Postoperative neurological management of subthalamic nucleus deep brain stimulation

A close cooperation of stereotactic neurosurgeons and movement disorders specialists is a mandatory prerequisite for successful bilateral stimulation of the subthalamic nucleus in the treatment of advanced Parkinson's disease. One of the most important tasks of the movement disorder neurologist besides selecting suited surgical candidates is the postoperative care of patients including adaptation of stimulation parameters and medication. In the following survey the authors summarize their experience in the postsurgical management of patients with deep brain stimulation. They introduce a treatment algorithm describing the initial adaptation of medication and stimulation parameters after surgery and discuss possible problems in postoperative care related to the complex interaction of drug and stimulation effects. Case reports of the postoperative course in three patients with typical surgical indications complement the practical guide, which is addressed to all neurologist currently or in future caring for patients with deep brain stimulation of the subthalamic nucleus.