From the Research
Young-onset Parkinson's disease patients should be considered for Deep Brain Stimulation (DBS) consultation when they experience motor fluctuations, dyskinesias, or tremor that remains inadequately controlled despite optimal medical therapy, as evidenced by a recent study published in 2022 1. This study demonstrated significant improvements in motor scores, quality of life, and reductions in levodopa equivalent dosage in early-onset Parkinson's disease patients who underwent subthalamic nucleus deep brain stimulation. The optimal timing for DBS consultation is typically after 3-5 years of levodopa treatment, when optimal medical management has been achieved, including adequate trials of levodopa, dopamine agonists, and adjunctive medications. Key considerations for DBS candidacy include a robust response to levodopa, fewer comorbidities, and longer life expectancy, which maximize the benefit-to-risk ratio of the procedure. Early consultation is advisable, as younger patients tend to have better surgical outcomes and can experience significant quality of life improvements, as supported by a 2020 study that reported 5-year outcomes from the subthalamic nucleus DBS in early-stage Parkinson disease 2. DBS works by delivering electrical stimulation to specific brain regions, modulating abnormal neural circuits that cause motor symptoms, and can reduce medication requirements by 30-50% and significantly improve motor function during "off" periods, though it does not slow disease progression. The choice of DBS target, either subthalamic nucleus or globus pallidus interna, should be tailored to each patient's clinical presentation, neuropsychiatric profile, and goals of surgery, as discussed in a 2018 review 3. Ultimately, the decision to consult for DBS should be based on individualized assessment and consideration of the potential benefits and risks, with a focus on maximizing quality of life and minimizing morbidity and mortality.