Tailoring the deep brain stimulation indications in Parkinson’s disease

Barbosa, Egberto Reis; Cury, Rubens Gisbert

doi:10.1590/0004-282x20180046

Cited by 3 publications

(3 citation statements)

References 8 publications

(8 reference statements)

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“…There are currently three indications for DBS in PD patients: refractory motor fluctuations/complications of chronic levodopa therapy (wearing off, dyskinesias, etc. ), refractory tremor, and intolerance to dopaminergic agents 3 . In addition to indications, patients should also fulfill other basic requirements.…”

Section: Dbs In Pd: Current State Of the Artmentioning

confidence: 99%

Deep brain stimulation in Parkinson’s disease: state of the art and future perspectives

França

Carra

Diniz

et al. 2022

Arq. Neuro-Psiquiatr.

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For more than 30 years, Deep Brain Stimulation (DBS) has been a therapeutic option for Parkinson’s disease (PD) treatment. However, this therapy is still underutilized mainly due to misinformation regarding risks and clinical outcomes. DBS can ameliorate several motor and non-motor symptoms, improving patients’ quality of life. Furthermore, most of the improvement after DBS is long-lasting and present even in advanced PD. Adequate patient selection, precise electric leads placement, and correct DBS programming are paramount for good surgical outcomes. Nonetheless, DBS still has many limitations: axial symptoms and signs, such as speech, balance and gait, do not improve to the same extent as appendicular symptoms and can even be worsened as a direct or indirect consequence of surgery and stimulation. In addition, there are still unanswered questions regarding patient’s selection, surgical planning and programming techniques, such as the role of surgicogenomics, more precise imaging-based lead placement, new brain targets, advanced programming strategies and hardware features. The net effect of these innovations should not only be to refine the beneficial effect we currently observe on selected symptoms and signs but also to improve treatment resistant facets of PD, such as axial and non-motor features. In this review, we discuss the current state of the art regarding DBS selection, implant, and programming, and explore new advances in the DBS field.

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Section: Dbs In Pd: Current State Of the Artmentioning

confidence: 99%

Deep brain stimulation in Parkinson’s disease: state of the art and future perspectives

França

Carra

Diniz

et al. 2022

Arq. Neuro-Psiquiatr.

Self Cite

View full text Add to dashboard Cite

show abstract

“…A aplicação do DBS, assim como todos os outros tratamentos para a DP, busca a melhoria da qualidade de vida do paciente visto que é inevitável a progressão dessa doença. Diante disso, o processo cirúrgico de aplicação dos eletrodos é mais indicado para pacientes que visam reduzir a terapia medicamentosa dopaminérgica e consequentemente reduzir a síndrome hiperdopaminérgica desencadeada (BARBOSA & CURY, 2018). Isso, por sua vez, acarreta em flutuações motoras e discinesias, como distonia, coreia descontrolada e alterações nos períodos "on" e "off", fatores que prejudicam seriamente as mais simples atividades cotidianas (BEITZ, 2014).…”

Section: Tratamento Cirúrgico -Deep Brain Stimulation (Dbs)unclassified

“…A cirurgia não está isenta de complicações visto que a implementação dos eletrodos pode piorar ou melhorar os distúrbios do controle de impulso (BARBOSA & CURY, 2018). Deste modo, de acordo com o quadro clínico do paciente a decisão pode ser contra o tratamento cirúrgico, o que enfatiza que o processo de estimulação cerebral profunda deve ser uma decisão individualizada com base nos sintomas motores e não motores do paciente (BARBOSA & CURY, 2018).…”

Section: Tratamento Cirúrgico -Deep Brain Stimulation (Dbs)unclassified