Subthalamotomy for Parkinson's disease

Current evidence on the safety and efficacy of subthalamotomy for Parkinson's disease does not appear adequate to support the use of this procedure without special arrangements for consent and for audit or research.

• Clinicians wishing to undertake subthalamotomy for Parkinson's disease should take the following actions.

• Inform the clinical governance leads in their Trusts.

• Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. Use of the information for the public is recommended.

• Audit and review clinical outcomes of all patients having subthalamotomy for Parkinson's disease.

Subthalamotomy for Parkinson's disease is a treatment option in the PD Surg trial, which is expected to complete randomisation in 2005/6. Clinicians are encouraged to consider randomising patients in the trial.

Publication of safety and efficacy outcomes will be useful in reducing the current uncertainty. NICE may review the procedure upon publication of further evidence.

It is recommended that patient selection should be made with the involvement of a multidisciplinary team, and that patients should be offered the procedure only when their disease has become refractory to best medical treatment.