The indication of DBS in Parkinosn's disease (from a neurosurgical standpoint)

概要

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It is obvious that deep brain stimulation (DBS) is one of the useful treatment choices for progressive Parkinson disease (PD). The main targets for DBS for PD are the thalamic Vim nucleus, globus pallidus interna (GPi), and subthalamic nucleus (STN). Vim-DBS is useful for tremor but not very effective for other Parkinson symptoms. Therefore, presently, STN and GPi are the common targets for DBS for PD. Diminishing the dose of anti-PD drugs is possible usually only after STN-DBS. However, no evident differences in the effect between STN-DBS and GPi-DBS are noted in the majority of studies. Appropriate indication should be decided on the basis of individual target's feature. Dopa responsiveness is a very important factor when considering the operative indications for both STN-DBS and GPi-DBS. CAPSIT protocol is usually used to evaluate the dopa responsiveness. DBS is considered to be characterized by the bottom-up and substitution effects. The disappearance of wearing-off is expected owing to the bottom-up effect and the disappearance of the side effects of anti-PD drugs is expected owing to the substitution effect. Age at surgery, duration of PD, and degree of dopa responsiveness are important factors for outcome prediction. On the other hand, the rate of complications such as cognitive decline, psychosis, and intracranial hemorrhage is relatively high in elderly patients.
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