Deep brain stimulation: postoperative issues
Günther Deuschl (1), Jan Herzog (1), Galit Kleiner-Fisman (2), Cynthia Kubu (3), Andrés M. Lozano (4), Kelly E. Lyons (5), María C. Rodríguez-Oroz (6), Filippo Tamma (7), Alexander I. Tröster (8), Jerrold L. Vitek (3), Jens Volkmann (1), Valerie Voon (9)
(1) Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
(2) Department of Neurology, Philadelphia VA Hospital, Philadelphia, Pennsylvania, USA
(3) Center for Neurological Restoration, Cleveland Clinic Foundation, Cleveland, Ohio, USA
(4) Department of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
(5) Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
(6) Department of Neurology and Neurosurgery, University of Navarra, Pamplona, Navarra, Spain
(7) Department of Neurology, Ospedale San Paolo, Milano, Italy
(8) Department of Neurology, University of North Carolina, Chapel Hill, North Carolina, USA
(9) National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
Numerous factors need to be taken into account when managing a patient with Parkinson's disease (PD) after deep brain stimulation (DBS). Questions such as when to begin programming, how to conduct a programming screen, how to assess the effects of programming, and how to titrate stimulation and medication for each of the targeted sites need to be addressed. Follow-up care should be determined, including patient adjustments of stimulation, timing of follow-up visits and telephone contact with the patient, and stimulation and medication conditions during the follow-up assessments.
A management plan for problems that can arise after DBS such as weight gain, dyskinesia, axial symptoms, speech dysfunction, muscle contractions, paresthesia, eyelid, ocular and visual disturbances, and behavioral and cognitive problems should be developed. Long-term complications such as infection or erosion, loss of effect, intermittent stimulation, tolerance, and pain or discomfort can develop and need to be managed. Other factors that need consideration are social and job-related factors, development of dementia, general medical issues, and lifestyle changes. This report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society, outlines answers to a series of questions developed to address all aspects of DBS postoperative management and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors.
The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery.
CITATION Mov Disord. 2006 Jun;21 Suppl 14:S219-37