Table 2. Surgical Option for Parkinson Disease
Î Deep brain stimulation (DBS)
Î Stereotactic surgical procedure using
an implanted electrode connected to
an implantable pulse generator that
delivers electric current through a lead
to the subthalamic nucleus (STN) in the
brain to:
> Improve motor function
> Reduce motor fluctuations, dyskinesia,
and antiparkinsonian medication
usage
Î Candidates are patients who are:
> Levodopa-responsive
> Non-demented
> Neuropsychiatrically intact with:
> Intractable motor f luctuations
> Intractable dyskinesia
> Intractable tremor
Î Factors predictive of outcome of DBS
of STN:
Î Preoperative response to levodopa
Î Age of patient and duration of
Parkinson disease may play a role
(improvement greater in younger with
shorter duration)
Î Possible adverse events of DBS:
Î Surgical complications (during or
within 1 month of surgery):
> Infection (5.6%)
> Intracranial hemorrhage (3.1%)
Î Hardware related complications
(up to 20%)
> Lead replacement (fracture,
migration, malfunction) or
reposition (misplacement)
> Extension wire replacement
(fracture, erosion)
> Generator replacement
(malfunction) or repositioning
(cosmetic, skin growth)
> Allergic reaction
Î Stimulation related (generally mild
and can be resolved with stimulation
parameter reprogramming):
> Dizziness
> Dysarthria
> Dyskinesia
> Eyelid-opening apraxia
> Facial contractions
> Hemibalismus
> Paresthesia
