title: What is the best treatment for fluctuating Parkinson's disease: continuous drug delivery or deep brain stimulation of the subthalamic nucleus?
abstract: Motor complications impair quality of life and cause severe disability in patients with advanced Parkinson's disease (PD). Since they are often refractory to medical therapy, interventional therapies have been developed, which can provide a considerable reduction of daily off-time and dopaminergic dyskinesias. Continuous dopaminergic drug delivery (CDD) is based on the steady stimulation of striatal dopamine receptors by subcutaneous apomorphine or duodenal L: -DOPA infusions via portable minipumps. Advances in the understanding of basal ganglia functioning and in neurosurgical, electrophysiological and neuroimaging techniques have led to a renaissance of neurosurgery for advanced PD. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the most invasive procedure promising great benefit and the highest level of independency for suitable patients, but is definitely associated with surgical risks and DBS-related side effects. Each of these more or less invasive therapy options has its own profile, and a thorough consideration of its advantages and drawbacks for the individual situation is mandatory. In this paper, we summarize relevant facts for this decision and provide some guidelines for a responsible counseling of eligible patients.
authors.affiliation: Department of Neurology, Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. hilker@med.uni-frankfurt.de
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Hilker
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.forename: Per
authors.initials: P
authors.lastname: Odin
mesh_terms: D003661:Decision Support Techniques; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D018491:Dopamine Agonists / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004409:Dyskinesia, Drug-Induced / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D018476:Hypokinesia / Q000503:physiopathology / Q000628:therapy*; D015918:Infusion Pumps, Implantable / Q000639:trends; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment / Q000592:standards; D020531:Subthalamic Nucleus / Q000502:physiology / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D018491:Dopamine Agonists