DBS effective therapy for Parkinson's: study

Deep brain stimulation (DBS) has proven to be a lifeline for some patients suffering from Parkinson's disease, those whose symptoms cannot be adequately controlled with medications. A neurosurgeon uses magnetic resonance imaging or computed tomography to identify the exact target within the brain 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.

More than 50 DBS experts -- including world-renowned neurologists, clinicians and surgeons -- pooled their experience with the procedure and reached a consensus, presented in the Archives of Neurology. 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.