PMID- 29538685
OWN - NLM
STAT- MEDLINE
DCOM- 20190911
LR  - 20200225
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Print)
IS  - 0148-396X (Linking)
VI  - 82
IP  - 6
DP  - 2018 Jun 1
TI  - Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline 
      on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for 
      the Treatment of Patients With Parkinson's Disease: Executive Summary.
PG  - 753-756
LID - 10.1093/neuros/nyy037 [doi]
AB  - QUESTION 1: Is bilateral subthalamic nucleus deep brain stimulation (STN DBS) 
      more, less, or as effective as bilateral globus pallidus internus deep brain 
      stimulation (GPi DBS) in treating motor symptoms of Parkinson's disease, as 
      measured by improvements in Unified Parkinson's Disease Rating Scale, part III 
      (UPDRS-III) scores? RECOMMENDATION: Given that bilateral STN DBS is at least as 
      effective as bilateral GPi DBS in treating motor symptoms of Parkinson's disease 
      (as measured by improvements in UPDRS-III scores), consideration can be given to 
      the selection of either target in patients undergoing surgery to treat motor 
      symptoms. (Level I). QUESTION 2: Is bilateral STN DBS more, less, or as effective 
      as bilateral GPi DBS in allowing reduction of dopaminergic medication in 
      Parkinson's disease? RECOMMENDATION: When the main goal of surgery is reduction 
      of dopaminergic medications in a patient with Parkinson's disease, then bilateral 
      STN DBS should be performed instead of GPi DBS. (Level I). QUESTION 3: Is 
      bilateral STN DBS more, less, or as effective as bilateral GPi DBS in treating 
      dyskinesias associated with Parkinson's disease? RECOMMENDATION: There is 
      insufficient evidence to make a generalizable recommendation regarding the target 
      selection for reduction of dyskinesias. However, when the reduction of medication 
      is not anticipated and there is a goal to reduce the severity of "on" medication 
      dyskinesias, the GPi should be targeted. (Level I). QUESTION 4: Is bilateral STN 
      DBS more, less, or as effective as bilateral GPi DBS in improving quality of life 
      measures in Parkinson's disease? RECOMMENDATION: When considering improvements in 
      quality of life in a patient undergoing DBS for Parkinson's disease, there is no 
      basis to recommend bilateral DBS in 1 target over the other. (Level I). QUESTION 
      5: Is bilateral STN DBS associated with greater, lesser, or a similar impact on 
      neurocognitive function than bilateral GPi DBS in Parkinson disease? 
      RECOMMENDATION: If there is significant concern about cognitive decline, 
      particularly in regards to processing speed and working memory in a patient 
      undergoing DBS, then the clinician should consider using GPi DBS rather than STN 
      DBS, while taking into consideration other goals of surgery. (Level I). QUESTION 
      6: Is bilateral STN DBS associated with a higher, lower, or similar risk of mood 
      disturbance than GPi DBS in Parkinson's disease? RECOMMENDATION: If there is 
      significant concern about the risk of depression in a patient undergoing DBS, 
      then the clinician should consider using pallidal rather than STN stimulation, 
      while taking into consideration other goals of surgery. (Level I). QUESTION 7: Is 
      bilateral STN DBS associated with a higher, lower, or similar risk of adverse 
      events compared to GPi DBS in Parkinson's disease? RECOMMENDATION: There is 
      insufficient evidence to recommend bilateral DBS in 1 target over the other in 
      order to minimize the risk of surgical adverse events.  The full guideline can be 
      found at: 
      https://www.cns.org/guidelines/deep-brain-stimulation-parkinsons-disease.
FAU - Rughani, Anand
AU  - Rughani A
AD  - Neuroscience Institute, Maine Medical Center, Portland, Maine.
FAU - Schwalb, Jason M
AU  - Schwalb JM
AD  - Department of Neurosurgery, Henry Ford Medical Gr-oup, West Bloomfield, Michigan.
FAU - Sidiropoulos, Christos
AU  - Sidiropoulos C
AD  - De-partment of Neurology and Ophthal-mology, Michigan State University, Michigan.
FAU - Pilitsis, Julie
AU  - Pilitsis J
AD  - Departments of Neuroscience and Experimental Therapeutics and of Neurosurgery, 
      Albany Medical College, Albany, New York.
FAU - Ramirez-Zamora, Adolfo
AU  - Ramirez-Zamora A
AD  - Center for Movement Disorders and Neurorestoration, Gain-esville, Florida.
FAU - Sweet, Jennifer A
AU  - Sweet JA
AD  - Department of Neuro-surgery, University Hospitals Cleveland Medical Center, 
      Cleveland, Ohio.
FAU - Mittal, Sandeep
AU  - Mittal S
AD  - De-partment of Neurosurgery, Wayne State University, Detroit, Michigan.
FAU - Espay, Alberto J
AU  - Espay AJ
AD  - James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, 
      University of Cincinnati, Cincinnati, Ohio.
FAU - Martinez, Jorge Gonzalez
AU  - Martinez JG
AD  - Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Abosch, Aviva
AU  - Abosch A
AD  - Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 
      Colorado.
FAU - Eskandar, Emad
AU  - Eskandar E
AD  - Department of Neurological Surgery, Massachusetts General Hospital and Harvard 
      Medical School, Boston, Massachusetts.
FAU - Gross, Robert
AU  - Gross R
AD  - Department of Neu-rosurgery, Emory University, Atlanta, Georgia.
FAU - Alterman, Ron
AU  - Alterman R
AD  - Division of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard 
      Medical School, Boston, Massa-chusetts.
FAU - Hamani, Clement
AU  - Hamani C
AD  - Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, 
      Canada.
LA  - eng
PT  - Journal Article
PT  - Practice Guideline
PT  - Systematic Review
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
MH  - Deep Brain Stimulation/*methods
MH  - *Globus Pallidus
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Parkinson Disease/*therapy
MH  - *Subthalamic Nucleus
MH  - Treatment Outcome
PMC - PMC6636249
EDAT- 2018/03/15 06:00
MHDA- 2019/09/12 06:00
PMCR- 2019/03/12
CRDT- 2018/03/15 06:00
PHST- 2018/01/04 00:00 [received]
PHST- 2018/02/07 00:00 [accepted]
PHST- 2018/03/15 06:00 [pubmed]
PHST- 2019/09/12 06:00 [medline]
PHST- 2018/03/15 06:00 [entrez]
PHST- 2019/03/12 00:00 [pmc-release]
AID - 4925265 [pii]
AID - nyy037 [pii]
AID - 10.1093/neuros/nyy037 [doi]
PST - ppublish
SO  - Neurosurgery. 2018 Jun 1;82(6):753-756. doi: 10.1093/neuros/nyy037.