title: Deep brain stimulation for Parkinson's disease prior to L-dopa treatment: A case report.
abstract: BACKGROUND
  Leva-dopa (L-dopa) is the gold-standard treatment for Parkinson's disease (PD). Deep brain stimulation is generally reserved for patients who become refractory to l-dopa treatment.
  
  
  METHODS
  We present a male patient with a 9-year course of PD who at 53 years of age preferred deep brain stimulation (DBS) of the subthalamic nucleus over initial l-dopa treatment. The patient argued that he wanted to avoid the serious adverse effects of l-dopa, which would have presented within his time of full professional activity. DBS resulted in significant motor improvement lasting for 6 years without l-dopa treatment.
  
  
  CONCLUSIONS
  Large multicentre-based international trials with long follow-ups are needed to answer the effectiveness of early DBS in PD.
authors.affiliation: Department of Neurosurgery and Neurology, Galeazzi Institute, Milan, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Servello
authors.affiliation: Department of Neurosurgery and Neurology, Galeazzi Institute, Milan, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Saleh
authors.affiliation: Department of Neurosurgery and Neurology, Galeazzi Institute, Milan, Italy.
authors.forename: Alberto R
authors.initials: AR
authors.lastname: Bona
authors.affiliation: Department of Neurosurgery and Neurology, Galeazzi Institute, Milan, Italy.
authors.forename: Edvin
authors.initials: E
authors.lastname: Zekaj
authors.affiliation: Department of Neurosurgery and Neurology, Galeazzi Institute, Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Zanaboni
authors.affiliation: Department of Neurosurgery and Neurology, Galeazzi Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Porta
keywords: Deep brain stimulation; L-dopa; Parkinson's disease