Deep brain stimulation: Preoperative issues

TLDR

Deciding on deep brain stimulation for Parkinson’s disease requires evaluating patient age, comorbidities, neuropsychological status, motor symptoms, prior therapies, and underlying Parkinsonism type. The report defines methods for evaluating outcomes in deep brain stimulation. It provides answers to questions covering all aspects of preoperative decision‑making for deep brain stimulation. This consensus report on DBS for Parkinson’s disease, commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society and endorsed by their scientific committees, is © 2006 Movement Disorder Society.

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. © 2006 Movement Disorder Society