ABSTRACT
A series of complementary technological and scientific advances have revived interest
in the surgical management of movement disorders. Deep brain stimulation (DBS) is
the most important of these advances because it has expanded the indications for surgical
intervention, made treatment at new targets possible, and improved the functional
impact of surgery. Consequently, the selection of surgical candidates is more complex
and more important to the successful management of movement disorder patients than
ever before. In this article we discuss our protocol for evaluating surgical candidates,
stressing the importance of the multidisciplinary team approach and strict selection
criteria. Critical factors include detailed clinical assessment, neurocognitive testing,
and when appropriate, positron emission tomography (PET). Indications for specific
interventions, both approved and ``investigational,'' are also discussed. Although
stereotactic surgery for movement disorders is becoming safer and more effective,
adverse neurologic sequelae can still occur. Therefore, surgery still should only
be considered for patients who are functionally disabled by symptoms that are refractory
to medical treatment.
KEYWORD
Stereotactic surgery - deep brain stimulation - positron emission tomography - Parkinson's
disease - tremor
