Ont Health Technol Assess Ser. 2005;5(2):1-56. Epub 2005 Mar 1.
To determine the effectiveness and adverse effects of deep brain stimulation (DBS) in the treatment of symptoms of idiopathic Parkinson's disease, essential tremor, and primary dystonia and to do an economic analysis if evidence for effectiveness is established.
Deep brain stimulation (DBS) is a surgical procedure indicated in the relief of motor function symptoms of Parkinson's disease, essential tremor and dystonia. It involves the surgical implantation of the DBS device, which include the implantable pulse generator or stimulator, the extension, and the lead. The electric impulse is produced within the stimulator component, and transmitted to the brain site by the extension and the lead(s). DBS surgery can be either unilateral or bilateral. The laterality of the surgery and target area for brain stimulation may vary with the type of symptom or spectrum of symptoms, and such decisions are made on a case-by-case basis. Advantages of DBS over ablative surgery is that it is comparatively less invasive, it is reversible, and it allows for stimulation of both sides of the brain. Ablative surgery, which is not practiced in Ontario, results in a non-reversible lesion and is often not conducted on both sides. Thus far, DBS has been considered as an adjunct to drug therapy.
The standard Medical Advisory Secretariat search strategy was conducted to identify international health technology assessments and English language journal articles published from January 1, 2001 onwards. Documents were reviewed separately for Parkinson's disease, essential tremor and primary dystonia.
There is level 1b evidence that bilateral DBS of the subthalamic nucleus is effective in the short-term control of advanced parkinsonian symptoms, and there is level 3a evidence that the effect is sustained for at least 5 years. There is Level 3a evidence that DBS of the thalamus is effective in the control of tremor in patients with essential tremor and PD for at least 6 years. There is level 3a evidence that bilateral DBS of the globus pallidus is effective in the control of symptoms of primary dystonia for at least 1 year.
According to the estimates of prevalence and evidence of effectiveness, there is a shortfall in the numbers of DBS currently done in Ontario for drug-resistant PD, essential tremor, and primary dystonia.Since complication rates are lower if DBS is performed in specialized centres, the number of sites should be limited.The cost per procedure to institutions with the expertise to undertake DBS and the human resource considerations are likely to be limiting factors in the further diffusion of DBS.
确定深部脑刺激（DBS）治疗特发性帕金森病、特发性震颤和原发性肌张力障碍症状的有效性和不良反应，并在确立有效性证据后进行经济分析。
深部脑刺激（DBS）是一种用于缓解帕金森病、特发性震颤和肌张力障碍运动功能症状的外科手术。它涉及DBS设备的外科植入，该设备包括植入式脉冲发生器或刺激器、延长线和电极。电脉冲在刺激器组件内产生，并通过延长线和电极传输到脑区。DBS手术可以是单侧的，也可以是双侧的。手术的侧别和脑刺激的目标区域可能因症状类型或症状谱而异，此类决定需逐案做出。DBS相对于毁损性手术的优势在于其侵入性相对较小、具有可逆性，并且能够刺激双侧大脑。毁损性手术在安大略省并不施行，会导致不可逆的损伤，且通常不进行双侧手术。迄今为止，DBS一直被视为药物治疗的辅助手段。
采用标准的医学咨询秘书处检索策略，以识别2001年1月1日起发表的国际卫生技术评估和英文期刊文章。分别对帕金森病、特发性震颤和原发性肌张力障碍的文献进行综述。
有1b级证据表明，双侧丘脑底核DBS在短期控制晚期帕金森症状方面有效，且有3a级证据表明该效果至少持续5年。有3a级证据表明，丘脑DBS在控制特发性震颤和帕金森病患者的震颤方面至少6年有效。有3a级证据表明，双侧苍白球DBS在控制原发性肌张力障碍症状方面至少1年有效。
根据患病率估计和有效性证据，安大略省目前针对耐药性帕金森病、特发性震颤和原发性肌张力障碍进行的DBS手术数量不足。由于在专业中心进行DBS手术的并发症发生率较低，手术地点数量应加以限制。具备DBS专业知识的机构每例手术的成本以及人力资源方面的考虑可能是DBS进一步推广的限制因素。
