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What is the best treatment for fluctuating Parkinson’s disease: continuous drug delivery or deep brain stimulation of the subthalamic nucleus?

  • Movement Disorders - Review Article
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Abstract

Motor complications impair quality of life and cause severe disability in patients with advanced Parkinson’s disease (PD). Since they are often refractory to medical therapy, interventional therapies have been developed, which can provide a considerable reduction of daily off-time and dopaminergic dyskinesias. Continuous dopaminergic drug delivery (CDD) is based on the steady stimulation of striatal dopamine receptors by subcutaneous apomorphine or duodenal l-DOPA infusions via portable minipumps. Advances in the understanding of basal ganglia functioning and in neurosurgical, electrophysiological and neuroimaging techniques have led to a renaissance of neurosurgery for advanced PD. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is the most invasive procedure promising great benefit and the highest level of independency for suitable patients, but is definitely associated with surgical risks and DBS-related side effects. Each of these more or less invasive therapy options has its own profile, and a thorough consideration of its advantages and drawbacks for the individual situation is mandatory. In this paper, we summarize relevant facts for this decision and provide some guidelines for a responsible counseling of eligible patients.

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Acknowledgments

This manuscript summarizes the debate “What is the best treatment for advanced fluctuating PD?” on the 3rd World Congress on Controversies in Neurology (CONy) held on 8–11 October 2009 in Prague. We thank Prof. Amos D. Korczyn for his support.

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Authors and Affiliations

  1. Department of Neurology, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany

    Rüdiger Hilker

  2. RCCS San Camillo Venice, Venice, Italy

    Angelo Antonini

  3. University of Padua, Padua, Italy

    Angelo Antonini

  4. Department of Neurology, Lund University Hospital, Sweden and Central Hospital, Bremerhaven, Germany

    Per Odin

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  1. Rüdiger Hilker
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  2. Angelo Antonini
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  3. Per Odin
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Correspondence to Rüdiger Hilker.

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Hilker, R., Antonini, A. & Odin, P. What is the best treatment for fluctuating Parkinson’s disease: continuous drug delivery or deep brain stimulation of the subthalamic nucleus?. J Neural Transm 118, 907–914 (2011). https://doi.org/10.1007/s00702-010-0555-8

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