[Pallidal and subthalamic stimulation in Parkinson's disease: lessons from the unsatisfactory results].
BACKGROUND
Deep brain stimulation is being widely used in advanced Parkinson's disease (PD). Outcome determinants are not known.


OBJECTIVE
Some relevant data about outcome may be obtained from the study of patients with unsatisfactory results.


METHODS
We have retrospectively analyzed the number and causes of unsatisfactory results (insufficient improvement 6 months after the intervention) in 211 patients.


RESULTS
Forty patients (18.9%) experienced an unsatisfactory result. Inadequate clinical selection by advanced age, abnormal MRI and levodopa unresponsive symptoms was the main cause in 28 cases. In 11 patients a misplacement of the electrode was reported. In 2 cases no cause was identified. Thirty-four out of the 40 patients corresponded to the early experience of the teams involved in the study.


CONCLUSIONS
We conclude that the main factors responsible for a negative outcome are related to the inadequate clinical selection of the patients and the incorrect placement of the electrode. The experience of the team may also be a key factor.
D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D002983:Clinical Competence; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008839:Microelectrodes; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D010348:Patient Care Team; D018579:Patient Selection; D012189:Retrospective Studies; D020530:Subthalamus / Q000503:physiopathology*; D017211:Treatment Failure
D000978:Antiparkinson Agents; D007980:Levodopa