Objective: To report recent result of indicative evaluation for deep brain stimulation (DBS) of Parkinson’s disease (PD) patients, ant to investigate relationship between pathological condition and the results.

Background: The most promising effect of DBS is improve motor complication of PD patients by prolong “On” time and diminish dyskinesia. Bilateral subthalamic nucleus DBS (STN-DBS) is superior to bilateral globus pallidus internus DBS (GPi-DBS) in its effect. However, stimulation related complications such as cognitive decline, psychiatric symptoms, axial symptoms worsening are more common with STN-DBS than GPi-DBS. On the other hand, STN-DBS is considered to be more useful in young patients because STN-DBS usually make possible to reduce PD medication.

Methods: 37 patients (20 females and 17 males, averaged age 61.9 years old, and averaged disease duration 10.9 years) who referred to our outpatient department for DBS therapy attended this study.

Results: Four patients were introduced STN-DBS. Thirteen patients were introduced GPi-DBS. The reasons of selection of GPi as target for DBS were cognitive decline in seven, freezing of gait in “Off” time in five, disabling dyskinesia in three and visual hallucination in one patient. Four of patients had more than two reasons. Seventeen patients were not operated. The reasons were active delusion or hallucination in four, cognitive decline in three, suicidal intention or ideation in three, hypersexuality in three, significant disabilities in “On” time in three, insignificant disabilities in “Off” time in three, frequent falls at “On” time in two, comorbidities unrelated to PD in two patients. Nine patients had more than two reasons.

Conclusions: In this series, about 75% of operated patients received GPi-DBS. The reason of choosing GPi as DBS target was related with cognitive function or axial symptoms or dyskinesia or more than two of them. It is considered that symptoms oriented target choice is useful to improve prognosis after introduction of DBS. Nearly half of referred patients were not operated. Most of them had significant psychiatric problem such as suicidal intention, troublesome hypersexuality and active hallucination. It is confirmed uncontrolled non-motor problem can be major limitation of DBS introduction to PD patients of advanced stage.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/recent-result-of-indicative-evaluation-for-deep-brain-stimulation-of-parkinsons-disease-patients/