Deep brain stimulation of the subthalamic nucleus in PD: an analysis of the exclusion causes.
OBJECTIVE
Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN) represents a proper choice for the treatment of advanced Parkinson's disease (PD). A correct selection of the patients as candidates for the surgery is essential for a good outcome. In this study, we analyzed the exclusion causes of a series of PD patients hospitalized for the selection protocol.


METHODS
Ninety-eight PD patients as potential candidates for the STN DBS were studied. All patients were hospitalized and underwent a clinical evaluation of the PD stage, a levodopa challenge, a MR of the brain and a neuropsychological assessment.


RESULTS
The percentage of subjects considered not suitable for the surgery was 29.6%. A single cause of exclusion was present in 65.5% of not suitable patients, while multiple causes were present in 34.5%. The most frequent cause of exclusion was the finding of neuropsychological or psychic disorders (48.3%); in 37.9% of the patients, the motor disability was not severe enough to justify the surgery, while in 31%, we found relevant abnormalities at the brain MR. Three patients (10.3%) were poorly motivated for the surgery, while in three others (10.3%), we found a significant illness other than PD.


CONCLUSIONS
The finding that about 30% of the PD patients potentially suitable for STN DBS presents some exclusion causes underlines the importance of a careful selection of the candidates for this surgery.
Lopiano
Leonardo
L
Department of Neuroscience, University of Turin, Via Cherasco 15, 10126, Turin, Italy. leonardo.lopiano@libero.it
Rizzone
Mario
M
Bergamasco
Bruno
B
Tavella
Alessia
A
Torre
Elena
E
Perozzo
Paola
P
Lanotte
Michele
M
D000367:Age Factors; D000368:Aged; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002986:Clinical Trials as Topic / Q000592:standards* / Q000706:statistics & numerical data; D004599:Electric Stimulation Therapy / Q000592:standards* / Q000706:statistics & numerical data; D004827:Epilepsy / Q000453:epidemiology; D005260:Female; D006402:Hematologic Diseases / Q000453:epidemiology; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009042:Motivation; D019635:Neurosurgical Procedures / Q000592:standards* / Q000706:statistics & numerical data; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D020531:Subthalamic Nucleus / Q000503:physiopathology / Q000601:surgery*
D007980:Levodopa