Authors' objectives:

To assess the efficacy, safety and surgical technique of deep brain stimulation (DBS) to treat idiopathic Parkinson's disease.

Authors' results and conclusions: (i)Definition: High frequency deep brain stimulation (DBS) is a form of functional stereotactic surgery which offers an alternative to lesional surgery. It involves implanting electrodes to stimulate one of the three target nuclei in the brain: the ventral intermediate nucleus of the thalamus (VIM), the globus pallidus internus (Gpi) and the subthalamic nucleus (STN). (ii) Studies selected: Three summary reviews and 10 clinical trials of a low level of evidence (3 randomised controlled trials (lesional surgery vs DBS); 2 non-randomised trials comparing stimulation of the Gpi and STN; the remainder were case series). (iii) Indications: DBS is restricted to patients suffering from severe Parkinson's disease who no longer respond to medical treatment, but who nevertheless retain good sensitivity to levadopa therapy and sufficiently good general and mental health to allow them to undergo surgery. (iv) Efficacy and safety: DBS has been shown to be feasible, but it is not yet possible to draw conclusions concerning its theoretical advantages (efficacy compared with lesional surgery or with optimum medical therapy, the possibility of bilateral stimulation without increasing the complications, and its reversibility) or its benefit-risk ratio. (v) Implementation: DBS consists of a complex sequence of diagnostic and therapeutic actions which are specific to each of the French centres. Surgery has to be carried out in a hospital with appropriate high-technology equipment and an experienced multidisciplinary team with the right skills.

Authors' recommendations: (i) A longitudinal prospective cohort study needs to be carried out with the participation of all the French centres to monitor the results from current practice. (ii) Multicentre, randomised controlled trials to be carried out: first of all, a randomised clinical trial comparing DBS with the best medical management, followed by trials to determine the best target nucleus and the best surgical technique. (iii) Awareness needs to be raised among the different teams to encourage them to improve their reporting of medical device vigilance incidents.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: L'Agence Nationale d'Accreditation d'Evaluation en Sante (ANAES)