Deep Brain Stimulation for Parkinson Disease

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Key points

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    Parkinson disease (PD) is the second most common neurodegenerative disorder and affects more than 1 million individuals in the United States.

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    Deep brain stimulation (DBS) is one form of treatment of PD.

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    DBS treatment is still evolving due to technological innovations that shape how this therapy is used.

Early Interventions and Stereotactic Lesioning

During the 1950s and 1960s, stereotactic surgery lesioning the globus pallidus internus (GPi) (pallidotomy) or the ventralis intermedius (Vim) nucleus of the thalamus (thalamotomy) was the primary surgical treatment of PD.8 These procedures were applied as treatment of symptoms in refractory cases and little was available in the way of medical management for motor complications in patients with advanced PD. Stereotactic ablations focused on the pallidothalamic pathway, including the globous

Ongoing procedural enhancements

Iterative technological advances have resulted in ongoing improvements in both patient customized target identification as well as novel surgical approaches for electrode placement. These ongoing technological improvements have allowed new working paradigms to emerge. Recent advances in microelectrode recording (MER)-based targeting techniques and imaging-based targeting techniques are reviewed. Direct comparisons between various methodological approaches are sparse. Excellent results have been

Selected advances in deep brain stimulation hardware and programming

The advent of DBS for PD has led to improved quality of life for many patients. Nonetheless, significant opportunities remain for improvement in this therapy.74 Patients who have elevated energy requirements to obtain effective therapy may require frequent battery changes. Furthermore, many patients have optimal settings that are task-specific, necessitating a manual change in programming in preparation for a specific activity. The concept of closed-loop DBS holds promise to improve therapy

Summary

Since FDA approval in 1997, DBS has revolutionized the treatment of PD. Within the past decade, the technology has seen an explosion of ideas in both surgical targeting and more nuanced stimulation delivery with new devices. The ability to use intraoperative imaging, as well as DTI, has made it possible to target deep nuclei more accurately, perhaps without the need for MER. DTI targeting also may allow for electrode placement that incorporates or avoids specific fiber tracts. Furthermore,

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    Disclosure: The authors have nothing to disclose.

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