Applying Guidelines to Individual Patients: Deep Brain Stimulation for Early-Stage Parkinson Disease

Esplin, Bryn S.; Machado, André G.; Ford, Paul J.; Beasley, Kara

doi:10.1001/virtualmentor.2015.17.01.ecas2-1501

Cited by 3 publications

(2 citation statements)

References 2 publications

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“…The implementation of this new criterion of early intervention based on the EARLY-STIM criteria requires a complete evaluation of the limitations of this study and has been the subject of extensive ethical discussion [ 56 , 57 ]. Despite a strong design, the inclusion criteria excluded patients older than 60 years, an age group that has a high risk of rapid development of motor complications.…”

Section: Dbs In the Contemporary Eramentioning

confidence: 99%

Earlier Intervention with Deep Brain Stimulation for Parkinson’s Disease

Suarez-Cedeno¹,

Suescun²,

Schiess³

2017

Parkinson's Disease

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Neuromodulation of subcortical areas of the brain as therapy to reduce Parkinsonian motor symptoms was developed in the mid-twentieth century and went through many technical and scientific advances that established specific targets and stimulation parameters. Deep Brain Stimulation (DBS) was approved by the FDA in 2002 as neuromodulation therapy for advanced Parkinson's disease, prompting several randomized controlled trials that confirmed its safety and effectiveness. The implantation of tens of thousands of patients in North America and Europe ignited research into its potential role in early disease stages and the therapeutic benefit of DBS compared to best medical therapy. In 2013 the EARLY-STIM trial provided Class I evidence for the use of DBS earlier in Parkinson's disease. This finding led to the most recent FDA approval in patients with at least 4 years of disease duration and 4 months of motor complications as an adjunct therapy for patients not adequately controlled with medications. This following review highlights the historical development and advances made overtime in DBS implantation, the current application, and the challenges that come with it.

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Section: Dbs In the Contemporary Eramentioning

confidence: 99%

Earlier Intervention with Deep Brain Stimulation for Parkinson’s Disease

Suarez-Cedeno¹,

Suescun²,

Schiess³

2017

Parkinson's Disease

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“…In recent times, however, the inclusion criteria of PD patients for DBS have been vividly debated. [357911131516] Within this context of the current debate on inclusion criteria for DBS for PD, we present a case of a patient who underwent DBS prior to L-dopa treatment.…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation for Parkinson′s disease prior to L-dopa treatment: A case report

Servello¹,

Saleh²,

Bona³

et al. 2016

Surg Neurol Int

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Background:Leva-dopa (L-dopa) is the gold-standard treatment for Parkinson's disease (PD). Deep brain stimulation is generally reserved for patients who become refractory to l-dopa treatment.Case Description:We present a male patient with a 9-year course of PD who at 53 years of age preferred deep brain stimulation (DBS) of the subthalamic nucleus over initial l-dopa treatment. The patient argued that he wanted to avoid the serious adverse effects of l-dopa, which would have presented within his time of full professional activity. DBS resulted in significant motor improvement lasting for 6 years without l-dopa treatment.Conclusion:Large multicentre-based international trials with long follow-ups are needed to answer the effectiveness of early DBS in PD.

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