Rapport d'étape évaluation de la stimulation cérébrale profonde dans la maladie de parkinson idiopathique - Progress report : evaluation of deep brain stimulation in idiopathic Parkinson’s disease - Abstract

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Publié par

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Evaluation of deep brain stimulation in idiopathic Parkinson’s disease -Progress report Anaes (French National Agency for Accreditation and Evaluation in Healthcare), Saint-Denis La Plaine, France Author: Marie -Claude Hittinger, M.D. Aim To assess the efficacy, safety and surgical technique of deep brain stimulation (DBS) to treat idiopathic Parkinson’s disease. Results and conclusions (i)onti.Denifi High frequency deep brain stimulation (DBS) is a form of functional stereotactic surgery which offers an alternative to lesional surgery. It involves implanting electrodes to stimulate one of the three target nuclei in the brain: the ventral intermediate nucleus of the thalamus (VIM), the globus pallidus internus (Gpi) and the subthalamic nucleus (STN). (ii)Studies selected. Three summary reviews and 10 clinical trials of a low level of evidence (3 randomised controlled trials (lesional surgeryvs DBS); 2 non-randomised trials comparing stimulation of the Gpi and STN; the remainder were case series). (iii)ndicatiosn:I DBSto patients suffering from severe Parkinson's disease who no is restricted longer respond to medical treatment, but who nevertheless retain good sensitivity to levadopa therapy and sufficiently good general and mental health to allow them to undergo surgery. (iv)Efficacy and safety: ti tub ,elbisae fbeo twnho senar wotd lb eossiet pot yis n Sah seb BD conclusions concerning its theoretical advantages (efficacy compared with lesional surgery or with optimum medical therapy, the possibility of bilateral stimulation without increasing the complications, and its reversibility) or its benefit-risk ratio. (v)tntaelemoinpmI: DBS consists of a complex sequence of diagnostic and therapeutic actions which are specific to each of the French centres. Surgery has to be carried out in a hospital with appropriate high-technology equipment and an experienced multidisciplinary team with the right skills. Methods ANAES searched the Medline, Embase, and Pascal databases (between 1996 and 2002) for relevant consensus conferences, guidelines, systematic reviews, and clinical trials (in English or French). This search was completed with a search of the contents pages of journals published during the previous 6 months, references cited in the articles selected, the grey literature and relevant websites. Studies were selected according to their level of evidence and quality of design (using review checklists). The critical analysis of these studies was validated by a working group of 10 experts and a multidisciplinary peer review group of 10 experts recruited from the relevant learned societies. Looking ahead (i) A longitudinal prospective cohort study needs to be carried out with the participation of all the French centres to monitor the results from current practice. (ii) Multicentre, randomised controlled trials to be carried out: first of all, a randomised clinical trial comparing DBS with the best medical management, followed by trials to determine the best target nucleus and the best surgical technique. (iii) Awareness needs to be raised among the different teams to encourage them to improve their reporting of medical device vigilance incidents. ANAES. 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France tel: +33 1 55 93 70 00, fax: +33 1 55 93 74 00, http://www.anaes.fr

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