBS-resistant nonmotor, gait, and neuropsychiatric symptoms, as well as other medical comorbidities. This may worsen the risk-benefit ratio of DBS IPG replacement. To properly counsel patients and families, we need to understand the impact of DBS IPG replacement as PD patients approach end of life.

We conducted a retrospective chart review of 334 IPG placements across 173 PD patients at Massachusetts General Hospital. We recorded DBS and IPG history, medical history, and cause of death (if applicable). We documented IPG replacement surgery-related complications including hardware problems, infection, delirium, and others.

10% of IPG replacements had at least one documented complication, most commonly delirium (3.3%), general medical (4.5%), surgical site infections (2.0%), and hardware-related complications (1.6%). 14.3% of patients experienced new stimulation-related side effects after replacement. Overall complication rates trended higher near end of life and with increased age, Parkinson’s disease duration, and severity. For IPG replacements performed within one year of death, 23% were associated with at least one documented complication. Of 52 deceased patients who had at least one IPG replacement before death, the vast majority (86%) chose to undergo IPG replacement, suggesting that they perceived ongoing benefit from DBS therapy.

Most patients treated with DBS for Parkinson's disease will continue to undergo IPG replacements to maintain active therapy through end of life. Although serious complications after IPG replacement are infrequent, the risk-benefit ratio of IPG replacement does change over the course of a patient’s life as medical comorbidities manifest and non-DBS-responsive symptoms increasingly impact quality of life. This highlights the importance of individualized patient counseling.