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Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary.
Neurosurgery. 2018 06 01; 82(6):753-756.N

Abstract

QUESTION 1

Is bilateral subthalamic nucleus deep brain stimulation (STN DBS) more, less, or as effective as bilateral globus pallidus internus deep brain stimulation (GPi DBS) in treating motor symptoms of Parkinson's disease, as measured by improvements in Unified Parkinson's Disease Rating Scale, part III (UPDRS-III) scores?

RECOMMENDATION

Given that bilateral STN DBS is at least as effective as bilateral GPi DBS in treating motor symptoms of Parkinson's disease (as measured by improvements in UPDRS-III scores), consideration can be given to the selection of either target in patients undergoing surgery to treat motor symptoms. (Level I).

QUESTION 2

Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in allowing reduction of dopaminergic medication in Parkinson's disease?

RECOMMENDATION

When the main goal of surgery is reduction of dopaminergic medications in a patient with Parkinson's disease, then bilateral STN DBS should be performed instead of GPi DBS. (Level I).

QUESTION 3

Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in treating dyskinesias associated with Parkinson's disease?

RECOMMENDATION

There is insufficient evidence to make a generalizable recommendation regarding the target selection for reduction of dyskinesias. However, when the reduction of medication is not anticipated and there is a goal to reduce the severity of "on" medication dyskinesias, the GPi should be targeted. (Level I).

QUESTION 4

Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in improving quality of life measures in Parkinson's disease?

RECOMMENDATION

When considering improvements in quality of life in a patient undergoing DBS for Parkinson's disease, there is no basis to recommend bilateral DBS in 1 target over the other. (Level I).

QUESTION 5

Is bilateral STN DBS associated with greater, lesser, or a similar impact on neurocognitive function than bilateral GPi DBS in Parkinson disease?

RECOMMENDATION

If there is significant concern about cognitive decline, particularly in regards to processing speed and working memory in a patient undergoing DBS, then the clinician should consider using GPi DBS rather than STN DBS, while taking into consideration other goals of surgery. (Level I).

QUESTION 6

Is bilateral STN DBS associated with a higher, lower, or similar risk of mood disturbance than GPi DBS in Parkinson's disease?

RECOMMENDATION

If there is significant concern about the risk of depression in a patient undergoing DBS, then the clinician should consider using pallidal rather than STN stimulation, while taking into consideration other goals of surgery. (Level I).

QUESTION 7

Is bilateral STN DBS associated with a higher, lower, or similar risk of adverse events compared to GPi DBS in Parkinson's disease?

RECOMMENDATION

There is insufficient evidence to recommend bilateral DBS in 1 target over the other in order to minimize the risk of surgical adverse events. The full guideline can be found at: https://www.cns.org/guidelines/deep-brain-stimulation-parkinsons-disease.

Authors+Show Affiliations

Neuroscience Institute, Maine Medical Center, Portland, Maine.Department of Neurosurgery, Henry Ford Medical Gr-oup, West Bloomfield, Michigan.De-partment of Neurology and Ophthal-mology, Michigan State University, Michigan.Departments of Neuroscience and Experimental Therapeutics and of Neurosurgery, Albany Medical College, Albany, New York.Center for Movement Disorders and Neurorestoration, Gain-esville, Florida.Department of Neuro-surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.De-partment of Neurosurgery, Wayne State University, Detroit, Michigan.James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio.Neurological Institute, Cleveland Clinic, Cleveland, Ohio.Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado.Department of Neurological Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.Department of Neu-rosurgery, Emory University, Atlanta, Georgia.Division of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massa-chusetts.Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Pub Type(s)

Journal Article
Practice Guideline
Systematic Review

Language

eng

PubMed ID

29538685

Citation

Rughani, Anand, et al. "Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline On Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary." Neurosurgery, vol. 82, no. 6, 2018, pp. 753-756.
Rughani A, Schwalb JM, Sidiropoulos C, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary. Neurosurgery. 2018;82(6):753-756.
Rughani, A., Schwalb, J. M., Sidiropoulos, C., Pilitsis, J., Ramirez-Zamora, A., Sweet, J. A., Mittal, S., Espay, A. J., Martinez, J. G., Abosch, A., Eskandar, E., Gross, R., Alterman, R., & Hamani, C. (2018). Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary. Neurosurgery, 82(6), 753-756. https://doi.org/10.1093/neuros/nyy037
Rughani A, et al. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline On Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary. Neurosurgery. 2018 06 1;82(6):753-756. PubMed PMID: 29538685.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary. AU - Rughani,Anand, AU - Schwalb,Jason M, AU - Sidiropoulos,Christos, AU - Pilitsis,Julie, AU - Ramirez-Zamora,Adolfo, AU - Sweet,Jennifer A, AU - Mittal,Sandeep, AU - Espay,Alberto J, AU - Martinez,Jorge Gonzalez, AU - Abosch,Aviva, AU - Eskandar,Emad, AU - Gross,Robert, AU - Alterman,Ron, AU - Hamani,Clement, PY - 2018/01/04/received PY - 2018/02/07/accepted PY - 2018/3/15/pubmed PY - 2019/9/12/medline PY - 2018/3/15/entrez SP - 753 EP - 756 JF - Neurosurgery JO - Neurosurgery VL - 82 IS - 6 N2 - QUESTION 1: Is bilateral subthalamic nucleus deep brain stimulation (STN DBS) more, less, or as effective as bilateral globus pallidus internus deep brain stimulation (GPi DBS) in treating motor symptoms of Parkinson's disease, as measured by improvements in Unified Parkinson's Disease Rating Scale, part III (UPDRS-III) scores? RECOMMENDATION: Given that bilateral STN DBS is at least as effective as bilateral GPi DBS in treating motor symptoms of Parkinson's disease (as measured by improvements in UPDRS-III scores), consideration can be given to the selection of either target in patients undergoing surgery to treat motor symptoms. (Level I). QUESTION 2: Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in allowing reduction of dopaminergic medication in Parkinson's disease? RECOMMENDATION: When the main goal of surgery is reduction of dopaminergic medications in a patient with Parkinson's disease, then bilateral STN DBS should be performed instead of GPi DBS. (Level I). QUESTION 3: Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in treating dyskinesias associated with Parkinson's disease? RECOMMENDATION: There is insufficient evidence to make a generalizable recommendation regarding the target selection for reduction of dyskinesias. However, when the reduction of medication is not anticipated and there is a goal to reduce the severity of "on" medication dyskinesias, the GPi should be targeted. (Level I). QUESTION 4: Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in improving quality of life measures in Parkinson's disease? RECOMMENDATION: When considering improvements in quality of life in a patient undergoing DBS for Parkinson's disease, there is no basis to recommend bilateral DBS in 1 target over the other. (Level I). QUESTION 5: Is bilateral STN DBS associated with greater, lesser, or a similar impact on neurocognitive function than bilateral GPi DBS in Parkinson disease? RECOMMENDATION: If there is significant concern about cognitive decline, particularly in regards to processing speed and working memory in a patient undergoing DBS, then the clinician should consider using GPi DBS rather than STN DBS, while taking into consideration other goals of surgery. (Level I). QUESTION 6: Is bilateral STN DBS associated with a higher, lower, or similar risk of mood disturbance than GPi DBS in Parkinson's disease? RECOMMENDATION: If there is significant concern about the risk of depression in a patient undergoing DBS, then the clinician should consider using pallidal rather than STN stimulation, while taking into consideration other goals of surgery. (Level I). QUESTION 7: Is bilateral STN DBS associated with a higher, lower, or similar risk of adverse events compared to GPi DBS in Parkinson's disease? RECOMMENDATION: There is insufficient evidence to recommend bilateral DBS in 1 target over the other in order to minimize the risk of surgical adverse events. The full guideline can be found at: https://www.cns.org/guidelines/deep-brain-stimulation-parkinsons-disease. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/29538685/Congress_of_Neurological_Surgeons_Systematic_Review_and_Evidence_Based_Guideline_on_Subthalamic_Nucleus_and_Globus_Pallidus_Internus_Deep_Brain_Stimulation_for_the_Treatment_of_Patients_With_Parkinson's_Disease:_Executive_Summary_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1093/neuros/nyy037 DB - PRIME DP - Unbound Medicine ER -