Post-Operative Management of Parkinson Patients with Deep Brain Stimulation

Abstract

Oral medication still remains the mainstay for treating Parkinson’s disease (PD). Since the introduction in the late 60ies levodopa is regarded as the gold standard because of the best efficacy on akinesia and rigidity compared to other drugs like dopamine agonists or anticholinergics (Poewe et al., 2010). However, oral dopaminergic treatment of motor symptoms is complicated by the development of motor fluctuations and dyskinesias. These complications can be observed in 40 % after 5 years and 80 % after 10 years PD duration. Moreover, tremor can be refractory to oral medication. During the past 15 years deep brain stimulation (DBS) has become an important therapeutic option for patients with these motor complications. DBS has been approved in Europe for the treatment of tremor in 1995 and for advanced PD in 1998. Approval by the Food and Drug Administration (FDA) was given for tremor in 1997 and for advanced PD in 2002. The main targets for DBS are the subthalamic nucleus (STN), the internal globus pallidus (GPi) and the ventral intermediate (Vim) thalamic nucleus. DBS is a symptomatic treatment and does not influence the progression of the disease (Hilker et al., 2005). Therefore, the number of patients eligible for DBS is limited. Experts estimate that some 10 to 15 % of PD patients are suitable candidates. The implantation of stimulation electrodes is not therapeutic in itself. Apart from the precise electrode localization the subsequent programming of optimal stimulation parameters and adjustment of medication is mandatory (Deuschl et al., 2006). An increasing number of PD patients are treated by DBS so that more and more doctors and care givers involved in the treatment of PD patients are regularly concerned with the special demands of these patients. The following chapter gives an overview on specific issues in the post-operative management of PD patients with DBS.