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[Parkinson's disease: deep brain stimulation]

P. Krack1

  • 1Département des Neurosciences Cliniques et Biologiques, Centre Hospitalier Universitaire, 38043 Grenoble Cedex 09, France et INSERM U 318, Université Joseph-Fourier, Grenoble, France.

Revue Neurologique
|April 12, 2003
PubMed
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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly effective for Parkinson's disease (PD) motor symptoms and dyskinesias, allowing significant medication reduction. Patient selection is key for successful STN DBS outcomes.

Area of Science:

  • Neurosurgery
  • Neurology
  • Movement Disorders

Background:

  • Deep brain stimulation (DBS) is a therapeutic option for Parkinson's disease (PD).
  • Subthalamic nucleus (STN) and internal pallidum (GPi) are common targets for DBS in PD.
  • Comparing STN DBS with GPi DBS and ventral intermediate nucleus (Vim) DBS is crucial for optimizing treatment.

Purpose of the Study:

  • To compare the efficacy of STN DBS versus GPi DBS for Parkinson's disease.
  • To evaluate the impact of STN DBS on motor symptoms and levodopa-induced dyskinesias.
  • To establish guidelines for patient selection for STN DBS.

Main Methods:

  • Bilateral STN DBS was performed in PD patients.
  • Effects on parkinsonian triad (tremor, rigidity, akinesia) and dyskinesias were assessed.

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  • Patient selection criteria included age, absence of dementia, and severity of motor fluctuations or dyskinesias.

    • Main Results:

    • STN DBS and GPi DBS showed similar effects on the parkinsonian triad and dyskinesias.
    • STN DBS demonstrated a slightly superior anti-akinesia effect and allowed for >50% reduction in dopaminergic medication.
    • STN DBS was as effective for tremor as Vim stimulation but also improved akinesia and dyskinesias, unlike Vim DBS.

    Conclusions:

    • STN DBS is a cost-effective and highly effective target for PD treatment, offering significant motor symptom improvement and medication reduction.
    • Preoperative levodopa response correlates well with postoperative outcomes, guiding patient selection.
    • Careful patient selection, surgical precision, and postoperative follow-up are critical for successful STN DBS outcomes in Parkinson's disease.