Long-term infective complications of deep brain stimulation in Parkinson’s disease: A 22-year follow-up

Introduction: Deep brain stimulation (DBS) is an established treatment for Parkinson’s disease (PD), but infections remain a significant concern. This study evaluated infection rates and their impact in PD patients who underwent subthalamic nucleus (STN)-DBS over a 23-year period. Methods: A total of 172 PD patients who underwent bilateral STN-DBS between 2000 and 2023 were included in this retrospective study. Patients were followed up for periods ranging from 5 to 22 years, with regular assessments conducted to monitor both clinical outcomes and the occurrence of infections. The study analyzed the timing of infections onset, clinical features, microbiological data, management and outcomes. Results: The overall infection rate was 8.7 % over the follow-up period (15/172). Most of the infections (63.6 %) involved the implantable pulse generator (IPG) subcutaneous pocket, developed after a median of 22 months and were related to the number of substitutions with a notable peak in incidence after the third replacement (3.3 ± 1.5). All the infected devices were non-rechargeable and Staphylococcus epidermidis was the isolated pathogen in all cases except by one. Surgical revision of the IPG pocket was necessary in 46.2 % of cases while all the others were treated by antibiotics. Factors that significantly correlated with infections were the years elapsed since DBS implantation, BMI decrease, and the number of IPG replacements. Conclusions: While STN-DBS remains effective for PD, infection risk rises with time, particularly during IPG replacements. Long-term follow-up and timely management are vital for sustaining therapeutic benefits.