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Postoperative management of deep brain stimulation in Parkinson's disease.
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Handb Clin Neurol 2013 ; 116:129-46
Authors: Anna Castrioto, Jens Volkmann, Paul Krack
Movement Disorder Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Joseph Fourier University, and INSERM, Unit 836, Grenoble Institut des Neurosciences, Grenoble, France.
Deep brain stimulation has become an established treatment for advanced Parkinson's disease. Its postoperative management is a delicate phase, dedicated to finding the optimal balance between stimulation and dopaminergic treatment. Postoperative management can be divided into an acute phase, aimed at the selection of the best stimulation contact, and a stabilization phase, aimed at the progressive adjustment of stimulation parameters and medications. A good knowledge of the electrophysiological anatomy of the target and surrounding structures, of the potential consequences of dopaminergic treatment modifications, and of the time course and interactions between stimulation and medication effects is mandatory for optimal outcome. This chapter focuses on the main strategies for the acute and chronic management of stimulation parameters and medication in the three main nuclei targeted in Parkinson's disease, namely the subthalamic nucleus, the ventral intermediate thalamic nucleus, and the internal part of the globus pallidus.
PMID: 24112890 [PubMed - as supplied by publisher]