Deep brain stimulation

Abstract

Stereotactic surgeries for movement disorders were introduced in the late 1940s (1-3) but were not widely accepted due to significant morbidity, mortality, and limited knowledge of the appropriate target for symptomatic benefit. With advancements in pharmacological therapy, particularly the availability of levodopa, these surgeries were rarely performed for Parkinson’s disease (PD) until the late 1980s (4). Based on the limitations of drug treatments for PD, and a better understanding of the physiology and circuitry of the basal ganglia there has been a marked increase in surgical therapies for PD. In addition, advances in surgical techniques, neuroimaging and improved electrophysiological recordings allow stereotactic procedures to be done more accurately leading to reduced morbidity. Deep brain stimulation (DBS) has largely replaced ablative surgery as the preferred surgical treatment for PD. There are currently three potential brain targets for the treatment of PD: the ventral intermediate (Vim) nucleus of the thalamus, the globus pallidus interna (GPi), and the subthalamic nucleus (STN).