Deep Brain Stimulation
The right candidate for this surgical procedure
Deep Brain Stimulation, a therapeutic option for treatment of Parkinson's disease. This article reviews which candidates are suitable for this surgical procedure
You have been diagnosed with Parkinson’s disease (PD) and are experiencing immobilizing medication-refractory tremors which is affecting your daily quality of life. You have tried anticholinergics, dopamine agonists and all possible combinations thereof but still there is no promising outcome (Siddiqui & Okun, 2007).
What about Deep Brain Stimulation?
Deep brain stimulation (DBS) is a surgical procedure that is used to treat Parkinson’s disease. DBS was primarily introduced in 1987 by Benabid and colleagues to treat tremors in Parkinson patients. It uses techniques that include inserting microelectrodes into various structures of the brain: these microelectrodes help map the target regions of surgery. Once these regions have been identified, the DBS lead can be located and macro stimulation can be carried out to determine benefits and side effects of the lead in relation to its surrounding structures. Finally when the best electrode contact point is found the lead stimulates the motor region of the target.
Currently, DBS is proven to be a very popular method and has now become an important standard of care for particular Parkinson’s patients (Siddiqui & Okun, 2007).
Which particular patients you ask?
Well, that leads to a critical answer: not all Parkinson patients can undergo DBS. There is evidence that patients who are suitable for this type of treatment are those whose symptoms respond to levodopa. The best candidates for DBS are those who have idiopathic PD, who do not show signs of moderate to severe dementia and have had the disease for a minimum of 5 years (Siddiqui & Okun, 2007).
What about age?
Due to a lack of knowledge, up-to-date there is no age constraint for DBS. However, it has sparked debates as to whether DBS is as effective in older patients as it is in younger patients. According to a recent study (Vesper et.al, 2007) the answer is clear that bilateral DBS was effective in both younger individuals and the elderly, although there are numerous reports of general complications linked to older patients: for one, there is a higher risk of bleeding in the elderly. Secondly, there have been several reports of side effects disturbing cognition and mood in the patient.
Moreover, life is expected to decrease as age increases and it is therefore important that elderly patients with Parkinson’s are carefully evaluated before they are considered as candidates for DBS (Siddiqui & Okun, 2007).
Resources
Siddiqui, M.S., Okun, M.S. (2007). Deep Brain Stimulation in Parkinson’s disease. Lifelong Learning in Neurology. 13(1) Movement Disorders: 39-57.
Vesper, J., Haak, S., Ostertag, C., & Nikkhah, G. (2007). Subthalamic nucleus deep brain stimulation in elderly patients – analysis of outcome and complications. BMC Neurology 7:7.
