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Title: Deep Brain Stimulation For Parkinson's Disease-Patient Selection
e-poster Number: INSIM119
Category: Neurosurgery
Author Name: Hidehiro Hirabayashi
Institute: National Hospital Organization Nara Meical Center
Co-Author Name:
Abstract :
Patients with OFF symptoms for 2 hours or longer and troublesome dyskinesia for 1 hour or longer under oral administration of levodopa 5 or more times a day should be considered to undergo deep brain stimulation (DBS).
The ideal DBS candidate is a patient with established PD, whose main disability is attributable to off-time motor symptoms like tremor, rigidity and bradykinesia which are present for considerable periods of time during awake hours accompanied by troublesome dyskinesias during the medication-ON time. Moreover, the patient who is severe intolerance or contraindication to the use of dopaminergic medications in sufficient dose is also candidate. The patients who are severely disabled in the ON time, those with cognitive impairment, advanced age, levodopa unresponsive gait and axial symptoms, significant autonomic dysfunction and poor social support are relative contraindications. Pre-operative levodopa responsiveness is the strongest predictor of good outcomes following DBS. Tremor is an exception even if levodopa unresponsive.
The STN and GPi are the nuclei that are commonly targeted for DBS in PD.
STN-DBS is more effective in improving motor fluctuation than GPi-DBS and reduce the medication dose, however, have a large impact on cognitive function. While GPi-DBS is excellent in improving dyskinesias and has little effect on cognitive function although the medication dose is not reduced, so there is a tendency to choose GPi-DBS for the elderly patients in Japan. However long-term prospective follow-up studies are available for both STN and GPi DBS.
