Deep brain stimulation in movement disorders. The applications reconsidered

Area of Science:

• Neurosurgery
• Neurology
• Movement Disorders

Background:

• Deep brain stimulation (DBS) is an established therapy for advanced Parkinson disease (PD).
• Re-evaluation of existing DBS techniques and exploration of new indications are crucial for optimizing patient care.

Purpose of the Study:

• To re-evaluate the efficacy of unilateral pallidal stimulation in advanced PD.
• To explore new indications for DBS in movement disorders, including multiple system atrophy-parkinsonism (MSA-P) and Tourette syndrome (TS).

Main Methods:

• Unilateral pallidal stimulation in 26 advanced PD patients.
• Bilateral subthalamic nucleus (STN) stimulation in 20 advanced PD patients.
• Bilateral STN stimulation in 4 MSA-P patients.
• Literature review and bilateral thalamic stimulation in 3 TS patients.

Main Results:

• Unilateral pallidal stimulation yielded unsatisfying motor effects in advanced PD.
• Bilateral STN stimulation in advanced PD resulted in significant long-term motor and functional improvement, with some patients experiencing hypomanic/manic side effects.
• Bilateral STN stimulation improved outcomes in MSA-P patients.
• Bilateral thalamic stimulation in TS led to the disappearance of major tics and associated behavioral disturbances.

Conclusions:

• Unilateral pallidal stimulation is not recommended for advanced PD.
• Bilateral STN stimulation is a favorable option for advanced PD, despite potential mood-related side effects.
• DBS shows promise for MSA-P and presents a novel therapeutic option for Tourette syndrome.