Parkinson’s disease DBS: what, when, who and why? The time has come to tailor DBS targets.
Parkinson’s disease DBS: what, when, who and why? The time has come to tailor DBS targets.
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DOI：
10.1586/ern.10.156
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发表时间：
2010-12
影响因子：
4.3
通讯作者：
Foote KD
中科院分区：
文献类型：
--
作者：
Okun MS;Foote KD
脑深部电刺激（DBS）最近已被证明是一种有效的治疗帕金森病的药物难治性症状。随着证据基础的不断发展，许多重要的问题已经浮出水面，包括：应该进行什么样的手术（大脑目标，单侧与双侧，同时与分期）;何时手术（多早干预太早？），应该对谁进行手术（疾病持续时间、年龄、症状特征和跨学科筛查小组的使用）;最后，为什么进行手术（手术与药物/阿扑吗啡泵/多多巴泵/干细胞试验/基因治疗试验的理由）。我们将解决这些关键问题中的每一个，并提出一个论点，即DBS和DBS目标的定制方法将最好地服务于每个潜在的候选人。我们将回顾多项同行评审研究，并强调随机DBS研究的最近可用数据。我们将争辩说，远离一个单一的DBS目标（例如，丘脑底核DBS）和DBS方法学的单一途径（例如，双侧同时手术）是帕金森病社区合理的下一步。在仔细的跨学科DBS筛选之后，医生-患者讨论有可能为每个潜在的DBS候选人建立以患者为中心的和特定于DBS的结果。跨学科的DBS团队可以共同制定和考虑最佳且量身定制的方法。量身定制的方法将允许考虑可能导致正面或负面总体DBS结局的复杂和众多变量。我们将审查并提供专家评论的一个潜在的跨学科的方法来选择单侧或双侧丘脑底核或苍白球内DBS。我们的方法旨在最大限度地提高收益并最大限度地降低风险，以便为个体患者提供最佳的治疗方案。
Deep brain stimulation (DBS) has recently been proven to be an effective therapy for medication-refractory symptoms of Parkinson’s disease. As the evidence base continues to evolve, many important issues have surfaced, including: what operation should be performed (brain target[s], unilateral vs bilateral, simultaneous vs staged); when to operate (how early is too early to intervene?), who should be operated on (disease duration, age, symptom profiles and the use of the interdisciplinary screening team); and finally, why to operate (the rationale of surgery vs medication/apomorphine pumps/duodopa pumps/stem cell trials/gene therapy trials). We will address each of these critical issues, as well make the argument that a tailored approach to DBS and DBS targeting will best serve each potential candidate. We will review the multiple peer-reviewed studies and we will emphasize the recently available data from randomized DBS studies. We will argue that moving away from a single DBS target (e.g., subthalamic nucleus DBS) and a single approach to DBS methodology (e.g., bilateral simultaneous operations) is a reasonable next step for the Parkinson’s disease community. Following careful interdisciplinary DBS screening, a physician–patient discussion has the potential to establish a patient-centered and symptom-specific outcome for each potential DBS candidate. The interdisciplinary DBS team can function together to formulate and to consider an optimal and tailored approach. A tailored approach will allow for the consideration of the complex and numerous variables that may contribute to a positive or negative overall DBS outcome. We will review and provide expert commentary on a potential interdisciplinary approach to selecting unilateral or alternatively bilateral subthalamic nucleus or globus pallidus internus DBS. Our approach is aimed to maximize benefit(s) and minimize risk(s) in order to best tailor therapy for an individual patient.
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影响因子：
11.2
作者：
Okun, Michael S.;Fernandez, Hubert H.;Wu, Samuel S.;Kirsch-Darrow, Lindsey;Bowers, Dawn;Bova, Frank;Suelter, Michele;Jacobson, Charles E.;Wang, Xinping;Gordon, Clifford W., Jr.;Zeilman, Pam;Romrell, Janet;Martin, Pam;Ward, Herbert;Rodriguez, Ramon L.;Foote, Kelly D.
通讯作者：
Foote, Kelly D.
影响因子：
158.5
作者：
Follett, Kenneth A.;Weaver, Frances M.;Reda, Domenic J.
通讯作者：
Reda, Domenic J.
影响因子：
5.7
作者：
Mikos, A;Bowers, D;Noecker, A M;McIntyre, C C;Won, M;Chaturvedi, A;Foote, K D;Okun, M S
通讯作者：
Okun, M S
影响因子：
4.1
作者：
Mikos, Ania;Pavon, Juliessa;Okun, Michael S.
通讯作者：
Okun, Michael S.
影响因子：
5.3
作者：
Alberts, Jay L.;Hass, Christopher J.;Vitek, Jerrold L.;Okun, Michael S.
通讯作者：
Okun, Michael S.