Barbosa Renata Montes Garcia, Soares Miriam Carvalho, Portela Denise Maria Meneses Cury, Guimarães Thiago Gonçalves, Cury Rubens Gisbert
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil.
Movement Disorders Center, Department of Neurology, School of Medicine, Centro Universitário Uninovafapi (UNINOVAFAPI), Teresina 64073505, Brazil.
Brain Sci. 2024 Jun 26;14(7):638. doi: 10.3390/brainsci14070638.
Deep Brain Stimulation (DBS) is an effective treatment option for patients with dopaminergic complications of Parkinson's disease (PD) and drug-refractory PD tremor. However, DBS and its indications can be challenging, and they are not often debated in the medical community. Through a critical narrative review, the objective of this paper is to improve the comprehension of DBS indications and help to solve the puzzle that this process can be. Proper patient selection is the first step for a good surgical outcome. In this review, then, relevant considerations are discussed, involving PD genes, PD phenotypes, indications of early stages, non-motor symptoms, neuroimaging predictors, comorbidities, and age. Individualized approaches are encouraged, including clinical and radiological factors. Social support during the whole follow-up and expectations alignment are necessary through this process and are also debated.
深部脑刺激（DBS）是帕金森病（PD）多巴胺能并发症患者和药物难治性PD震颤患者的一种有效治疗选择。然而，DBS及其适应症可能具有挑战性，并且在医学界并不常被讨论。通过一篇批判性叙述性综述，本文的目的是提高对DBS适应症的理解，并帮助解决这一过程可能存在的难题。正确的患者选择是取得良好手术效果的第一步。因此，在本综述中，讨论了相关的考虑因素，包括PD基因、PD表型、早期阶段的适应症、非运动症状、神经影像学预测指标、合并症和年龄。鼓励采用个体化方法，包括临床和放射学因素。在整个随访过程中提供社会支持以及使期望保持一致在这个过程中是必要的，并且也进行了讨论。
