Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 1314 (2012)

Current status and future challenges of deep brain stimulation in Switzerland

  • Markus Christen
  • Sabine Müller
DOI
https://doi.org/10.4414/smw.2012.13570
Cite this as:
Swiss Med Wkly. 2012;142:w13570
Published
25.03.2012

Abstract

QUESTIONS UNDER STUDY: Deep brain stimulation (DBS) has become a standard therapy for some forms of severe movement disorders and is investigated for other neurological and psychiatric disorders, although many scientific, clinical and ethical issues are still open. We analyse how the Swiss DBS community addresses these problematic issues and future challenges.

METHODS: We have performed a survey among Swiss DBS centres and a Delphi study with representatives of all centres and further stakeholders related to the topic.

RESULTS: The current DBS infrastructure in Switzerland consists of seven facilities. About 850–1,050 patients have received a DBS system in Switzerland for various indications since its advent in 1976. Critical issues like patient selection and dealing with side effects are in accordance with international standards. There are indications of a conservative referral practice in Switzerland for DBS interventions, but the data available do not allow verifying or refuting this point.

CONCLUSIONS: Issues to investigate further are whether or not there is an unmet medical need with respect to DBS, long-term medical and psychosocial sequelae of the intervention, conditions for enhancing the (research) collaboration of Swiss DBS centers, and the effect of the recent decision to reduce the number of DBS centres to 4 (resp. possibly 3) on the potential of this therapeutic approach.

References

  1. Sironi VA. Origin and evolution of deep brain stimulation. Front Integr Neurosci. 2011;5:42.
  2. Hariz MI, Blomstedt P, Zrinzo L. Deep brain stimulation between 1947 and 1987: The untold story. Neurosurg Focus. 2010;29(2):E1.
  3. Christen M, Bittlinger M, Ineichen C, Müller S (in preparation): Assessing the international research, practice, and infrastructure in deep brain stimulation.
  4. Krames EF, Peckham PH, Rezai AR (eds.). Neuromodulation. London: Academic Press; 2009.
  5. Siegfried J. Effect of stimulation of the sensory nucleus of the thalamus on dyskinesia and spasticity. Revue Neurologie (Paris). 1986;142(4):380–3.
  6. Siegfried J, Shulman J. Deep brain stimulation. Pacing Clin Electrophysiol. 1987;10(1 Pt 2):271–2.
  7. Müller S, Christen M. Deep brain stimulation in Parkinsonian patients – ethical evaluation of cognitive, affective, and behavioral sequelae. AJOB Neurosci. 2011;2(1):3–13.
  8. Hardesty DE, Sackeim HA. Deep brain stimulation in movement and psychiatric disorders. Biol Psychiatry. 2007;61:831–5.
  9. Pilitsis JG, Burrows A, Peters ML, Sargent S, Ng SC, Tseng JF. Changing practice patterns of deep brain stimulation in Parkinson’s disease and essential tremor in the USA. Stereotact Funct Neurosurg. 2012;90:25–9.
  10. Lad SP, Kalanithi PS, Patil CG, Itthimathin P, Batya S, Bronte-Stewart H, Boakye M, Henderson JM. Socioeconomic trends in deep brain stimulation (DBS) surgery. Neuromodulation 2010;13:182–6.
  11. Ponce FA, Lozano AM. Deep brain stimulation state of the art and novel stimulation targets. Prog Brain Res. 2010;184:311–24.
  12. Schüpbach WM, Maltête D, Houeto JL, du Montcel ST, Mallet L, Welter ML, et al. Neurosurgery at an earlier stage of Parkinson disease: a randomized, controlled trial. Neurology. 2007;68(4):267–71.
  13. Awan NR, Lozano A, Hamani C. Deep brain stimulation: current and future perspectives. Neurosurg Focus. 2009;27(1):E2.
  14. Zacks Equity Research. Medical devices industry outlook – April 2011. March 31, 2011: http://www.zacks.com/stock/news/50398/Medical+Devices+Industry+Outlook+%96+April+2011 (accessed on September 19th 2011).
  15. Infiniti Research Limited. Global Neuromodulation Market 2010-2014. June 13, 2011: http://www.technavio.com/content/global-neuromodulation-market-2010-2014 (accessed on September 19th 2011).
  16. Cavuoto J. Neurotech Report. Neuromodulation. 2011;14:206–7.
  17. Hemm S, Wårdell K. Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems, methods and emerging tools. Med Biol Eng Comput. 2010;48(7):611–24.
  18. Wider C, Pollo C, Bloch J, Burkhard PR, Vingerhoets FJ. Long-term outcome of 50 consecutive Parkinson’s disease patients treated with subthalamic deep brain stimulation. Parkinsonism Relat Disord. 2008;14(2):114–9.
  19. Maes H, Vingerhoets F, Berney A. Prévalence des troubles de l’humeur dans la maladie de Parkinson traitée par stimulation cérébrale profonde. Rev Med Suisse. 2011;7(282):385–8.
  20. Christen M, Bittlinger M, Walter H, Brugger P, Müller S. Dealing with side effects of deep brain stimulation: Lessons learned from stimulating the STN. AJOB Neurosci. 2012;3(1):37–43.
  21. Entscheid zur Planung der hochspezialisierten Medizin (HSM) im Bereich der stereotaktischen Chirurgie der anormalen/ungewollen Bewegungen und tiefe Hirnstimulation (Deep Brain Stimulation) beim Erwachsenen. Bundesblatt vom 21. Juni 2011. Available through: http://www.gdk-cds.ch/fileadmin/docs/public/gdk/Themen/HSM/HSM_Spitalliste/BB_DC_NCH_DBS_20110520_def_d.pdf.
  22. Linstone HA, Turoff M (eds.). The Delphi Method: Techniques and Applications. New Jersey: Science and Technology University; 2002.
  23. Krauss JK, Broggi B, Reulen HJ, Trojanowski T, Lazorthes Y. Training chart in movement disorders surgery added competence. Acta Neurochirurgica. 2009;151:1505–9.
  24. Siegfried J. Les pacemakers neurologiques. Bilan de trois décennies. Neurochirurgie. 1991;37:81–5.
  25. Wirdefeldt K, Adami H-O, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson’s disease: a review of the evidence. Eur J Epidemiol. 2011;26:S1–S58.
  26. Grey sources for estimating the PD incidence in Germany. MedKolleg: http://www.med-kolleg.de/magazin/parkinson-0806081.html; Parkinson-Web: http://www.parkinson-web.de/content/was_ist_parkinson/die_parkinson_krankheit/haeufigkeit/index_ger.html; Medworld: http://www.medworld.de/therapiegebiete/morbus-parkinson/grundlagen/haeufigkeit.htm (websites accessed on November 8th 2011)
  27. Thümler R. Die Parkinson-Krankheit. Mehr wissen, besser verstehen. Stuttgart: Thieme; 2006.
  28. Morgante L, Morgante F, Moro E, Epifanio A, Girlanda P, Ragonese P, et al. How many Parkinsonian patients are suitable candidates for deep brain stimulation of subthalamic nucleus? Results of a questionnaire. Parkinsonism Relat Disord. 2007;13:528–31.
  29. Cacciola F. Letter to the Editor. Parkinsonism Relat Disord. 2008;14:264–5.
  30. Okun MS, Foote KD. Parkinson’s disease DBS: what, when, who and why? The time has come to tailor DBS targets. Expert Rev Neurother. 2010;10(12):1847–57.
  31. Hariz MI, Rehncrona S, Quinn NP, Speelman JD, Wensing C, and the Multicentre Advanced Parkinson’s Disease Deep Brain Stimulation Group. Multicenter study on deep brain stimulation in Parkinson’s disease: An independent assessment of reported adverse events at 4 years. Mov Disord. 2008;23(3):416–21.
  32. Agid Y, Schüpbach M, Gargiulo M, Mallet L, Houeto JL, Behar C, et al. Neurosurgery in Parkinson’s disease: the doctor is happy, the patient less so? J Neural Transm Suppl. 2006;70:409–14.
  33. Blomstedt P, Hariz MI. Hardware-related complications of deep brain stimulation: a ten year experience. Acta Neurochir. 2005;147:1061–4.
  34. Moro E, Poon Y-YW, Lozano AM, Saint-Cyr JA, Lang AE. Subthalamic nucleus stimulation. Improvements in outcome with reprogramming. Arch Neurol. 2006;63:E1–E7.
  35. Kondziolka D, Flickinger JC, Hudak R. Results following Gamma Knife radiosurgical anterior capsulotomies for obsessive compulsive disorder. Neurosurgery. 2011;68:28–33.
  36. Gabriëls L, Cosyns P, Nuttin B, Demeulemeester H, Gybels J. Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases. Acta Psychiatr Scand. 2003;107:275–82.
  37. Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A, et al. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol. 2011;68(2):165–71.
  38. Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987;50:344–6.
  39. Albin RL, Young AB, Penney JB. The functional anatomy of basal ganglia disorders. Trends Neurosci. 1998;12:366–75.
  40. DeLong MR. Primate models of movement disorders of basal ganglia origin. Trends Neurosci. 1990;13:281–5.

Most read articles by the same author(s)