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Treatment results: Parkinson's disease

Authors

  • Pierre Pollak MD,

    Corresponding author
    1. Department of Clinical and Biological Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, France
    2. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
    • Department of Neurology, University of Grenoble, BP 217, 38043 Grenoble Cedex 9, France
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  • Valérie Fraix MD,

    1. Department of Clinical and Biological Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, France
    2. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
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  • Paul Krack MD,

    1. Department of Clinical and Biological Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, France
    2. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
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  • Elena Moro MD, PhD,

    1. Department of Clinical and Biological Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, France
    2. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
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  • Alexandre Mendes MD,

    1. Department of Clinical and Biological Neurosciences, Service de Neurologie, Centre Hospitalier Universitaire de Grenoble, France
    2. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
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  • Stephan Chabardes MD,

    1. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
    2. Department of Clinical and Biological Neurosciences, Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
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  • Adnan Koudsie MD,

    1. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
    2. Department of Clinical and Biological Neurosciences, Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
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  • Alim-Louis Benabid MD, PhD

    1. Institut National de la Santé et de la Recherche Médicale, Unit 318, Joseph Fourier University, Grenoble, France
    2. Department of Clinical and Biological Neurosciences, Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
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Abstract

Deep brain stimulation (DBS) is a neurosurgical treatment of Parkinson's disease that is applied to three targets: the ventral intermediate nucleus of the thalamus (Vim), the globus pallidus internas (GPi) and the subthalamic nucleus (STN). Vim DBS mainly improves contralateral tremor and, therefore, is being supplanted by DBS of the two other targets, even in patients with tremor dominant disease. STN and GPi DBS improve off-motor phases and dyskinesias. There is little comparative data between these procedures. The magnitude of the motor improvement seems more constant with STN than GPi DBS. STN DBS allows a decrease in antiparkinsonian drug doses and consumes moderate current. These advantages of STN over GPi DBS are offset by the need for more intensive postoperative management. The DBS procedure has the unique advantage of reversibility and adjustability over time. Patients with young-onset Parkinson's disease suffering from levodopa-induced motor complications but still responding well to levodopa and who exhibit no behavioral, mood, or cognitive impairment benefit the most from STN DBS. Adverse effects more specific of the DBS procedure are infection, cutaneous erosion, and lead breaking or disconnection. Intracranial electrode implantation can induce a hematoma or contusion. Most authors agree that the benefit to risk ratio of DBS is favorable. © 2002 Movement Disorder Society

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