Functional Stereotactic Neurosurgery for Movement Disorders: Deep Brain Stimulation

Abstract

Before chronic deep brain stimulation (DBS) became the treatment of choice in movement disorders surgery, lesioning procedures like thalamotomy and pallidotomy were used widely to treat patients with Parkinson’s disease (PD), tremor or dystonia. Compared to ablative surgery, DBS offers a non-lesional modulation of basal ganglia output; its effects are principally reversible, and it is possible to adapt the therapy to the course of the disease and the individual needs of the patient [16, 14]. The main advantage, however, is that bilateral surgery can be performed in the same operative session without increased risk for side effects (Table 8.3.1). The renaissance of movement disorders surgery for PD also renewed interest in functional stereotactic surgery for other movement disorders like dystonia [16]. In large prospective randomized studies, DBS has been shown to provide substantial benefit in PD, but also in essential tremor (ET) and generalized dystonia [2, 13, 7, 21, 8, 17, 20, 22].