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Experts Reach Consensus on Deep Brain Stimulation for Parkinsonís
- Oct 26 2010
A consensus on the use of deep brain stimulation (DBS) for Parkinson’s disease (PD), made by 50 international experts in neurology, neurosurgery and other specialties, was published in the October issue of Archives of Neurology.
In 1997, DBS was approved by the US Food and Drug Administration for Parkinson’s. Since then, this procedure has become a standard treatment for people with PD who experience disabling tremors, wearing-off fluctuations and dyskinesias. More than 70,000 people have undergone the surgical implantation of electrodes that stimulate specific brain areas in DBS according to the leading manufacturer.
Yet DBS is a complicated procedure, and many questions have remained. This panel met in New York and made certain recommendations for people with Parkinson’s and their doctors.
The panel concluded that:
- People with PD who are most likely to benefit from DBS are those whose motor symptoms are not well controlled by medication or who cannot tolerate side effects of medication, and who do not have significant active cognitive or psychiatric problems.
- DBS surgery is best performed by an experienced team and neurosurgeon with expertise in surgery deep within the brain that uses three-dimensional imaging to guide the procedure.
- Surgical complication rates vary widely, with infection being the most commonly reported complication of DBS.
- The benefits of DBS for improving symptoms such as dyskinesia and tremor seem to be long-lasting.
- DBS, when used in the two most commonly treated areas of the brain—the subthalamic nuclei or the globus pallidus pars interna—is effective in addressing the motor symptoms of PD, but treatment in the subthalamic nuclei may cause increased depression and other symptoms in some people with Parkinson's.
- Surgical electrical removal of a part of the brain affected by PD is an effective alternative to DBS that should be considered in a select group of appropriate people with Parkinson's.
What Does it Mean?
The new report can help people with PD and their doctors make informed decisions when considering DBS as a therapy. It confirms that people with certain PD symptoms such as tremor and dyskinesias can benefit from DBS. As with any surgery, there are risks, and it can take three to six months of adjustment to tune the implanted apparatus so that it works effectively. In addition, PD continues to progress after DBS. Over time, people may still develop problems not addressed by DBS, such as gait impairment, balance difficulties, and cognitive impairment.
Reference: Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A, Horak FB, Okun MS, Foote KD, Krack P, Pahwa R, Henderson JM, Hariz MI, Bakay RA, Rezai A, Marks WJ Jr, Moro E, Vitek JL, Weaver FM, Gross RE, Delong MR.Deep Brain Stimulation for Parkinson Disease: An Expert Consensus and Review of Key Issues. Arch Neurol. 2010 Oct 11. [Epub ahead of print] (http://www.ncbi.nlm.nih.gov/pubmed/20937936)
Source Date: Oct 26 2010