IPG19

Deep brain stimulation for Parkinson's disease (IPG19)

  • Interventional procedures IPG19
  • Issued: November 2003
    • Deep brain stimulation for Parkinson's disease

      The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on deep brain stimulation for Parkinson's disease.

      Further recommendations have been made as part of the clinical guideline on Parkinson's disease published in June 2006. Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. The IP guidance on deep brain stimulation for Parkinson's disease remains current, and should be read in conjunction with the clinical guideline.

      • Description

        This procedure is used to treat Parkinson's disease.

        Parkinson's disease is a chronic disease of the brain characterised by gradually worsening tremor, muscle rigidity and difficulties with starting and stopping movements. The condition is usually treated with drugs. Surgery may be considered in people who have responded poorly to drugs, who have severe side-effects from medication, or who have severe fluctuations in response to drugs (on-off syndrome).

        Parkinson's disease is common, affecting about 0.5% of people aged 65 to 74 and 1-2% of people aged 75 and over. Experts believe that 1 to 10% of people with Parkinson's disease might be suitable for brain surgery.

        Surgery for Parkinson's disease is carried out on structures within the brain that are responsible for the modification of movements, such as the thalamus, the globus pallidus and the subthalamic nucleus. Each of these structures consists of two parts; one on the left hand side of the brain and one on the right. Surgery may be carried out on one or both sides.

        Surgical treatment aims to correct the imbalance created by diminished function of the substantia nigra, the underlying abnormality in Parkinson's disease. Surgery alters, through either destruction or electrical stimulation, the function of brain nuclei - such as the thalamus, globus pallidus or subthalamus - that interact functionally with the substantia nigra. Deep brain stimulation is one form of surgery for Parkinson's disease.

        This procedure involves inserting very fine needles into the brain through small holes made in the skull to determine the exact position of the nucleus, which may be different in each patient. This part of the procedure is usually carried out under local anaesthetic. Once the nucleus is identified, a permanent electrode is placed into it. Under general anaesthetic, this electrode is then connected to a pulse generator, which is implanted subcutaneously on the anterior chest wall.

      • OPCS4.6 Code(s)

        A09.1 Implantation of neurostimulator into brain      

        Includes: Neurostimulation of brainstem

        In addition the ICD-10 code G20.X Parkinson’s disease would be recorded.

        The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding

      • Other information

      This page was last updated: 25 March 2014

    • Guidance formats

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Implementation tools and resources

  • None available

Patient

The summary of the key recommendations in the guidance written for patients, carers and those with little medical knowledge and may be used in local patient information leaflets.

Quick Reference Guide

The quick reference guide presents recommendations for health professionals

NICE Guidance

The published NICE clinical guidance, contains the recommendations for health professionals and NHS bodies.

Full Guidance

The published full clinical guidance for specialists with background, evidence, recommendations and methods used.

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.