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Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders

Deep brain stimulation (DBS) is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in “deep” structures within the brain with targets varying depending on the surgical indication....

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Detalles Bibliográficos
Autores principales: Nagy, Adam M., Tolleson, Christopher M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187560/
https://www.ncbi.nlm.nih.gov/pubmed/27740598
http://dx.doi.org/10.3390/brainsci6040046
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author Nagy, Adam M.
Tolleson, Christopher M.
author_facet Nagy, Adam M.
Tolleson, Christopher M.
author_sort Nagy, Adam M.
collection PubMed
description Deep brain stimulation (DBS) is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in “deep” structures within the brain with targets varying depending on the surgical indication. An implanted programmable pulse generator supplies the electrodes with a chronic, high frequency electrical current that clinically mimics the effects of ablative lesioning techniques. DBS’s efficacy has been well established for its movement disorder indications (Parkinson’s disease, essential tremor, and dystonia). However, clinical outcomes are sometimes suboptimal, even in the absence of common, potentially reversible complications such as hardware complications, infection, poor electrode placement, and poor programming parameters. This review highlights some of the rescue procedures that have been explored in suboptimal DBS cases for Parkinson’s disease, essential tremor, and dystonia. To date, the data is limited and difficult to generalize, but a large majority of published reports demonstrate positive results. The decision to proceed with such treatments should be made on a case by case basis. Larger studies are needed to clearly establish the benefit of rescue procedures and to establish for which patient populations they may be most appropriate.
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spelling pubmed-51875602016-12-30 Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders Nagy, Adam M. Tolleson, Christopher M. Brain Sci Review Deep brain stimulation (DBS) is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in “deep” structures within the brain with targets varying depending on the surgical indication. An implanted programmable pulse generator supplies the electrodes with a chronic, high frequency electrical current that clinically mimics the effects of ablative lesioning techniques. DBS’s efficacy has been well established for its movement disorder indications (Parkinson’s disease, essential tremor, and dystonia). However, clinical outcomes are sometimes suboptimal, even in the absence of common, potentially reversible complications such as hardware complications, infection, poor electrode placement, and poor programming parameters. This review highlights some of the rescue procedures that have been explored in suboptimal DBS cases for Parkinson’s disease, essential tremor, and dystonia. To date, the data is limited and difficult to generalize, but a large majority of published reports demonstrate positive results. The decision to proceed with such treatments should be made on a case by case basis. Larger studies are needed to clearly establish the benefit of rescue procedures and to establish for which patient populations they may be most appropriate. MDPI 2016-10-08 /pmc/articles/PMC5187560/ /pubmed/27740598 http://dx.doi.org/10.3390/brainsci6040046 Text en © 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Nagy, Adam M.
Tolleson, Christopher M.
Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders
title Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders
title_full Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders
title_fullStr Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders
title_full_unstemmed Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders
title_short Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders
title_sort rescue procedures after suboptimal deep brain stimulation outcomes in common movement disorders
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187560/
https://www.ncbi.nlm.nih.gov/pubmed/27740598
http://dx.doi.org/10.3390/brainsci6040046
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