[ XXXX : deep brain stimulation]

@entity1 @entity14243 @entity303 @entity910 @entity191 @entity1726 @entity400
The effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the internal pallidum ( @entity14243 ) on the @entity191 triad and on levodopa-induced @entity910 are very similar. The antiakinetic effect of STN DBS seems to be slightly better. On the contrary to pallidal DBS, stimulation of the STN allows to reduce dopaminergic treatment by more than 50p.100 on average. Moreover, the current drain is smaller in STN. Thus, the STN is a low budget target compared to the @entity14243 . STN DBS seems to be as effective on @entity1726 @entity400 as stimulation of the classic thalamic target, the ventral intermediate nucleus (Vim), whereas Vim stimulation has no effect on @entity910 and very little on levodopa-induced @entity910 . Thus, the STN has become the main target nucleus for DBS in @entity1726 , which is most often performed bilaterally in one surgical procedure. There is a good correlation of the preoperative response to levodopa and postoperative effects of bilateral STN DBS and this defines the @entity1 population. Given the large @entity1 population, simple guidelines for @entity1 selection are developed. The referring physician can preselect @entity1 based mainly on age (less than 70), absence of @entity303 and presence of severe disability related to motor fluctuations or @entity910 . It is the responsibility of the operating centre to determine the levodopa response, to confirm the diagnosis, to rule out contraindications and to make sure that the medical treatment cannot be further optimised. Severe surgical complications with permanent sequels are relatively rare, about 1p.100 per implanted side. The @entity1 selection, the precision of the surgery and the quality of the postoperative follow-up are the three main determinants of success.
