When should patients with Parkinson disease (PD) be referred to a movement-disorder center for evaluation of a surgical intervention? Is there a window of opportunity when such intervention is most successful? — Pauline Rankin, CRNP, Emlenton, Pa.

Deep brain stimulation (DBS) of either the subthalmic nucleus (STN) or the globus pallidus pars interna (GPi) is currently the most frequently performed surgical procedure on individuals with medically intractable motor fluctuations of PD.

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Accumulating evidence suggests that DBS of the STN and GPi provides persistent beneficial antiparkinson effect for at least three to five years after electrode implantation. There is no evidence that it slows the progression of the underlying neurodegenerative process. The best candidates are those with idiopathic PD who have been responsive to levodopa prior to surgery, are cognitively intact, and do not have end-stage disease. It is best to seek consultation with a neurologist in a movement-disorder center before recommending the procedure. — Deborah L. Cross, MPH, CRNP, ANP-BC (165-3)

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