Parkinson病脳深部刺激療法における多職種連携

抄録

Parkinson disease (PD) is characterized by motor symptoms such as bradykinesia, rigidity, and resting tremor. These motor symptoms are usually alleviated by anti–parkinsonian drugs such as levodopa. However, in advanced stages of the disease, PD patients often experience motor complications, such as wearing off and dyskinesia, which are difficult to manage with medications alone. Device–aided therapy (DAT) has proven effective in mitigating motor complications that cannot be adequately treated with medication.

The clinical indication for DAT is determined based on the severity of motor complications as well as non–motor symptoms, including cognitive impairments, psychiatric conditions, and autonomic dysfunctions. Additionally, the medical team must assess the degree to which PD patients and their families understand the clinical utility of DAT, along with evaluating the caregivers' capabilities and the patients' living environments.

Indications for DAT should be carefully determined by a multidisciplinary medical team comprising doctors (neurologists, neurosurgeons, psychiatrists) and co–medical staff (nurses, rehabilitation therapists). It is common for PD patients to consult co–medical staff about their concerns even after receiving detailed informed consent from doctors. While motor complications often improve with DAT, patient satisfaction may be limited if expectations for the therapy are unrealistically high.

The multidisciplinary team should thoroughly evaluate the extent to which motor symptoms and activities of daily living improve following the introduction of DAT. This review highlights the importance of multidisciplinary teams in assessing the indications for DAT in PD patients.