Deep brain stimulation: research needs to be streamlined

Authors reviewing recent publications on deep-brain stimulation argue that there is an urgent need for co-ordinated research into unanswered issues and no need for publications that replicate well-established results.Reviewing recent data on the use of deep-brain stimulation for Parkinson's disease, Dr Benabid and colleagues from Grenoble, France conducted a Pubmed search from 2004 to 2005, which yielded 260 references. It's been 18 years since the technique's introduction in 1987, and the authors say, "One might expect that everything has been said and done, and nothing is left to be written." They note that some major concepts "have reached global agreement". However, some important issues have not been considered or solved and others are debated vigorously.The authors say, "There is currently a fairly strong consensus about the beneficial effects, their stability, the inclusion criteria, the other indications which respond (parkin) or do not respond (multiple system atrophy; MSA)." However, there is still a lack of evidence of a neuroprotective role, and this should be further evaluated using case by case analysis.It is also still unknown how frequently neuropsychological complications occur, and they may be dependent upon the technique, as some centres report more side effects than others. Other issues requiring clarification include the precise location of the target, usefulness of the different subcomponents of the surgical procedure, and the mechanisms of action.The authors believe there is an urgent need to organise research and reports to address the remaining areas of uncertainty and that there is no need to report small series that replicate well-established conclusions. They add that the lack of progression in the area "is essentially the result of methodological problems, which, if they are not properly solved, will lead to a similar lack of progress at the time of the next equivalent review, be it in a year or in 10 years."Reference...