title: Treatment results: Parkinson's disease.
abstract: Deep brain stimulation (DBS) is a neurosurgical treatment of Parkinson's disease that is applied to three targets: the ventral intermediate nucleus of the thalamus (Vim), the globus pallidus internas (GPi) and the subthalamic nucleus (STN). Vim DBS mainly improves contralateral tremor and, therefore, is being supplanted by DBS of the two other targets, even in patients with tremor dominant disease. STN and GPi DBS improve off-motor phases and dyskinesias. There is little comparative data between these procedures. The magnitude of the motor improvement seems more constant with STN than GPi DBS. STN DBS allows a decrease in antiparkinsonian drug doses and consumes moderate current. These advantages of STN over GPi DBS are offset by the need for more intensive postoperative management. The DBS procedure has the unique advantage of reversibility and adjustability over time. Patients with young-onset Parkinson's disease suffering from levodopa-induced motor complications but still responding well to levodopa and who exhibit no behavioral, mood, or cognitive impairment benefit the most from STN DBS. Adverse effects more specific of the DBS procedure are infection, cutaneous erosion, and lead breaking or disconnection. Intracranial electrode implantation can induce a hematoma or contusion. Most authors agree that the benefit to risk ratio of DBS is favorable.
authors.affiliation: Department of Clinical and Biological Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, France. pierre.pollak@ujf-grenoble.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Pollak
authors.forename: Valérie
authors.initials: V
authors.lastname: Fraix
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mendes
authors.forename: Stephan
authors.initials: S
authors.lastname: Chabardes
authors.forename: Adnan
authors.initials: A
authors.lastname: Koudsie
authors.forename: Alim-Louis
authors.initials: AL
authors.lastname: Benabid
mesh_terms: D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D005917:Globus Pallidus / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D018579:Patient Selection; D018570:Risk Assessment; D020531:Subthalamic Nucleus / Q000503:physiopathology / Q000601:surgery; D013788:Thalamus / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome