Timing of deep brain stimulation in Parkinson's disease: A need for reappraisal?

AuthorsDesouza R, et al. Show all Journal
Ann Neurol. 2013 Mar 8.

Affiliation
Dept. of Clinical Neurosciences, Institute of Neurology, University College London, Rowland Hill St., London NW3 2PF.

Abstract
We review the current application of deep brain stimulation (DBS) in Parkinson's disease (PD) and consider the evidence that earlier use of DBS confers long-term symptomatic benefit for patients compared to best medical therapy. Electronic searches were performed of PubMed, Web of Knowledge, EMBASE, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials to identify all article types relating to the timing of DBS in PD Current evidence suggests that DBS is typically performed in late stage PD, a mean of 14-15 years after diagnosis. Current guidelines recommend that PD patients who are resistant to medical therapies, have significant medication side effects and lengthening off periods, but are otherwise cognitively intact and medically fit for surgery be considered for DBS. If these criteria are rigidly interpreted, it may be that, by the time medical treatment options have been exhausted, the disease has progressed to the point that the patient may no longer be fit for neurosurgical intervention. From the evidence available, we conclude that surgical management of PD alone or in combination with medical therapy results in greater improvement of motor symptoms and quality of life than medical treatment alone. There is evidence to support the use of DBS in less advanced PD and that it may be appropriate for earlier stages of the disease than for which it is currently. The improving short and long term safety profile of DBS makes early application a realistic possibility. ANN NEUROL 2010.

Copyright © 2013 American Neurological Association.
http://www.ncbi.nlm.nih.gov/m/pubmed/23483564/

Which I had mine early on in my disease. This conclusion, earlier is better, can be supported by my experiences. Some early onset patients are extremely sensitive to sinemet. The slightest change in dosage can set them off. To much and they may fall on the floor and experience severe dyskinsias, to the point where they may be placed on a drug holiday. A drug holiday is when they withhold all drugs and start adding a little drugs each day until the patient responds. The patient is put into a medical forced coma state untill they can be taken out of the coma with a responsive state.

The advantage for these patients is to lower their need of Sinemet. My dosage of Sinement, after DBS surgery, was cut down by 2/3rd's prior to DBS. I am in very good shape for the condition I'm in.

Dianna