Update on surgery for Parkinson's disease.

PURPOSE OF REVIEW

The clinical effectiveness and limitations of subthalamic nucleus deep brain stimulation for Parkinson's disease are summarized and recent developments concerning alternative brain targets for deep brain stimulation or restorative surgical therapies are discussed.

RECENT FINDINGS

In a controlled study subthalamic nucleus deep brain stimulation was superior to best medical management in improving quality of life of patients with advanced Parkinson's disease. The benefits of the procedure on levodopa-sensitive motor symptoms are sustained for up to 5 years, but it does not halt disease progression. Cognitive decline and worsening of axial motor symptoms may limit the overall benefit. Age at the time of surgery is an important factor for long-term stability and safety. Psychosocial aspects of Parkinson's disease can profoundly impact on the ability of a patient to reintegrate after surgery and have to be considered in patient selection. Stimulation of the pedunculopontine nucleus may have an additive effect on postural and gait symptoms, which do not respond to levodopa or subthalamic nucleus deep brain stimulation.

SUMMARY

Deep brain stimulation is emerging from an empirical to an evidence based therapy. The safety and efficacy of the procedure may legitimize surgery at a younger age before social maladjustment prevents reintegration of the patient into a normal life.