DEEP BRAIN STIMULATION FOR PARKINSON'S DISEASE
DOI:
https://doi.org/10.5457/ams.v37i1.56Keywords:
Parkinson’s disease, deep brain stimulationAbstract
Introduction: Surgeons first became interested in Parkinson's disease in the early part of the 20th century when surgical attempts were made to control the tremor of Parkinson's disease. The "Golden Age†of surgery for Parkinson's disease was in the 1950's and 1960's when stereotactic frames were available and very precise lesions within the basal ganglia could be accomplished with relative safety. Surgeons in Europe, North America and Asia all developed the field of "Functional and Stereotaxic Neurosurgeryâ€. Patients with tremor, which does not respond to medical management, who are medically stable, are candidates for thalamic deep brain stimulation. The tremor must be disabling and interfere with activities of daily living such as eating, dressing and writing. Material and methods: The pre-operative evaluation of all Parkinsonian patients prior to bilateral subthalamic nucleus (STN) surgery includes neuropsychological testing to rule out dementia and extensive medical workup to be certain that the patients have adequate cardiorespiratory reserves to undergo the stressful period of the multiple surgical procedures. Our protocol, besides the above-mentioned testing, does include pre-operative videotaping of each patient in both the on and the off phase of their medication. We have chosen to use both MRI and CT scans for image guidance for our stereotactic procedures. Results and Discussion: Despite this being a very rigorous surgical endeavor for the patients, the benefit has been quite worth the effort. In our series, 2/3 of the patients would report a very significant benefit while 1/3 have had minor benefit from the deep brain stimulation system for Parkinson's. Overall, we have seen a reduction in the need for Parkinsonian medications and a dramatic decrease in the incidence of dyskinesias in the patients who had them pre-operatively. After this initial programming period of 4-6 weeks, most patients reach a relative plateau with a lower dose of medicine and improved level of function. Gait has improved in almost all of the patients. There are two basic types of complications; those associated with surgery and those associated with stimulation itself. The surgical complication rate in our hands mirrors that of the existing literature. Conclusion: Deep brain stimulation is technically challenging but offers a significant potential to improve the quality of life for patients with Parkinson's disease or disabling tremor.
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