The role of deep brain stimulation as a surgical treatment for Parkinson'sdisease

Patients with advanced Parkinson's disease (PD) frequently suffer disabling motor complications that cannot be satisfactorily controlled with medical therapy. Deep brain stimulation (DBS) has recently been introduced by Benab id and his colleagues in Grenoble, France, as a new surgical procedure for the treatment of PD patients. DBS simulates the effects of a lesion without the need to make a destructive brain lesion. In this procedure, an electro de is implanted in the brain target and connected to a subcutaneous pacemak er. DBS of the ventro-intermediate (Vim) nucleus of the thalamus has been s hown to ameliorate tremor in patients with tremor-dominant PD. DBS of the s ubthalamic nucleus (STN) and globus pallidus pars interna (GPi) have been s hown to improve all of the cardinal features of PD and to markedly reduce d yskinesia and motor fluctuations. Adverse events are associated with the su rgical procedure, the device, and stimulation, but the procedure is usually well tolerated. On the basis of these findings, the FDA has recently appro ved unilateral DBS of the Vim for treatment of tremor in PD and is currentl y considering approval of DBS for STN and GPi. This article reviews existin g information with respect to DBS.