Deep brain stimulation for Parkinson's disease: recent trends and future direction

Area of Science:

• Neurosurgery
• Neurology
• Medical Engineering

Background:

• Deep brain stimulation (DBS) is widely used for Parkinson's disease (PD), with over 120,000 global procedures.
• Fundamental understanding of DBS effects on pathological neural circuitry, particularly cortico-striato-thalamo-cortical (CSTC) loops, remains limited.
• DBS can impact motor, cognitive, and affective functions in PD patients.

Purpose of the Study:

• To review the current state of DBS for PD, focusing on subthalamic nucleus (STN) and globus pallidus interna (GPi) targets.
• To discuss indications, practical effects, complications, and adverse events associated with DBS in PD.
• To explore target selection (GPi vs. STN), DBS effects on non-motor symptoms, and unresolved issues.

Main Methods:

• Review of existing literature on DBS for Parkinson's disease.
• Analysis of studies focusing on STN-DBS and GPi-DBS.
• Discussion of surgical complications and stimulation-induced adverse events.

Main Results:

• Subthalamic nucleus (STN) and globus pallidus interna (GPi) are primary DBS targets for PD.
• Ventralis intermedius (Vim)-DBS is effective for tremor but not akinesia or rigidity.
• DBS influences both motor and non-motor symptoms, with ongoing research into optimal targets and parameters.

Conclusions:

• Further research is needed to fully understand DBS mechanisms in PD.
• Optimal surgical timing, management of unresponsive symptoms (e.g., axial symptoms), and postoperative programming require resolution.
• Continued investigation into target selection and non-motor symptom effects will refine DBS therapy for PD.