Consensus reached on use of Parkinson's treatment

Oct 13, 2010 By Mark Wheeler

Since the late 1990s, deep brain stimulation (DBS) has proven to be a lifeline for some patients suffering from Parkinson's disease, a cruel neurological disorder that can cause lack of control over movement, poor balance and coordination, and rigidity, among other symptoms.

The procedure is used only for patients whose symptoms cannot be adequately controlled with medications. A uses or computed tomography to identify the exact target within the where abnormal electrical nerve signals generate the disease's tremors and other symptoms, and a neurostimulator is then surgically implanted to deliver electrical stimulation to that area to block the signals.

The goal, ultimately, is to improve the patient's quality of life.

Yet despite its effectiveness, there has been no consensus on several aspects of the use DBS, including which patients make the best candidates, where the optimal location for the placement of electrodes is, and the role that still exists for surgical removal of the damaged areas of the brain.

To address these concerns, a more than 50 DBS experts — including world-renowned neurologists, clinicians and surgeons — pooled their experience with the procedure and reached a consensus. The goal of this "meeting of the minds" was to better inform Parkinson's patients and their families about the potential of DBS treatment and to better inform the medical community in suggesting the procedure.

The results of their April 2009 meeting are presented in the current online edition of the journal Archives of Neurology.

"We know that very little accessible information is out there to help a Parkinson's patient make an informed decision as to whether he or she would be a good candidate for ," said Jeff Bronstein, a UCLA professor of neurology and lead author of the report.

Surgical trials take a long time, he said, and what information is available on DBS appears in academic journals, is focused and limited, and is usually written by one group reflecting their biases. 

Bronstein, who directs the UCLA Movement Disorder Program and is a member of the UCLA Brain Research Institute, said the results of the group's meeting will help clarify some of the issues about DBS treatment. Among their findings:

  • The best candidates for DBS are those who can't tolerate the side effects of medications, who don't suffer from significant active cognitive or psychiatric problems, and who do suffer from tremors and/or motor fluctuations.

  • DBS surgery is best performed by an experienced team and neurosurgeon with expertise in stereotactic neurosurgery — microsurgery deep within the brain that is based on a three-dimensional coordinate system using advanced neuroimaging.

  • DBS, when used in the two most commonly treated areas of the brain — the subthalamic nuclei and the globus pallidus pars interna — is effective in addressing the motor symptoms of Parkinson's, but treatment in the subthalamic nuclei may cause increased depression and other symptoms in some patients.

  • Surgical removal of the area of the brain causing Parkinson's disease is still an effective alternative and should be considered in patients.

  • Surgical complication rates vary widely, with infection being the most commonly reported complication of DBS.
Multiple authors were involved in the report; Bronstein, the lead author, reports no conflict of interest.

Explore further: Major dopamine system helps restore consciousness after general anesthesia, study finds

add to favorites email to friend print save as pdf

Related Stories

The sweet spot? Doctors test targets for Parkinson surgery

Mar 13, 2009

Doctors may be able to tailor a specialized form of brain surgery to more closely match the needs of Parkinson patients, according to results from the first large-scale effort to compare the two current target areas of deep ...

Shedding some light on Parkinson's treatment

Apr 16, 2009

A research team lead by Karl Deisseroth in the bioengineering department at Stanford University has developed a technique to systematically characterize disease circuits in the brain. By precisely controlling ...

Recommended for you

A new cause of mental disease?

1 hour ago

Astrocytes, the cells that make the background of the brain and support neurons, might be behind mental disorders such as depression and schizophrenia, according to new research by a Portuguese team from ...

Molecular basis of age-related memory loss explained

Jul 22, 2014

From telephone numbers to foreign vocabulary, our brains hold a seemingly endless supply of information. However, as we are getting older, our ability to learn and remember new things declines. A team of ...

The neurochemistry of addiction

Jul 22, 2014

We've all heard the term "addictive personality," and many of us know individuals who are consistently more likely to take the extra drink or pill that puts them over the edge. But the specific balance of ...

Study examines blood markers, survival in patients with ALS

Jul 21, 2014

The blood biomarkers serum albumin and creatinine appear to be associated with survival in patients with amyotrophic lateral sclerosis (ALS) and may help define prognosis in patients after they are diagnosed with the fatal ...

User comments : 0