Place de la neurostimulation dans le traitement de la maladie de Parkinson du sujet âgé

Bilateral high frequency stimulation of the subthalamic nucleus is an effective treatment in parkinsonian patients with advanced levodopa-responsive form of the disease who have disabling levodopa-related motor complications in absence of dementia, psychiatric disorders and abnormal MRI. The post-operative clinical outcome depends upon strict selection criteria of which age, a key factor to consider when determining surgical candidacy. Older age influences many criteria (dopa-sensitivity, axial signs and neuropsychological performance) and it is correlated with higher risk of per and postoperative complications. However, some elderly patients benefit from deep brain stimulation. Therefore age should not be a rigid criterion to exclude older patients from this therapeutic option and it should be mandatory for older patient to strictly respect the other inclusion criteria.