Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?
Identifieur interne : 000102 ( France/Analysis ); précédent : 000101; suivant : 000103Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?
Auteurs : Ruth-Mary Desouza [Royaume-Uni] ; Elena Moro [France] ; Anthony E. Lang [Canada] ; Anthony H. V. Schapira [Royaume-Uni]Source :
- Annals of Neurology [ 0364-5134 ] ; 2013-05.
English descriptors
- KwdEn :
- MESH :
- methods : Deep Brain Stimulation.
- statistics & numerical data : Databases, Factual.
- therapy : Parkinson Disease.
- trends : Deep Brain Stimulation.
- Humans, Treatment Outcome.
Abstract
We review the current application of deep brain stimulation (DBS) in Parkinson disease (PD) and consider the evidence that earlier use of DBS confers long‐term symptomatic benefit for patients compared to best medical therapy. Electronic searches were performed of PubMed, Web of Knowledge, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials to identify all article types relating to the timing of DBS in PD. Current evidence suggests that DBS is typically performed in late stage PD, a mean of 14 to 15 years after diagnosis. Current guidelines recommend that PD patients who are resistant to medical therapies, have significant medication side effects and lengthening off periods, but are otherwise cognitively intact and medically fit for surgery be considered for DBS. If these criteria are rigidly interpreted, it may be that, by the time medical treatment options have been exhausted, the disease has progressed to the point that the patient may no longer be fit for neurosurgical intervention. From the evidence available, we conclude that surgical management of PD alone or in combination with medical therapy results in greater improvement of motor symptoms and quality of life than medical treatment alone. There is evidence to support the use of DBS in less advanced PD and that it may be appropriate for earlier stages of the disease than for which it is currently used. The improving short and long‐term safety profile of DBS makes early application a realistic possibility. Ann Neurol 2013;73:565–575
Url:
- https://api-v5.istex.fr/document/AB57024472EC1838596F63D9A25DD0708F542980/fulltext/pdf
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065356
DOI: 10.1002/ana.23890
Affiliations:
- Canada, France, Royaume-Uni
- Angleterre, Auvergne-Rhône-Alpes, Grand Londres, Rhône-Alpes
- Grenoble, Londres
- University College de Londres
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ISTEX:AB57024472EC1838596F63D9A25DD0708F542980Le document en format XML
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Electronic searches were performed of PubMed, Web of Knowledge, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials to identify all article types relating to the timing of DBS in PD. Current evidence suggests that DBS is typically performed in late stage PD, a mean of 14 to 15 years after diagnosis. Current guidelines recommend that PD patients who are resistant to medical therapies, have significant medication side effects and lengthening off periods, but are otherwise cognitively intact and medically fit for surgery be considered for DBS. If these criteria are rigidly interpreted, it may be that, by the time medical treatment options have been exhausted, the disease has progressed to the point that the patient may no longer be fit for neurosurgical intervention. From the evidence available, we conclude that surgical management of PD alone or in combination with medical therapy results in greater improvement of motor symptoms and quality of life than medical treatment alone. There is evidence to support the use of DBS in less advanced PD and that it may be appropriate for earlier stages of the disease than for which it is currently used. The improving short and long‐term safety profile of DBS makes early application a realistic possibility. 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Schapira</name></country><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></region></country><country name="Canada"><noRegion><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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