Postoperative management of subthalamic nucleus stimulation for Parkinson's disease.
The postoperative neurologic management of patients with deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson' s disease is a complex dynamic process that involves a progressive increase in stimulation intensity and a parallel decrease in antiparkinsonian medication while assessing the interactions of both treatments. Neurologists responsible for postoperative management of patients receiving STN DBS must have expert knowledge of the electroanatomy of the subthalamic area and be familiar with the medical treatment of motor and nonmotor symptoms, including the management of long-term complications of levodopa treatment. Neurosurgeons who perform DBS need to understand the principles that guide the postoperative adaptation of treatment. This article defines guidelines for setting stimulation parameters, adapting drugs and managing adverse effects.
Krack
Paul
P
Department of Clinical and Biological Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France. pkrack@ujf-grenoble.fr
Fraix
Valérie
V
Mendes
Alexandre
A
Benabid
Alim-Louis
AL
Pollak
Pierre
P
D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D002983:Clinical Competence / Q000592:standards; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D007980:Levodopa / Q000009:adverse effects / Q000627:therapeutic use; D010300:Parkinson Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005791:Patient Care / Q000592:standards; D020531:Subthalamic Nucleus / Q000601:surgery*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa