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Choosing the optimal treatment for people with Parkinson disease (PD) can be a challenge for clinicians and patients. Indeed, clinical features and PD phenotype, financial or economic issues, treatment characteristics and availability, and patient choice greatly influence the management of PD. Nevertheless, recent pharmacologic and technological advances have expanded the arsenal to better manage advanced PD.1 In advanced PD, deep brain stimulation (DBS) of both the subthalamic nucleus (STN) and the globus pallidus internus has proved to be highly effective in treating motor signs, including motor fluctuations and medically unresponsive tremor.1 Some open studies have also reported a very long-term efficacy of STN DBS,2 although the magnitude of improvement tends to decline over time, likely reflecting the progression of the disease and the involvement of nondopaminergic pathways. However, DBS therapy remains a complex and invasive therapy, and it is offered to those who meet strict inclusion criteria (absence of cognitive decline and surgical contraindications, presence of levodopa-responsive signs, relatively young age, etc). Moreover, DBS therapy requires centers with highly specialized multidisciplinary teams and experience in the surgery and the follow-up care (battery replacement, etc).3
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
See page 618
- Received November 28, 2022.
- Accepted in final form December 21, 2022.
- © 2023 American Academy of Neurology
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