A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

Moro, Elena; Allert, Niels; Eleopra, Roberto; Houeto, Jean‐Luc; Phan, Tra-Mi; Stoevelaar, Herman

doi:10.1007/s00415-009-0069-1

Cited by 46 publications

(47 citation statements)

References 21 publications

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“…Some authors suggest that exhausting all pharmacological options before considering DBS can delay the surgery to a time when the patient is no longer fit because of disease progression [58,127,128]. …”

Section: Timing Of the Surgerymentioning

confidence: 99%

Deep brain stimulation in Parkinson’s disease

Mehanna

Lai

2013

Transl Neurodegener

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For the last 50 years, levodopa has been the cornerstone of Parkinson’s disease management. However, a majority of patients develop motor complications a few years after therapy onset. Deep brain stimulation has been approved by the FDA as an adjunctive treatment in Parkinson disease, especially aimed at controlling these complications. However, the exact mechanism of action of deep brain stimulation, the best nucleus to target as well as the best timing for surgery are still debatable. We here provide an in-depth and critical review of the current literature on this topic.

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Section: Timing Of the Surgerymentioning

confidence: 99%

Deep brain stimulation in Parkinson’s disease

Mehanna

Lai

2013

Transl Neurodegener

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“…Age was probably the major contributor and risk factor for the intracranial bleeding, postoperative confusion, and later dementia development [26, 40, 41]. …”

Section: Discussionmentioning

confidence: 99%

Dementia after DBS Surgery: A Case Report and Literature Review

Rektorová

Hummelová

Baláž

2011

Parkinson's Disease

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We report the case history of a 75-year-old woman with Parkinson's disease who developed severe cognitive problems after deep brain stimulation (DBS) of the bilateral subthalamic nuclei (STN). After a brief cognitive improvement, the patient gradually deteriorated until she developed full-blown dementia. We discuss the case with respect to the cognitive effects of STN DBS and the possible risk factors of dementia after STN DBS surgery.

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“…The study found a significant correlation between the FLASQ-PD scores recorded and the ultimate decision of the DBS interdisciplinary team [41]. In another study, Moro et al [42] used the RAND method to evaluate surgical candidacy. In their study, the authors examined 972 patient profiles, and observed that the appropriateness for surgical referral was correct in 33 % of the patients.…”

Section: Florida Surgical Questionnaire-pd and Rand Methods For Screementioning

confidence: 98%

Surgical Treatment of Parkinson's Disease: Patients, Targets, Devices, and Approaches

Shukla

Okun

2014

Neurotherapeutics

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Surgical treatment for Parkinson's disease (PD) has evolved from ablative procedures, within a variety of brain regions, to implantation of electrodes into specific targets of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred to ablative procedures by many experts owing to its reversibility, programmability, and the ability to be safely performed bilaterally. Several randomized clinical studies have demonstrated the effectiveness of DBS surgery for control of PD symptoms. Many brain targets, including the subthalamic nucleus and the globus pallidus internus, have emerged as potentially effective, with each target being closely associated with important pros and cons. Selection of appropriate PD candidates through a methodical interdisciplinary screening is considered a prerequisite for a successful surgical outcome. Despite recent growth in DBS knowledge, there is currently no consensus on the ideal surgical technique, the best surgical approach, and the most appropriate surgical target. DBS is now targeted towards treating specific PD-related symptoms in a given individual, and not simply addressing the disease with one pre-defined approach. In this review we will discuss the historical aspects of surgical treatments, the selection of an appropriate DBS candidate, the current surgical techniques, and recently introduced DBS-related technologies. We will address important pre-and postoperative issues related to DBS. We will also discuss the lessons learned from the randomized clinical studies for DBS and the shifting paradigm to tailor to a more patient-centered and symptom-specific approach.

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A decision tool to support appropriate referral for deep brain stimulation in Parkinson’s disease

Abstract: The RAND/UCLA method proved to be useful in determining the appropriate criteria for DBS referral. Validity and applicability of the decision tool (accessible via http://test.stimulus-dbs.org) in clinical practice need to be further determined.

Cited by 46 publications

References 21 publications

Deep brain stimulation in Parkinson’s disease

Deep brain stimulation in Parkinson’s disease

Dementia after DBS Surgery: A Case Report and Literature Review

Surgical Treatment of Parkinson's Disease: Patients, Targets, Devices, and Approaches

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