Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?
Identifieur interne : 000796 ( Istex/Corpus ); précédent : 000795; suivant : 000797Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?
Auteurs : Ruth-Mary Desouza ; Elena Moro ; Anthony E. Lang ; Anthony H. V. SchapiraSource :
- Annals of Neurology [ 0364-5134 ] ; 2013-05.
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:
DOI: 10.1002/ana.23890
Links to Exploration step
ISTEX:AB57024472EC1838596F63D9A25DD0708F542980Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title><author><name sortKey="Desouza, Ruth Ary" sort="Desouza, Ruth Ary" uniqKey="Desouza R" first="Ruth-Mary" last="Desouza">Ruth-Mary Desouza</name><affiliation><mods:affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><mods:affiliation>Movement Disorders Center, Department of Psychiatry and Neurology, University Hospital Center of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><affiliation><mods:affiliation>Toronto Western Hospital, Ontario, Toronto, Canada</mods:affiliation></affiliation></author><author><name sortKey="Schapira, Anthony H V" sort="Schapira, Anthony H V" uniqKey="Schapira A" first="Anthony H. V." last="Schapira">Anthony H. V. Schapira</name><affiliation><mods:affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: a.schapira@ucl.ac.uk</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:AB57024472EC1838596F63D9A25DD0708F542980</idno><date when="2013" year="2013">2013</date><idno type="doi">10.1002/ana.23890</idno><idno type="url">https://api-v5.istex.fr/document/AB57024472EC1838596F63D9A25DD0708F542980/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000796</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000796</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title><author><name sortKey="Desouza, Ruth Ary" sort="Desouza, Ruth Ary" uniqKey="Desouza R" first="Ruth-Mary" last="Desouza">Ruth-Mary Desouza</name><affiliation><mods:affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</mods:affiliation></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><mods:affiliation>Movement Disorders Center, Department of Psychiatry and Neurology, University Hospital Center of Grenoble, Grenoble, France</mods:affiliation></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><affiliation><mods:affiliation>Toronto Western Hospital, Ontario, Toronto, Canada</mods:affiliation></affiliation></author><author><name sortKey="Schapira, Anthony H V" sort="Schapira, Anthony H V" uniqKey="Schapira A" first="Anthony H. V." last="Schapira">Anthony H. V. Schapira</name><affiliation><mods:affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: a.schapira@ucl.ac.uk</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of Neurology</title><title level="j" type="abbrev">Ann Neurol.</title><idno type="ISSN">0364-5134</idno><idno type="eISSN">1531-8249</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><date type="published" when="2013-05">2013-05</date><biblScope unit="volume">73</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="565">565</biblScope><biblScope unit="page" to="575">575</biblScope></imprint><idno type="ISSN">0364-5134</idno></series><idno type="istex">AB57024472EC1838596F63D9A25DD0708F542980</idno><idno type="DOI">10.1002/ana.23890</idno><idno type="ArticleID">ANA23890</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0364-5134</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="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</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>Ruth‐Mary deSouza MRCS</name><affiliations><json:string>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</json:string></affiliations></json:item><json:item><name>Elena Moro PhD, MD</name><affiliations><json:string>Movement Disorders Center, Department of Psychiatry and Neurology, University Hospital Center of Grenoble, Grenoble, France</json:string></affiliations></json:item><json:item><name>Anthony E. Lang FRCP, MD</name><affiliations><json:string>Toronto Western Hospital, Ontario, Toronto, Canada</json:string></affiliations></json:item><json:item><name>Anthony H. V. Schapira DSc, MD, FRCP, FMedSci</name><affiliations><json:string>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</json:string><json:string>E-mail: a.schapira@ucl.ac.uk</json:string></affiliations></json:item></author><articleId><json:string>ANA23890</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>miscellaneous</json:string></originalGenre><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</abstract><qualityIndicators><score>7.94</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 800.957 pts</pdfPageSize><refBibsNative>false</refBibsNative><abstractCharCount>1563</abstractCharCount><pdfWordCount>6565</pdfWordCount><pdfCharCount>43727</pdfCharCount><pdfPageCount>11</pdfPageCount><abstractWordCount>245</abstractWordCount></qualityIndicators><title>Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title><genre><json:string>other</json:string></genre><host><title>Annals of Neurology</title><language><json:string>unknown</json:string></language><doi><json:string>10.1002/(ISSN)1531-8249</json:string></doi><issn><json:string>0364-5134</json:string></issn><eissn><json:string>1531-8249</json:string></eissn><publisherId><json:string>ANA</json:string></publisherId><volume>73</volume><issue>5</issue><pages><first>565</first><last>575</last><total>11</total></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Point of View</value></json:item></subject></host><categories><wos><json:string>science</json:string><json:string>neurosciences</json:string><json:string>clinical neurology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>neurology & neurosurgery</json:string></scienceMetrix></categories><publicationDate>2013</publicationDate><copyrightDate>2013</copyrightDate><doi><json:string>10.1002/ana.23890</json:string></doi><id>AB57024472EC1838596F63D9A25DD0708F542980</id><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api-v5.istex.fr/document/AB57024472EC1838596F63D9A25DD0708F542980/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api-v5.istex.fr/document/AB57024472EC1838596F63D9A25DD0708F542980/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api-v5.istex.fr/document/AB57024472EC1838596F63D9A25DD0708F542980/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Ltd</publisher><availability><p>© 2013 American Neurological Association© 2013 American Neurological Association</p></availability><date>2013-03-28</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title><author xml:id="author-1"><persName><forename type="first">Ruth‐Mary</forename><surname>deSouza</surname></persName><roleName type="degree">MRCS</roleName><affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</affiliation></author><author xml:id="author-2"><persName><forename type="first">Elena</forename><surname>Moro</surname></persName><roleName type="degree">PhD, MD</roleName><affiliation>Movement Disorders Center, Department of Psychiatry and Neurology, University Hospital Center of Grenoble, Grenoble, France</affiliation></author><author xml:id="author-3"><persName><forename type="first">Anthony E.</forename><surname>Lang</surname></persName><roleName type="degree">FRCP, MD</roleName><affiliation>Toronto Western Hospital, Ontario, Toronto, Canada</affiliation></author><author xml:id="author-4"><persName><forename type="first">Anthony H. V.</forename><surname>Schapira</surname></persName><roleName type="degree">DSc, MD, FRCP, FMedSci</roleName><email>a.schapira@ucl.ac.uk</email><affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</affiliation></author></analytic><monogr><title level="j">Annals of Neurology</title><title level="j" type="abbrev">Ann Neurol.</title><idno type="pISSN">0364-5134</idno><idno type="eISSN">1531-8249</idno><idno type="DOI">10.1002/(ISSN)1531-8249</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><date type="published" when="2013-05"></date><biblScope unit="volume">73</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="565">565</biblScope><biblScope unit="page" to="575">575</biblScope></imprint></monogr><idno type="istex">AB57024472EC1838596F63D9A25DD0708F542980</idno><idno type="DOI">10.1002/ana.23890</idno><idno type="ArticleID">ANA23890</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2013-03-28</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>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</p></abstract><textClass><keywords scheme="Journal Subject"><list><head>article-category</head><item><term>Point of View</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2012-07-13">Received</change><change when="2013-03-01">Registration</change><change when="2013-03-28">Created</change><change when="2013-05">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-12-12">References added</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2017-02-8">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api-v5.istex.fr/document/AB57024472EC1838596F63D9A25DD0708F542980/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en" xml:id="ana23890"><header><publicationMeta level="product"><doi origin="wiley" registered="yes">10.1002/(ISSN)1531-8249</doi><issn type="print">0364-5134</issn><issn type="electronic">1531-8249</issn><idGroup><id type="product" value="ANA"></id></idGroup><titleGroup><title type="main" sort="ANNALS OF NEUROLOGY">Annals of Neurology</title><title type="short">Ann Neurol.</title></titleGroup></publicationMeta><publicationMeta level="part" position="50"><doi>10.1002/ana.v73.5</doi><copyright ownership="thirdParty">© 2013 American Neurological Association</copyright><numberingGroup><numbering type="journalVolume" number="73">73</numbering><numbering type="journalIssue">5</numbering></numberingGroup><coverDate startDate="2013-05">May 2013</coverDate></publicationMeta><publicationMeta level="unit" position="60" type="miscellaneous" status="forIssue" accessType="open"><doi>10.1002/ana.23890</doi><idGroup><id type="unit" value="ANA23890"></id></idGroup><countGroup><count type="pageTotal" number="11"></count></countGroup><titleGroup><title type="articleCategory">Point of View</title><title type="tocHeading1">Point of View</title></titleGroup><copyright ownership="thirdParty">© 2013 American Neurological Association</copyright><eventGroup><event type="manuscriptReceived" date="2012-07-13"></event><event type="manuscriptRevised" date="2013-02-28"></event><event type="manuscriptAccepted" date="2013-03-01"></event><event type="xmlCreated" agent="Cenveo Publisher Services" date="2013-03-28"></event><event type="publishedOnlineAccepted" date="2013-03-08"></event><event type="publishedOnlineFinalForm" date="2013-05-28"></event><event type="firstOnline" date="2013-05-28"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-03"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.6.4 mode:FullText" date="2015-10-03"></event></eventGroup><numberingGroup><numbering type="pageFirst">565</numbering><numbering type="pageLast">575</numbering></numberingGroup><correspondenceTo>Address correspondence to Dr Schapira, Head of Department of Clinical Neurosciences, UCL Institute of Neurology, Rowland Hill St, London NW3 2PF, United Kingdom. E‐mail: <email>a.schapira@ucl.ac.uk</email>.</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:ANA.ANA23890.pdf"></link></linkGroup></publicationMeta><contentMeta><titleGroup><title type="main">Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title><title type="short">Timing of DBS in PD</title><title type="shortAuthors">deSouza et al</title></titleGroup><creators><creator affiliationRef="#ana23890-aff-0001" creatorRole="author" xml:id="ana23890-cr-0001"><personName><givenNames>Ruth‐Mary</givenNames><familyName>deSouza</familyName><degrees>MRCS</degrees></personName></creator><creator affiliationRef="#ana23890-aff-0002" creatorRole="author" xml:id="ana23890-cr-0002"><personName><givenNames>Elena</givenNames><familyName>Moro</familyName><degrees>PhD, MD</degrees></personName></creator><creator affiliationRef="#ana23890-aff-0003" creatorRole="author" xml:id="ana23890-cr-0003"><personName><givenNames>Anthony E.</givenNames><familyName>Lang</familyName><degrees>FRCP, MD</degrees></personName></creator><creator affiliationRef="#ana23890-aff-0001" corresponding="yes" creatorRole="author" xml:id="ana23890-cr-0004"><personName><givenNames>Anthony H. V.</givenNames><familyName>Schapira</familyName><degrees>DSc, MD, FRCP, FMedSci</degrees></personName></creator></creators><affiliationGroup><affiliation countryCode="GB" type="organization" xml:id="ana23890-aff-0001"><orgDiv>Department of Clinical Neurosciences</orgDiv><orgName>Institute of Neurology</orgName><orgName>University College London</orgName><address><city>London</city><country>United Kingdom</country></address></affiliation><affiliation countryCode="FR" type="organization" xml:id="ana23890-aff-0002"><orgDiv>Movement Disorders Center, Department of Psychiatry and Neurology</orgDiv><orgName>University Hospital Center of Grenoble</orgName><address><city>Grenoble</city><country>France</country></address></affiliation><affiliation countryCode="CA" type="organization" xml:id="ana23890-aff-0003"><orgName>Toronto Western Hospital</orgName><address><city>Toronto</city><countryPart>Ontario</countryPart><country>Canada</country></address></affiliation></affiliationGroup><abstractGroup><abstract type="main"><section xml:id="ana23890-sec-0001"><p>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.</p></section><section xml:id="ana23890-sec-0002"><p>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.</p></section><section xml:id="ana23890-sec-0003"><p>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.</p></section><section xml:id="ana23890-sec-0004"><p>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</p></section></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Timing of DBS in PD</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?</title></titleInfo><name type="personal"><namePart type="given">Ruth‐Mary</namePart><namePart type="family">deSouza</namePart><namePart type="termsOfAddress">MRCS</namePart><affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elena</namePart><namePart type="family">Moro</namePart><namePart type="termsOfAddress">PhD, MD</namePart><affiliation>Movement Disorders Center, Department of Psychiatry and Neurology, University Hospital Center of Grenoble, Grenoble, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anthony E.</namePart><namePart type="family">Lang</namePart><namePart type="termsOfAddress">FRCP, MD</namePart><affiliation>Toronto Western Hospital, Ontario, Toronto, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Anthony H. V.</namePart><namePart type="family">Schapira</namePart><namePart type="termsOfAddress">DSc, MD, FRCP, FMedSci</namePart><affiliation>Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom</affiliation><affiliation>E-mail: a.schapira@ucl.ac.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="other" displayLabel="miscellaneous"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><dateIssued encoding="w3cdtf">2013-05</dateIssued><dateCreated encoding="w3cdtf">2013-03-28</dateCreated><dateCaptured encoding="w3cdtf">2012-07-13</dateCaptured><dateValid encoding="w3cdtf">2013-03-01</dateValid><copyrightDate encoding="w3cdtf">2013</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><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</abstract><relatedItem type="host"><titleInfo><title>Annals of Neurology</title></titleInfo><titleInfo type="abbreviated"><title>Ann Neurol.</title></titleInfo><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>Point of View</topic></subject><identifier type="ISSN">0364-5134</identifier><identifier type="eISSN">1531-8249</identifier><identifier type="DOI">10.1002/(ISSN)1531-8249</identifier><identifier type="PublisherID">ANA</identifier><part><date>2013</date><detail type="volume"><caption>vol.</caption><number>73</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>565</start><end>575</end><total>11</total></extent></part></relatedItem><identifier type="istex">AB57024472EC1838596F63D9A25DD0708F542980</identifier><identifier type="DOI">10.1002/ana.23890</identifier><identifier type="ArticleID">ANA23890</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2013 American Neurological Association© 2013 American Neurological Association</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Canada/explor/ParkinsonCanadaV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000796 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 000796 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Canada
|area= ParkinsonCanadaV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:AB57024472EC1838596F63D9A25DD0708F542980
|texte= Timing of deep brain stimulation in Parkinson disease: A need for reappraisal?
}}
| This area was generated with Dilib version V0.6.29. |  |