Artikel
Deep brain stimulation for Parkinson’s disease is a multicenter task
Tiefenhirnstimulation bei Morbus Parkinson : eine multizentrische Aufgabe
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Autoren
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C. Kappus
- Klinik für Neurochirurgie der Philipps-Universität Marburg
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D. Hellwig
- Klinik für Neurochirurgie der Philipps-Universität Marburg
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F. Sixel-Döring
- Paracelsus-Elena-Klinik Kassel
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H. Bertalanffy
- Klinik für Neurochirurgie der Philipps-Universität Marburg
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
Parkinson’s disease (PD) is a common neurodegenerative disease that affects approximately 150.000 to 200.000 patients in Germany at any one time. In accordance with the inclusion and exclusion criteria, deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a valid treatment option for patients suffering advanced PD. The success rates depend on the well-circumscribed indication as well as on the quality of the surgical procedure and the individually adapted postoperative medical care of the patients.
Methods
104 patients (144 electrodes) with different central movement disorders were operated on using deep brain stimulation (Vim, GPi, STN). 26 patients of those with PD were evaluated for deep brain stimulation in a highly specialized neurological centre for PD. All patients underwent bilateral DBS of the STN. Target calculation was done by CCT/MRI image-fusion using the frame-link software, microrecording and macrostimulation (Medtronic Co.). Intraoperative neurological examinations and postoperative adjustment of the stimulation parameters, medical treatment and long-term follow-up’s were carried out by the neurological specialists.
Results
24 (92.3%) cases showed a continuing decrease of fluctuations and dyskinesias after electrode placement. A significant improvement of UPDRS part 3 in the defined drug-off state could be assessed, reproducible in examinations 2¾ years after surgery. In two cases a cognitive alteration could be detected, both patients had CSF protein patterns typical for a secondary Lewy-body-dementia. There was one intraoperative haemorrhage followed by a permanent paresis and one rejection response against the implanted material.
Conclusions
Deep brain stimulation of the STN has been effective in more than 90 % of our patients. The good results are dependent on the refinements of the operative technique including image-fusion, microrecording and macrostimulation. However, the preoperative evaluation of patients, who are suitable candidates for DBS and the problems of postoperative short and long-term management can only be solved by a close cooperation between the neurosurgical unit and the neurological centre for PD.
