The Need for a Multifactorial Approach to Raise the Standard in Deep Brain Stimulation Reporting

Abstract

Deep brain stimulation (DBS) has been demonstrated to be an effective therapeutic strategy for the treatment of pharmacologically refractory Parkinson disease (PD) ( 1. Kleiner-Fisman G Herzog J Fisman DN et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord. 2006; 21: S290-S304 Crossref Scopus (761) Google Scholar ). Since its renaissance in 1987 ( 2. Benabid AL Pollak P Louveau A Henry S de Rougemont J Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987; 50: 344-346 PubMed Google Scholar , 3. Hariz MI Blomstedt P Zrinzo L Deep brain stimulation between 1947 and 1987: the untold story. Neurosurg Focus. 2010; 29: E1 Crossref Scopus (150) Google Scholar ), it has become widely accepted in the movement disorders community with more than 33,000 patients currently implanted. Targets have evolved from the ventral intermediate nucleus of the thalamus ( 2. Benabid AL Pollak P Louveau A Henry S de Rougemont J Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol. 1987; 50: 344-346 PubMed Google Scholar , 4. Benabid AL Pollak P Gervason C et al. Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet. 1991; 337: 403-406 Abstract PubMed Scopus (1393) Google Scholar ) to the globus pallidus internus ( 5. Siegfried J Lippitz B Bilateral chronic electrostimulation of ventroposterolateral pallidum: a new therapeutic approach for alleviating all parkinsonian symptoms. Neurosurgery. 1994; 35 (discussion 1129–1130): 1126-1129 Crossref PubMed Scopus (409) Google Scholar ), subsequently to the subthalamic nucleus (STN) ( 6. Pollak P Benabid AL Gross C et al. [Effects of the stimulation of the subthalamic nucleus in Parkinson disease]. Rev Neurol (Paris). 1993; 149: 175-176 PubMed Google Scholar ), and recently to the pedunculopontine nucleus ( 7. Stefani A Lozano AM Peppe A et al. Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson’s disease. Brain. 2007; 130: 1596-1607 Crossref PubMed Scopus (636) Google Scholar ). While debate exists with respect to the optimal therapeutic target ( 8. Okun MS Foote KD Subthalamic nucleus vs globus pallidus interna deep brain stimulation, the rematch: will pallidal deep brain stimulation make a triumphant return?. Arch Neurol. 2005; 62: 533-536 Crossref PubMed Scopus (64) Google Scholar , 9. Minguez-Castellanos A Escamilla-Sevilla F Pallidal vs subthalamic deep brain stimulation for Parkinson disease: winner and loser or a sharing of honors?. Arch Neurol. 2005; 62 (author reply 1643): 1642-1643 Crossref Google Scholar ), DBS of STN is the most common surgical intervention for PD ( 10. Benabid AL Chabardes S Mitrofanis J Pollak P Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease. Lancet Neurol. 2009; 8: 67-81 Abstract Full Text Full Text PDF PubMed Scopus (971) Google Scholar ). DBS of the STN has resulted in substantial motor improvements and often leads to a significant reduction in levodopa administration ( 11. Molinuevo JL Valldeoriola F Tolosa E et al. Levodopa withdrawal after bilateral subthalamic nucleus stimulation in advanced Parkinson disease. Arch Neurol. 2000; 57: 983-988 Crossref PubMed Scopus (191) Google Scholar ). Now that these major advances in motor function have been achieved, the apparent limbic side-effects of DBS have come into greater focus ( 12. Okun MS Green J Saben R Gross R Foote KD Vitek JL Mood changes with deep brain stimulation of STN and GPi: results of a pilot study. J Neurol Neurosurg Psychiatry. 2003; 74: 1584-1586 Crossref PubMed Scopus (93) Google Scholar ).