Pahwa et al.2727. Pahwa R, Factor SA, Lyons KE, Ondo WG, Gronseth G, Bronte-Stewart H et al. Practice Parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006 Apr;66(7):983-95. https://doi.org/10.1212/01.wnl.0000215250.82576.87
https://doi.org/10.1212/01.wnl.000021525...
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American Academy of Neurology (AAN). |
USA |
Response in levodopa challenge test is an outcome predictor for STN DBS (Evidence level B). |
Not addressed |
STN DBS could be offered as a therapeutic option to improve motor function and reduce dyskinesia, motor fluctuations and medication dosage (level C). |
Lang et al.2828. Lang AE, Houeto JL, Krack P, Kubu C, Lyons KE, Moro E et al. Deep brain stimulation: preoperative issues. Mov Disord. 2006 Jun;21(S14 Suppl 14):S171-96. https://doi.org/10.1002/mds.20955
https://doi.org/10.1002/mds.20955...
|
International Parkinson and Movement Disorder Society (MDS); |
Diverse |
Defined PD diagnosis; levodopa responsive; significant functional impairment; |
Age does not predict outcome. |
Mandatory preoperative MRI. |
Congress of Neurological Surgeons |
UPDRS-III > 30 in OFF time and UPDRS-III < 30 in ON time; |
Trials have excluded patients with comorbidities. |
STB DBS could impair verbal fluency, induce psychiatric side effects (depression, hypomania, dopaminergic dysregulation syndrome, suicide risk) |
|
Individualized decision; evaluate interpersonal relations, work situation, expectations; |
Active depression, suicidal ideation history, psychosis, bipolar disorder, medication abuse history, unable to give informed consent. |
Psychiatric and neuropsychological evaluation is mandatory before surgery. |
|
Disease progression for, at least, 5 years. |
|
Vim thalamic DBS could be considered if tremor is more important than rigidity or bradykinesia. |
Bronstein et al.2929. Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A et al. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol. 2011 Feb;68(2):165. https://doi.org/10.1001/archneurol.2010.260
https://doi.org/10.1001/archneurol.2010....
|
Multi-institutional |
Diverse |
PD diagnosis for, at least, 5 years; |
Dementia; |
- |
dyskinesia, tremor or fluctuations refractory to best medical therapy. |
Active psychiatric disorder |
> 30% improvement in UPDRS-III in the levodopa test; |
|
Fox et al.3030. Fox SH, Katzenschlager R, Lim SY, Ravina B, Seppi K, Coelho M et al. The movement disorder society evidence-based medicine review update: treatments for the motor symptoms of Parkinson’s disease. Mov Disord. 2011 Oct;26(S3 Suppl 3):S2-41. https://doi.org/10.1002/mds.23829
https://doi.org/10.1002/mds.23829...
|
International Parkinson and Movement Disorders Society (MDS) |
Diverse |
Not addressed |
Not addressed |
STN DBS is effective for dyskinesia and motor fluctuation; |
GPi DBS is effective for motor symptoms, as an adjunct to levodopa, and to treat dyskinesia and motor fluctuations. |
Rieder et al.3131. Rieder CR, Silva DJ. Indicações de tratamento cirúrgico na doença de Parkinson. In: Dias-Tosta E, Rieder CRM, Borges V, Correa-Neto Y. Doença de Parkinson: recomendações. São Paulo: Omnifarma, 2010. p. 129-39.
|
Academia Brasileira de Neurologia (ABN) |
Brazil |
Defined PD diagnosis, lasting at least 5 years; |
Dementia; |
Class B recommendation |
Levodopa-responsive (> 25-50% improvement in UPDRS-III) (with the exception of tremor); |
Active psychiatric disorder (depression and psychosis); |
Unsatisfactory symptom improvement with best medical therapy (dyskinesia, tremor or fluctuations) |
Significant brain atrophy, |
Easy access to the medical centre; |
Significant ventricle enlargement. |
Intolerance to dopaminergic therapy; |
|
Ferreira et al.3232. Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G et al. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson’s disease. Eur J Neurol. 2013 Jan;20(1):5-15. https://doi.org/10.1111/j.1468-1331.2012.03866.x
https://doi.org/10.1111/j.1468-1331.2012...
|
European Federation of Neurological Societies (EFNS) |
Europe |
Defined PD; severe motor fluctuations, unpredictable ON-OFF, dyskinesia*; |
Exclude patients with advanced age (>70 y); |
STN DBS: level A for reducing dopaminergic drug dosage; |
* There was no reference to disease duration, levodopa response. |
Major cognitive or psychiatric disorder. |
GPi DBS: level A for reducing severe dyskinesias; |
|
|
STN or GPi DBS: level A for treating severe dyskinesia or motor fluctuations; |
|
|
Slight decline in executive functions may occur (Stroop test and verbal fluency). |