Deep brain stimulation in advanced PD


REPORT FROM THE ENS 2008 – Deep brain stimulation is an evolving surgical technique for managing patients with advanced PD.

Subthalamic DBS cheap mlb jerseys (STN-DBS) has shown long-term benefits with respect to motor fluctuations and dyskinesias, but morbidity may be higher than with other targets.  A recent analysis of adverse events 4 years post-surgery reported AEs in 53% ПРО of patients undergoing STN-DBS versus 35% of patients undergoing DBS of the internal globus pallidus (GPi-DBS; Hariz et al. cheap jerseys free shipping Mov Disord 2008;23:416-421). Most AEs involved You? cognitive, psychiatric and behavioural symptoms, and many of these occurred in patients following STN-DBS.

At the ENS meeting, researchers at the Mayo Clinic, Scottsdale, Arizona, presented a retrospective analysis of data on 24 patients undergoing either STN-DBS or GPi-DBS (Pemkumar et al. Baninfo Abstract P399. J Neurol 2008;255(suppl 2): 98-99). At that centre, STN was the preferred target but GPi was performed after 2005 following increasing reports of cognitive and/or psychiatric AEs with wholesale jerseys STN-DBS.

Both approaches were found to be equivalent with respect to levodopa dose reductions (STN 38% vs. GPi 36.9% reduction). Mean medication off/stimulation on motor UPDRS scores postsurgery were similar (19.1 vs. 16.4). The group concluded that GPi may be preferred over STN due to the lower risk of neuropsychiatric complications.

In a separate report, executive function was investigated following STN-DBS in 60 PD patients (Daniels et al. Abstract 0142. J Neurol 2008;255(suppl 2): 32). Patients undergoing STN-DBS demonstrated significant declines Sports in verbal fluency and Stroop test performance mild compared to patients receiving optimized medical therapy. The largest declines were seen in patients with higher scores on executive function tests at baseline.

Additional research is needed to determine the optimal approaches, targets and patient selection for DBS.

There are a number of wholesale nba jerseys recent reports suggesting that STN DBS is associated with initially unrecognized side recent effects.  Previous studies comparing STN DBS to GPi DBS have shown that both procedures were usually well tolerated but that the amount of medication reduction was wholesale nfl jerseys greater with STN DBS (Rodriguez-Oroz et al. Brain 2005;128(Pt 10):2222-2223; Weaver et al. J Neurosurg 2005;103:956-967.

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