Abstract
Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient's profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute's DBS paradigm to ensure that patients receive the optimal therapy.
Highlights
Introduction and Evolution of the ProgramThe Deep Brain Stimulation program at UT Southwestern Medical Center in Dallas began in 1998 following FDA approval of DBS, with steady growth in the number of procedures performed, up to 45 per year in 2016
This, coupled with the deterioration of motor scores in Subthalamic Nucleus (STN)-DBS patients in the “off-off” phase, not seen in Globus Pallidus Interna (GPi)-DBS patients which retain stable scores [57], bolsters the theory of dopaminergic medication advantage, and not merely disease progression as a possible explanation for these phenomena. This leads to various lines of thoughts such as the desirability of medication reduction in the absence of side effects, the nature of the relationship between medications and stimulation, whether STN stimulation interferes with dopaminergic stimulation, and whether there is an inherent disease modulating effect of GPi-DBS outside the role played by medications [58]
Deep Brain Stimulation has revolutionized the lives of patients living with Parkinson disease
Summary
Therapeutic targets for ameliorating the disabling symptoms of Parkinson disease, namely, tremor, were discovered early in the 20th century by neurosurgical observations, leading to an era of ablative procedures targeting the basal ganglia, refined further by advancements such as stereotactic surgery. While the use of electrical stimulation of the nervous system for pain control and seizures has been in play from the early part of the 20th century, the role of DBS in Parkinson disease can be traced to the outpatient stimulation of the thalamus and globus pallidus for motor disorders in 1972 by Bechtereva, to the first implanted stimulator for tremor in a Multiple Sclerosis patient in 1980 by Brice and McLellan, and last but not least to the first reported case of DBS in Parkinson disease at the ventral intermediate nucleus of the thalamus in 1987, by Dr Benabid’s group in France [2, 3] This was followed by a rapid exploration into the potential of DBS, resulting in a field continuously evolving and improving in its technique, technology, knowledge, and mandate [4]. These reports have culminated in a consensus in the field to move away from a ‘one size fits all’ use of STN for the disease, to a target choice which is tailor-made to a patient’s specific symptoms and profile
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
