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Deep brain stimulation for Parkinson's disease
Department of Clinical Neuroscience, University Hospital of Umeå, Umeå, Sweden; 2UCL-Queen Square Institute of Neurology, London, UK.ORCID-id: 0000-0001-5930-6037
Department of Clinical Neuroscience, University Hospital of Umeå, Umeå, Sweden.
2022 (Engelska)Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 292, nr 5, s. 764-778Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia-thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long-lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow-up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2022. Vol. 292, nr 5, s. 764-778
Nyckelord [en]
Parkinson's disease, deep brain stimulation, globus pallidus, pallidotomy, subthalamic nucleus, thalamotomy
Nationell ämneskategori
Neurologi
Forskningsämne
neurokirurgi
Identifikatorer
URN: urn:nbn:se:umu:diva-202373DOI: 10.1111/joim.13541ISI: 000823519000001PubMedID: 35798568Scopus ID: 2-s2.0-85134057831OAI: oai:DiVA.org:umu-202373DiVA, id: diva2:1724845
Tillgänglig från: 2023-01-09 Skapad: 2023-01-09 Senast uppdaterad: 2023-01-09Bibliografiskt granskad

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