eprintid: 10152002 rev_number: 6 eprint_status: archive userid: 699 dir: disk0/10/15/20/02 datestamp: 2022-07-14 11:56:42 lastmod: 2022-07-14 11:56:42 status_changed: 2022-07-14 11:56:42 type: article metadata_visibility: show sword_depositor: 699 creators_name: Deuschl, Günther creators_name: Antonini, Angelo creators_name: Costa, Joao creators_name: Śmiłowska, Katarzyna creators_name: Berg, Daniela creators_name: Corvol, Jean-Christophe creators_name: Fabbrini, Giovanni creators_name: Ferreira, Joaquim creators_name: Foltynie, Tom creators_name: Mir, Pablo creators_name: Schrag, Annette creators_name: Seppi, Klaus creators_name: Taba, Pille creators_name: Ruzicka, Evzen creators_name: Selikhova, Marianna creators_name: Henschke, Nicholas creators_name: Villanueva, Gemma creators_name: Moro, Elena title: European Academy of Neurology/Movement Disorder Society - European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies ispublished: inpress divisions: C07 divisions: F84 divisions: B02 divisions: UCL divisions: D07 keywords: Parkinson's disease, guideline, infusion therapies, surgical interventions note: © 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. abstract: BACKGROUND AND PURPOSE: This update of the treatment guidelines was commissioned by the European Academy of Neurology and the European section of the Movement Disorder Society. Although these treatments are initiated usually in specialized centers, the general neurologist and general practitioners taking care of PD patients should know the therapies and their place in the treatment pathway. METHODS: Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to assess the spectrum of approved interventions including deep brain stimulation (DBS) or brain lesioning with different techniques (radiofrequency thermocoagulation, radiosurgery, magnetic resonance imaging-guided focused ultrasound surgery [MRgFUS] of the following targets: subthalamic nucleus [STN], ventrolateral thalamus, and pallidum internum [GPi]). Continuous delivery of medication subcutaneously (apomorphine pump) or through percutaneous ileostomy (intrajejunal levodopa/carbidopa pump [LCIG]) was also included. Changes in motor features, health-related quality of life (QoL), adverse effects, and further outcome parameters were evaluated. Recommendations were based on high-class evidence and graded in three gradations. If only lower class evidence was available but the topic was felt to be of high importance, clinical consensus of the guideline task force was gathered. RESULTS: Two research questions have been answered with eight recommendations and five clinical consensus statements. Invasive therapies are reserved for specific patient groups and clinical situations mostly in the advanced stage of Parkinson's disease (PD). Interventions may be considered only for special patient profiles, which are mentioned in the text. Therapy effects are reported as change compared with current medical treatment. STN-DBS is the best-studied intervention for advanced PD with fluctuations not satisfactorily controlled with oral medications; it improves motor symptoms and QoL, and treatment should be offered to eligible patients. GPi-DBS can also be offered. For early PD with early fluctuations, STN-DBS is likely to improve motor symptoms, and QoL and can be offered. DBS should not be offered to people with early PD without fluctuations. LCIG and an apomorphine pump can be considered for advanced PD with fluctuations not sufficiently managed with oral treatments. Unilateral MRgFUS of the STN can be considered for distinctly unilateral PD within registries. Clinical consensus was reached for the following statements: Radiosurgery with gamma radiation cannot be recommended, unilateral radiofrequency thermocoagulation of the pallidum for advanced PD with treatment-resistant fluctuations and unilateral radiofrequency thermocoagulation of the thalamus for resistant tremor can be recommended if other options are not available, unilateral MRgFUS of the thalamus for medication-resistant tremor of PD can be considered only within registries, and unilateral MRgFUS of the pallidum is not recommended. CONCLUSIONS: Evidence for invasive therapies in PD is heterogeneous. Only some of these therapies have a strong scientific basis. They differ in their profile of effects and have been tested only for specific patient groups. date: 2022-07-06 date_type: published publisher: Wiley official_url: https://doi.org/10.1111/ene.15386 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1965310 doi: 10.1111/ene.15386 medium: Print-Electronic lyricists_name: Foltynie, Thomas lyricists_id: TFOLT83 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: European Journal of Neurology event_location: England issn: 1351-5101 citation: Deuschl, Günther; Antonini, Angelo; Costa, Joao; Śmiłowska, Katarzyna; Berg, Daniela; Corvol, Jean-Christophe; Fabbrini, Giovanni; ... Moro, Elena; + view all <#> Deuschl, Günther; Antonini, Angelo; Costa, Joao; Śmiłowska, Katarzyna; Berg, Daniela; Corvol, Jean-Christophe; Fabbrini, Giovanni; Ferreira, Joaquim; Foltynie, Tom; Mir, Pablo; Schrag, Annette; Seppi, Klaus; Taba, Pille; Ruzicka, Evzen; Selikhova, Marianna; Henschke, Nicholas; Villanueva, Gemma; Moro, Elena; - view fewer <#> (2022) European Academy of Neurology/Movement Disorder Society - European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies. European Journal of Neurology 10.1111/ene.15386 <https://doi.org/10.1111/ene.15386>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10152002/1/Euro%20J%20of%20Neurology%20-%202022%20-%20Deuschl.pdf