Deep brain stimulation for the treatment of Parkinson’s disease: efficacy and safety

Nader Pouratian,1,2 Sandeep Thakkar,3 Won Kim,1 Jeff M Bronstein3–51Departments of Neurosurgery, 2Bioengineering, 3Neurology, 4Brain Research Institute, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles, 5Veterans Administration, Southwest Parkinson’s Disease Reseach, Education, and Clinical Center Los Angeles, CA, USAAbstract: Deep brain stimulation (DBS) surgery has become increasingly utilized in the treatment of advanced Parkinson’s disease. Over the past decade, a number of studies have demonstrated that DBS is superior to best medical management in appropriately selected patients. The primary targets for DBS in Parkinson’s disease include the subthalamic nucleus and the internal segment of the globus pallidus, both of which improve the cardinal motor features in Parkinson’s disease. Recent randomized studies have revealed that both targets are similarly effective in treating the motor symptoms of Parkinson’s disease, but emerging evidence suggests that the globus pallidus may be the preferred target in many patients, based on differences in nonmotor outcomes. Here, we review appropriate patient selection, and the efficacy and safety of DBS therapy in Parkinson’s disease. Best outcomes are achieved if the problems of the individual patient are considered when evaluating surgical candidates and considering whether the subthalamic nucleus or the globus pallidus internus should be targeted.Keywords: Parkinson’s disease, deep brain stimulation, subthalamic nucleus, globus pallidus, dyskinesia