Reviewing DBS for Parkinson’s Disease

In 2002, the FDA approved the use of deep brain stimulation (DBS) for patients with Parkinsons disease. Although it isn’t a cure, DBS has been shown to help manage symptoms of the disease. A workshop of experts was recently convened to create a consensus review of key issues involving DBS surgery. Published in the February 2011 Archives of Neurology, the review is designed to assist patients and physicians who are considering DBS based on clinical research and expert opinion. Patient Selection One of the most important steps toward achieving consistently good outcomes with DBS is careful patient selection. Studies have suggested that more than 30% of failed DBS procedures can be attributed to inappropriate indications for surgery. Patient selection should be based on an individual risk-benefit evaluation for each patient. Good candidates for DBS include patients with Parkinson’s who do not have significant cognitive or psychiatric problems and medically intractable motor fluctuations, intractable tremor, or intolerance of medication adverse effects. DBS has yielded the best results in patients with advanced Parkinson’s and excellent levodopa response, younger age, no or few axial non–levodopa-responsive motor symptoms, no or very mild cognitive impairment, and absence of or well-controlled psychiatric disease. Experience & Teamwork Matter The surgical techniques for implanting DBS devices are continuing to evolve, but few studies directly compare the safety or effectiveness of these methods; the best techniques for DBS require more research. However, the workgroup did reach a consensus on the importance of having Parkinson’s patients receive care in expert centers that deliver DBS. A multidisciplinary team is essential; it should involve a movement disorder neurologist, a neurosurgeon, a neuropsychologist,...