Deep brain stimulation: postoperative issues.
Numerous factors need to be taken into account when managing a patient with Parkinson's disease (PD) after deep brain stimulation (DBS). Questions such as when to begin programming, how to conduct a programming screen, how to assess the effects of programming, and how to titrate stimulation and medication for each of the targeted sites need to be addressed. Follow-up care should be determined, including patient adjustments of stimulation, timing of follow-up visits and telephone contact with the patient, and stimulation and medication conditions during the follow-up assessments. A management plan for problems that can arise after DBS such as weight gain, dyskinesia, axial symptoms, speech dysfunction, muscle contractions, paresthesia, eyelid, ocular and visual disturbances, and behavioral and cognitive problems should be developed. Long-term complications such as infection or erosion, loss of effect, intermittent stimulation, tolerance, and pain or discomfort can develop and need to be managed. Other factors that need consideration are social and job-related factors, development of dementia, general medical issues, and lifestyle changes. This 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, outlines answers to a series of questions developed to address all aspects of DBS postoperative management and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors. The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery.
Deuschl
Günther
G
Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany. g.deuschl@neurologie.uni-kiel.de
Herzog
Jan
J
Kleiner-Fisman
Galit
G
Kubu
Cynthia
C
Lozano
Andres M
AM
Lyons
Kelly E
KE
Rodriguez-Oroz
Maria C
MC
Tamma
Filippo
F
Tröster
Alexander I
AI
Vitek
Jerrold L
JL
Volkmann
Jens
J
Voon
Valerie
V
D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D001921:Brain / Q000473:pathology / Q000601:surgery*; D003072:Cognition Disorders / Q000453:epidemiology; D046690:Deep Brain Stimulation / Q000379:methods*; D003704:Dementia / Q000453:epidemiology / Q000628:therapy; D004567:Electrodes, Implanted / Q000382:microbiology; D006287:Health Planning Guidelines; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D010300:Parkinson Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011182:Postoperative Care; D013064:Speech Disorders / Q000453:epidemiology