Deep brain stimulation in movement disorders

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By Vikas Kotagal MD, Kelly Collins BS, Parag G Patil MD PhD, and Kelvin L Chou MD

Dr. Vikas Kotagal, Dr. Parag Patil, and Dr. Kelvin Chou, all from the University of Michigan, briefly review the basics regarding the surgical treatment of deep brain stimulation in movement disorders such as Parkinson disease, essential tremor, dystonia, and Tourette syndrome. In this clinical summary, they address patient selection, surgical procedure, programming, and postoperative medical management in deep brain stimulation for these disorders. They also cover clinical outcomes and prognosis of deep brain stimulation.

Key points

  • Deep brain stimulation is a FDA-approved therapy for Parkinson disease, tremor, and dystonia. The goal of deep brain stimulation is to improve quality of life and improve ability to function.
  • In Parkinson disease, deep brain stimulation is considered when patients have intolerable wearing-off, motor fluctuations, or dyskinesias despite optimal medical management or, alternatively, medication-refractory tremor.
  • In essential tremor, deep brain stimulation is considered when patients have tremor that is disabling and unresponsive to medical therapies.
  • In dystonia, deep brain stimulation is considered in patients with significant disability from their dystonia who have failed medical therapy. Primary dystonias tend to respond better than secondary dystonias. Dystonia patients with fixed dystonic postures are not candidates.
  • Dementia and untreated depression are contraindications to deep brain stimulation.