Indications and Contraindications for DBS Treatment in Parkinson’s Disease

Indications for DBS Treatment:

1. Primary Parkinson’s Disease
2. Effective response to levodopa treatment.
3. Reduced efficacy of medications or the occurrence of motor fluctuations and on-off phenomena.
4. Inability to tolerate medication side effects.
5. History of lesioning surgery with resulting complications.

Contraindications for DBS Treatment:

1. Patients with a bleeding tendency or other serious medical conditions that do not tolerate stereotactic surgery.
2. Dementia, suicidal tendencies, severe anxiety, etc.
3. Patients in the advanced stages of Parkinson’s disease who are completely dependent on others and bedridden.

There is no strict age limit for surgery. For Parkinson’s Plus syndromes (e.g., Shy-Drager syndrome, Striatonigral degeneration, Progressive Supranuclear Palsy, and Olivopontocerebellar atrophy), which have a different pathophysiological basis than primary Parkinson’s disease, the response to DBS treatment is poor. Therefore, surgical options should be considered with caution. These syndromes often present with pyramidal tract signs, such as positive pathological findings, and cerebellar symptoms like ataxia, as well as poor response to levodopa, which distinguishes them from Parkinson’s disease.