Retrospective Multicenter Analysis of Withdrawal Syndrome in Parkinson’s Disease Patients After Cessation of Deep Brain Stimulation

TL;DR

This study examines how Parkinson’s disease patients react when deep brain stimulation is stopped, finding that withdrawal symptoms are rare and usually not severe.

Contribution

The study provides empirical evidence that DBS withdrawal syndrome is uncommon and not reliably predicted by standard clinical factors.

Findings

DBS battery shutdown occurred in 13.3% of patients but did not reliably predict withdrawal syndrome.

Severe DBS withdrawal syndrome requiring intensive care was observed in only 1.4% of patients.

Preoperative medication dose was not associated with withdrawal risk.

Abstract

Background: Abrupt cessation of deep brain stimulation (DBS) in Parkinson’s disease (PD), most commonly due to implantable pulse generator (IPG) battery depletion, may lead to DBS withdrawal syndrome (DBS-WDS). However, withdrawal syndrome does not occur in all patients following stimulation cessation. Methods: We retrospectively analyzed 210 PD patients treated with DBS. Patients with documented stimulation cessation were evaluated for the presence of withdrawal syndrome based on established clinical criteria. Demographic, disease-related, and treatment characteristics were assessed, and descriptive analysis was conducted on severe cases requiring intensive care. Results: DBS battery shutdown occurred in 28 patients (13.3%). Most patients did not develop withdrawal syndrome and experienced only transient motor worsening. Severe DBS-WDS requiring intensive care was rare, occurring in only three patients (1.4%). Battery shutdown alone did not predict withdrawal, nor was preoperative levodopa equivalent daily dose associated with withdrawal risk. Conclusions: DBS battery shutdown is usually not accompanied by withdrawal syndrome, and severe DBS-WDS is uncommon. Proactive battery management may help to prevent this rare but serious complication.