title: Deep brain stimulation: preoperative issues.
abstract: Numerous factors need to be taken into account in deciding whether a patient with Parkinson's disease (PD) is a candidate for deep brain stimulation. Patient-related personal factors including age and the presence of other comorbid disorders need to be considered. Neuropsychological and neuropsychiatric concerns relate both to the presurgical status of the patient and to the potential for surgery to result in new problems postoperatively. A number of factors related to the underlying PD need to be considered, including the specific parkinsonian motor indications (e.g., tremor, bradykinesia, gait dysfunction), previous medical therapies, including benefit from current therapy and adverse effects, and past surgical treatments. Definable causes of Parkinsonism, particularly atypical Parkinsonisms, should be considered. Finally, methods of evaluating outcomes should be defined and formalized. This is a report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society (MDS). The report has been endorsed by the Scientific Issues Committee of the MDS and the American Society of Stereotactic and Functional Neurosurgery. It outlines answers to a series of questions developed to address all aspects of deep brain stimulation preoperative decision-making.
authors.affiliation: Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada. lang@uhnres.utoronto.ca
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lang
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Houeto
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kubu
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Lyons
authors.forename: Elena
authors.initials: E
authors.lastname: Moro
authors.forename: William
authors.initials: W
authors.lastname: Ondo
authors.forename: Rajesh
authors.initials: R
authors.lastname: Pahwa
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Alexander I
authors.initials: AI
authors.lastname: Tröster
authors.forename: Ryan
authors.initials: R
authors.lastname: Uitti
authors.forename: Valerie
authors.initials: V
authors.lastname: Voon
mesh_terms: D001921:Brain / Q000601:surgery*; D003071:Cognition; D046690:Deep Brain Stimulation / Q000379:methods*; D003863:Depression / Q000209:etiology; D004298:Dopamine / Q000502:physiology; D017408:Guidelines as Topic; D006801:Humans; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications; D011300:Preoperative Care; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology
chemical_list: D004298:Dopamine