Am I being too hasty in seeing problems with this article, and wondering about it. I do not have a DBS myself, and do not wish to have one, but have been following information about it for a while.

Lindy,
Not at all. We need to challenge the information we’re provided with, especially when there seem to be discrepancies. I had the opportunity to read the original journal article, and thought that important details were left out of many of the news stories. And while there was some consensus noted, there were also areas where they coul not come to agreement on the best DBS candidates, surgical techniques and results. (after some 70,000 patients have had the surgery). The article does not seem to be freely available online yet.

If anyone would like a copy of the journal article, in Archives of Neurology) you can contact me offline


From: “Deep Brain Stimulation for Parkinson Disease
An Expert Consensus and Review of Key Issues”
in Archives of Neurology, online, Oct 11, 2010


The discussion Panel consisted of :" 33 neurologists, 13 neurosurgeons, a psychiatrist, a speech researcher, 2 neuropsychologists, a rehabilitation specialist, and a research scientist). Not one patient!

Who funded the study?
Funding/Support: by The Parkinson Alliance but also received funding from the Davis Phinney Foundation, National Parkinson’s Disease Foundation, the Lee Silverman Voice Treatment Foundation; and the National Institutes of Health .
Outcomes –There was little consensus on targeted area, surgical techniques, effects and measuring of cognitive problems, etc. The experience and skill of the surgeon and programmer was the best predictor of the outcome.
Although it seemed in recent years that many earlier stage patients were being encouraged to have dbs “sooner, not later, This study did not report any evidence for early dbs. “It is appropriate for advanced pD.”

And stated, "There is currently no evidence of a neuroprotective effect of DBS to provide a clear rationale for earlier DBS surgery."
Also:” PD continues to progress after DBS, and there is little evidence that DBS alters disease progression. Over time, patients who have DBS often develop LD-resistant symptoms including freezing of gait, postural instability, and cognitive decline."

On Surgical technique: " surgical techniques for implanting DBS devices are constantly evolving, and surgeons select their preferred technique based on training, experience, and the capabilities of their institution. There are few studies that have directly compared the safety or effectiveness of various surgical techniques. Thus, the best technique for performing DBS surgery remains a source of debate"

Complications:
" The rates of surgical complications are quite variable in the literature and include intracranial hemorrhage (0%-10%), stroke (0%-2%), infection (0%-15%), lead erosion without infection (1%-2.5%), lead fracture (0%-15%), lead migration (0%-19%), and death (0%-4.4%)"

"there is a critical need for prospective standardized reporting of complications."

This report is a beginning in providing evidence based information about DBS, but it I s not the final word.
They also reported, contrary to what many of us were told in the past that MRIs should be ok following DBS.

"The group recommended additional studies and discussions with the Food and Drug Administration and Medtronic to potentially modify the restrictive recommendations and allow for more flexibility in MR scanning. There were no issues of concern with respect to current induction, device functionality, and magnetic field interactions with DBS systems.


Finally, it was reported that “Ablative therapy (e.g. pallidotomy) is still an effective alternative and should be re-considered in a select group of appropriate patients." These types of surgical treatment in which brain tissue in the globus pallidus was destroyed by heat, were used before DBS was available. Unlike DBS, this was a permanent change, and are rarely performed now. The report however states they might be reconsidered…

"Although thalamotomy and pallidotomy have been largely abandoned and replaced by DBS, ablative therapies may yet have a role in certain patients such as those with an increased risk of infection or a history of recurrent infection of their DBS systems; with limited access to centers specializing in DBS surgery; and not desiring implanted hardware, as well as being unwilling to commit to long-term programming. Potential disadvantages of ablative surgery include mistargeted lesions with permanent neurological deficit(s), suboptimal benefits requiring repeat procedures, and risk of bilateral lesions.”

Hoping the near future brings better options....