Abstract
Deep brain stimulation (DBS) is an effective therapy for Parkinson's disease patients
experiencing motor fluctuations, medication-resistant tremor, and/or dyskinesia. Currently,
the subthalamic nucleus and the globus pallidus internus are the two most widely used
targets, with individual advantages and disadvantages influencing patient selection.
Potential DBS patients are selected using the few existing guidelines and the available
DBS literature, and many centers employ an interdisciplinary team review of the individual's
risk–benefit profile. Programmed settings vary based on institution- or physician-specific
protocols designed to maximize benefits and limit adverse effects. Expectations should
be realistic and clearly defined during the evaluation process, and each bothersome
symptom should be addressed in the context of building the risk–benefit profile. Current
DBS research is focused on improved symptom control, the development of newer technologies,
and the improved efficiency of stimulation delivery. Techniques deliver stimulation
in a more personalized way, and methods of adaptive DBS such as closed-loop approaches
are already on the horizon.
Keywords
Parkinson's disease - deep brain stimulation - closed-loop
