Deep-Brain Stimulation for Parkinson's Disease

Foreword This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations. Stage A 72-year-old right-handed man with a 12-year history of Parkinson's disease presents with a diminished response to medication and right-sided dyskinesia (involuntary movements). During the past several years, he has been taking multiple drugs for Parkinson's disease, including a monoamine oxidase inhibitor, amantadine, a dopamine agonist, and carbidopa?levodopa. He reports that with his current regimen, which includes 1.5 tablets of 25/100 carbidopa?levodopa taken every 2 hours, he has marked reductions in tremor, rigidity, and bradykinesia and substantial improvement in his walking. Despite multiple interval and dose adjustments, however, he also reports 6 hours per day of ?off? time, when . . .