Hallelujah! There is finally something "official" in print about the do's and don'ts of DBS! An "Expert Consensus and Review of Key Issues" is being published in a forthcoming issue of Archives of Neurology. This consensus statement is the work product of a meeting sponsored by The Parkinson's Alliance and is signed by 21 of the country's preeminent neurosurgeons and neurologists.
While it is not a set of regulations or formal guidelines, I believe that this document should be viewed as a framework for evaluating deep brain stimulation for Parkinson's disease. (I would still like to see a mandate for neurosurgeon training and patient selection.) It is even written in fairly plain language, making it a poterntial tool for people living with PD and their families.
Getting 21 of these extremely confident, very busy individuals to agree on anything is quite a feat. Getting them to agree on so many issues and put their decisions in writing is nothing short of a miracle! Great work, Carol Walton!
I have pasted in the abstract and the link to it. The key points are contained in the abstract but if you know anyone who has a subscription to Archives of Neurology, the entire statment is well worth a read.
http://archneur.ama-assn.org/cgi/content/short/archneurol.2010.260
"Deep Brain Stimulation for Parkinson Disease
An Expert Consensus and Review of Key Issues
Jeff M. Bronstein, MD, PhD; Michele Tagliati, MD; Ron L. Alterman, MD; Andres M. Lozano, MD, PhD; Jens Volkmann, MD, PhD; Alessandro Stefani, MD; Fay B. Horak, PhD; Michael S. Okun, MD; Kelly D. Foote, MD; Paul Krack, MD, PhD; Rajesh Pahwa, MD; Jaimie M. Henderson, MD; Marwan I. Hariz, MD, PhD; Roy A. Bakay, MD; Ali Rezai, MD; William J. Marks Jr, MD; Elena Moro, MD, PhD; Jerrold L. Vitek, MD, PhD; Frances M. Weaver, PhD; Robert E. Gross, MD, PhD; Mahlon R. DeLong, MD
Arch Neurol. Published online October 11, 2010. doi:10.1001/archneurol.2010.260
Objective To provide recommendations to patients, physicians, and other health care providers on several issues involving deep brain stimulation (DBS) for Parkinson disease (PD).
Data Sources and Study Selection An international consortium of experts organized, reviewed the literature, and attended the workshop. Topics were introduced at the workshop, followed by group discussion. Data Extraction and Synthesis A draft of a consensus statement was presented and further edited after plenary debate. The final statements were agreed on by all members. [The formatting below is a change I made to make it easier to read.] Conclusions (1) Patients with PD without significant active cognitive or psychiatric problems who have medically intractable motor fluctuations, intractable tremor, or intolerance of medication adverse effects are good candidates for DBS. (2) Deep brain stimulation surgery is best performed by an experienced neurosurgeon with expertise in stereotactic neurosurgery who is working as part of a interprofessional team. (3) Surgical complication rates are extremely variable, with infection being the most commonly reported complication of DBS. (4) Deep brain stimulation programming is best accomplished by a highly trained clinician and can take 3 to 6 months to obtain optimal results. (5) Deep brain stimulation improves levodopa-responsive symptoms, dyskinesia, and tremor; benefits seem to be long-lasting in many motor domains. (6) Subthalamic nuclei DBS may be complicated by increased depression, apathy, impulsivity, worsened verbal fluency, and executive dysfunction in a subset of patients. (7) Both globus pallidus pars interna and subthalamic nuclei DBS have been shown to be effective in addressing the motor symptoms of PD. (8) Ablative therapy is still an effective alternative and should be considered in a select group of appropriate patients. "
