Subthalamic deep brain stimulation for advanced Parkinson’s disease: all that glitters is not gold

• deep brain stimulation
• Parkinson’s disease

I read with interest the article “Behavioural disorders, Parkinson’s disease and subthalamic stimulation” by Houeto et al and the accompanying editorial published last year in your journal.1,2 One of the main conclusions of that study was that sometimes the reality cannot be completely reflected in a paper because many studies conducted to assess the efficacy of therapeutic interventions in Parkinson’s disease focus on the motor aspects of the disease, while other aspects—cognitive or emotional, for example—are forgotten or insufficiently assessed by current rating scales such as the UPDRS. This is the case with most of the published studies related to deep brain stimulation (DBS). For this reason, I would like to add our experience with 18 patients operated on in our centre and included in the largest multicentre study conducted up to now.3 In this study neither cognitive functioning nor quality of life were properly evaluated. Four of the 18 patients were prematurely withdrawn because of the occurrence of severe adverse events (two intracranial haemorrhages, one possible cortical venous thrombosis resulting in infarction, and one severe infection necessitating the removal of both DBS systems). In another patient with an impressive clinical result, one electrode was removed because of an infection, leading to …