Table 2. Surgical Option for Parkinson Disease ÎDeep 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
Î Candidates are patients who are: > Levodopa-responsive > Non-demented > Neuropsychiatrically intact with: > Intractable motor fluctuations > Intractable dyskinesia > Intractable tremor
and antiparkinsonian medication usage
ÎFactors 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)
ÎPossible adverse events of DBS:
Î Surgical complications (during or within 1 month of surgery): > Infection (5.6%) > Intracranial hemorrhage (3.1%)
brain to: > Improve motor function > Reduce motor fluctuations, dyskinesia,
Î Hardware related complications
(up to 20%) > Lead replacement (fracture, migration, malfunction) or reposition (misplacement)
> Extension wire replacement (fracture, erosion)
Î Stimulation related (generally mild and can be resolved with stimulation
> Generator replacement (malfunction) or repositioning (cosmetic, skin growth) > Allergic reaction
parameter reprogramming): > Dizziness > Dysarthria > Dyskinesia > Eyelid-opening apraxia > Facial contractions > Hemibalismus > Paresthesia
