Abstract
Deep Brain Stimulation for Parkinson's Disease: Where Do We Stand?
Highlights
Three recent studies have compared the effects of subthalamic nucleus (STN) and globus pallidum internum (GPi) stimulation in complicated Parkinson’s disease (PD) patients (Table 1)
That target selection could be tailored to the patient’s clinical and personal profile: GPi Deep brain stimulation (DBS) may suit better patients with dose-limiting dyskinesias or behavioral and cognitive issues, whereas STN DBS may be more indicated for younger patients with prominent akinesia and tremor or with behavioral disorders related to dopaminergic medication
A recent prospective study showed that the occurrence of REM sleep behavior disorder in PD patients undergoing STN DBS may be per se associated with a less favorable outcome and a more prominent development of axial symptoms over time (Zibetti et al, 2010); by contrast, cardiovascular dysautonomia is compatible with satisfactory motor outcome, as reported 1 year after STN DBS (Holmberg et al, 2005)
Summary
Three recent studies (two randomized and one uncontrolled) have compared the effects of STN and GPi stimulation in complicated PD patients (Table 1). That target selection could be tailored to the patient’s clinical and personal profile: GPi DBS may suit better patients with dose-limiting dyskinesias or behavioral and cognitive issues, whereas STN DBS may be more indicated for younger patients with prominent akinesia and tremor or with behavioral disorders related to dopaminergic medication.
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