What criteria should I use to determine if a patient with Parkinson's disease is a suitable candidate for deep brain stimulation?

Deep brain stimulation (DBS) should be considered for people with advanced Parkinson's disease whose symptoms are not adequately controlled by best medical therapy, including optimized pharmacological treatment such as levodopa and adjunctive medications NICE NG71. Candidates typically have significant motor fluctuations or dyskinesia despite optimal medical management, and their symptoms substantially impact quality of life NICE NG71.

Key criteria for suitability include a confirmed clinical diagnosis of Parkinson's disease, responsiveness to levodopa, and the absence of significant cognitive impairment or uncontrolled psychiatric illness, as these factors influence DBS outcomes and risks NICE NG71. Patients should have a comprehensive assessment by a multidisciplinary team with expertise in Parkinson's disease and DBS, including neurologists and neurosurgeons, to evaluate motor symptoms, cognitive status, and overall health NICE NG71.

Additional considerations from recent expert consensus and literature emphasize the importance of individualized evaluation beyond traditional criteria, incorporating genetic background and detailed phenotypic characterization to predict DBS outcomes more accurately Bronstein et al. 2011Rizzone et al. 2019Artusi et al. 2020. This approach suggests that while levodopa responsiveness remains a cornerstone, emerging evidence supports integrating genetic and clinical heterogeneity into patient selection to optimize benefits and minimize adverse effects Artusi et al. 2020.

In summary, the decision to offer DBS should be based on advanced disease with motor complications refractory to best medical therapy, good levodopa responsiveness, preserved cognition, and a thorough multidisciplinary assessment, with consideration of emerging personalized factors from recent research NICE NG71 Bronstein et al. 2011Rizzone et al. 2019Artusi et al. 2020.