PD Surgery referrals 2003-2014 Birmingham

Dr Hardev Pall

Why STN DBS PD surgery?

• When motor problems of PD (other than postural instability) become intrusive despite optimal medical treatment.

• How optimal and how extensive? • PPN for postural instability – NOT COVERED

Patient selection for STN stimulation

• Good quality on-phase • Motor fluctuations not controlled by medication • Mental stability – Measured how? • Motor symptoms more disabling than non-motor

ones? • No off-period hallucinations? Evidence? • No severe depression? Local experience • Younger patients with moderate motor disability and

good family support seem to do better

What’s a good candidate?

• At best, 5-8 yrs of PD – maybe even 3-5 yrs? • Under 70 yrs old? With no co-morbidities • Excellent dopa response but not predictable or

sustained • Severe off phase with normal mental function • No depression or psychosis • Little dysarthria • Good compliance with medication • Good family support

Male 37 yrs

• PD with asymmetric tremor 3 yrs • Lots of dystonia – neck, foot, eyes, trunk • “Drugs don’t work” – if I say they work, they

won’t consider me for surgery • Thoughts being inserted into mind – settled

off pramipexole • Rapid pace of progression • Video