Deep brain stimulation in Parkinson's disease and essential tremor. Rationale, indication, pre-, intra- and postoperative management, psychosomatics and rehabilitation

Deep brain stimulation (DBS), the stereotactic guided implantation of electrodes in deep brain structures and chronic stimulation has become an established option in the treatment of advanced Parkinson's disease and essential tremor. Despite new anti-parkinsonian drugs levodopa fluctuations and long term complications such as on-off-phenomena and dyskinesias continue to represent a challenge. In those patients who are clearly responsive to levodopa, DBS can alleviate the symptoms effectively. DBS is also effective in treatment of essential tremor. This review discusses the rationale of DBS and patient selection and describes pre-, intra- and postoperative management and psychiatric, psychosomatic and rehabilitative aspects.