PD – DBS Candidacy Criteria — SCE Neurology MCQ
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Correct answer: C — DBS candidates should have: (1) a definite diagnosis of PD with good levodopa response, (2) motor complications (wearing off, dyskinesia) not adequately controlled by medication optimisation, (3) no significant cognitive impairment or active psychiatric disease, (4) realistic expectations — symptoms that respond to levodopa will improve; symptoms that do not (postural instability, speech, freezing, autonomic) generally will not
DBS of the STN or GPi is indicated for PD patients with motor complications refractory to optimal medical therapy. Key selection criteria: (1) levodopa-responsive PD (the levodopa response predicts DBS outcome), (2) disabling motor fluctuations and/or dyskinesia despite optimal medication, (3) adequate cognitive function (dementia is a contraindication), (4) no active psychiatric comorbidity (psychosis, severe depression), (5) reasonable life expectancy, (6) realistic expectations. DBS primarily improves levodopa-responsive symptoms; it does not improve levodopa-non-responsive symptoms. A: Careful selection is required. C: Tremor is one indication among others. D: DBS is for advanced PD. E: DBS is an established PD treatment.
Reference: NICE NG71; NICE IPG19 DBS for PD