According to background information in the article, since the Food and Drug Administration approved deep brain stimulation for the treatment of Parkinson's disease, essential tremor and dystonia (uncontrolled muscle movement), there has been a surge in the number of centers offering this surgical procedure, which involves implanting a device to deliver mild electrical stimulation to block the brain signals that cause tremor. There is currently no consensus regarding appropriate screening procedures, necessary training of individuals providing the therapy, the need for an interdisciplinary team, or guidelines for the management of complications, the authors report.
Michael S. Okun, M.D., of the University of Florida Movement Disorders Center, Gainesville, Fla., and colleagues evaluated 41 consecutive patients who came to one of two specialty movement disorder centers over a two year period complaining of unsatisfactory results from deep brain stimulation surgery performed elsewhere. Each patient was evaluated by a movement disorders neurologist; the patient's medical record was reviewed; the DBS device was examined and properly programmed; and postoperative imaging studies were evaluated whenever possible.
The researchers found problems with screening for surgery and determination of diagnosis, five patients (12 percent) had disorders that would not be expected to respond to deep brain stimulation therapy. The researchers found that 19 patients (46 percent) had suboptimal placements of electrodes and three patients' devices had failed due to end of battery life (although these findi
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