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Time for a New 3-D Image for Globus Pallidus Internus Deep Brain Stimulation Targeting and Programming
Joshua K Wong1, Justin D Hilliard2, Vanessa M Holanda3,4
1Fixel Institute for Neurological Diseases, Department of Neurology, University of Florida, Gainesville, FL, USA.
Journal of Parkinson'S Disease
|August 23, 2021
Summary
Deep brain stimulation (DBS) for Parkinson's disease (PD) has relied on a 2D model of the globus pallidus internus (GPi). A new 3D spatial boundary hypothesis for GPi DBS may improve patient outcomes.
Area of Science:
- Neuromodulation
- Neurosurgery
- Movement Disorders
Background:
- Deep brain stimulation (DBS) is a key therapy for Parkinson's disease (PD).
- Early research conceptualized the globus pallidus internus (GPi) for DBS as having two functional zones, forming the 'GPi triangle'.
- This 2D model persists in clinical practice despite advances in understanding the pallidum.
Discussion:
- The 'GPi triangle' model is a simplification of the complex pallidal anatomy.
- Evolving understanding of pallidal function necessitates a re-evaluation of current DBS targeting strategies.
- A 2D model may limit the optimization of DBS parameters and patient outcomes.
Key Insights:
- The 'GPi triangle' concept, while historically significant, may not fully represent GPi functional organization for DBS.
- A 3D spatial boundary hypothesis offers a more comprehensive framework for understanding GPi's role in DBS.
- This updated model has the potential to refine surgical targeting and improve therapeutic efficacy.
Outlook:
- Further research validating the 3D spatial boundary hypothesis is crucial.
- Implementing a 3D model could lead to more precise GPi DBS targeting.
- This approach promises enhanced and more consistent outcomes for PD patients undergoing DBS.
