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Deep Brain Stimulation for Essential Tremor and Parkinson's Disease - Inactivated 04/2005
TA #048; released 01/2000; inactivated 04/2005
Description of Treatment/ProcedureEssential tremor (ET) and Parkinson’s disease (PD) are the two most common movement disorders. Although each may potentially be controlled by medications, some patients are unable to tolerate the medications and, with prolonged use, the medications become less effective and the complications increase. Surgical options include ablative surgery (pallidotomy or thalamotomy) or deep brain stimulation (DBS) via electrodes implanted in the brain. The advantages of DBS are that it is reversible and adjustable; the disadvantages include the cost of the equipment and the need to periodically adjust the stimulation parameters. Committee Summary
With respect to deep brain stimulation (DBS) for essential tremor (ET) and Parkinson’s disease (PD), the ICSI Technology Assessment Committee finds the following:
- DBS offers a reversible, adjustable, and lower risk option to ablative surgery for the control of ET and for the control of tremor and motor disorders in patients with PD. Suitability for DBS must be established on a case-by-case basis following an examination by a movement disorders specialist. DBS involves risks but most of the observed adverse effects have been transient. Higher complication rates are likely with bilateral DBS, especially bilateral DBS of the STN and GPi. In patients with PD, it has not been determined how to identify the most appropriate location for DBS. Long-term follow-up data are limited.
- DBS of the Vim is effective in reducing tremor associated with ET and PD. For ET patients, functional ability is also improved; for PD patients, motor performance is enhanced. For bilateral tremor, DBS should also be bilateral as the effects are observed primarily on the contralateral side. (Conclusion Grade II based on Class D evidence)
- In PD, DBS of the STN is effective in improving motor function and ADL scores and reducing tremor. Bilateral stimulation is superior to unilateral stimulation. (Conclusion Grade II based on Class D evidence)
- In PD, stimulation of the GPi can lead to improved clinical and functional outcomes (including motor function, ADL score, and other symptoms of PD) although the results have been less consistent than with Vim or STN stimulation. (Conclusion Grade II based on Class D evidence)
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