====== Deep brain stimulation for Parkinson's disease Indications ======

[[Deep brain stimulation]] is an established and [[evidence-based]] therapeutic option for the [[treatment]] of advanced [[Parkinson's disease]]. Main [[indication]] and [[inclusion criteria]] are the presence of [[idiopathic Parkinsonism]] with motor fluctuations and/or [[dyskinesia]]s and/or with medication refractory [[tremor]], a significant improvement of [[akinesia]]/[[rigidity]] in response to [[dopa]]minergic [[medication]], the absence of relevant [[cognitive deficit]]s and other significant comorbidities. DBS neurosurgery has a low risk of [[complication]]s. The clinical programming should follow an established [[monopolar review]] [[algorithm]]. Regular follow-up visits are required for [[stimulation]] [[monitoring]]
((Nikolov P, Groiss SJ, Schnitzler A. Tiefe Hirnstimulation bei Morbus Parkinson [Deep brain stimulation for Parkinson's disease]. Fortschr Neurol Psychiatr. 2021 Jan;89(1-02):56-65. German. doi: 10.1055/a-1260-0401. Epub 2021 Jan 19. PMID: 33465811.)).
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The results indicate that the patients' age, rather than disease duration (DD), has a negative effect on the levodopa response (LR). 
Therefore, patients with an advanced age and with a poor LR are not good candidates 
((Aygun D, Kocabicak E, Yildiz MO, Temel Y. Effect of Age and Disease Duration
on the Levodopa Response in Patients with Advanced Parkinson's Disease for Deep
Brain Stimulation of the Subthalamic Nucleus. Front Neurol. 2016 Jun 27;7:97.
doi: 10.3389/fneur.2016.00097. eCollection 2016. PubMed PMID: 27445964; PubMed
Central PMCID: PMC4921481.
)).

It is only beneficial to some elderly PD patients aged 70 years or older. Tremor, axial dysfunctions and drug-induced dyskinesia are the main indications for the elderly; however, their clinical benefits are inferior to those of younger patients
((Chiou SM. Benefits of subthalamic stimulation for elderly parkinsonian
patients aged 70 years or older. Clin Neurol Neurosurg. 2016 Jul 29;149:81-86.
doi: 10.1016/j.clineuro.2016.07.028. [Epub ahead of print] PubMed PMID: 27494146.
)).