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Expert Review of Medical Devices Volume 17, 2020 - Issue 10
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Review

Subthalamic nucleus deep brain stimulation for Parkinson’s disease: current trends and future directions

Antonella Macerolloa Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK;b School of Psychology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK;c Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UKView further author information
,
Ludvic Zrinzoc Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK;d Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UKView further author information
,
Harith Akramc Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK;d Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UKView further author information
,
Thomas Foltyniec Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK;d Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UKView further author information
&
Patricia Limousinc Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK;d Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UKCorrespondence[email protected]
View further author information
Pages 1063-1074 | Received 19 Nov 2019, Accepted 23 Mar 2020, Published online: 06 Apr 2020
 
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ABSTRACT

Over the last three decades, extensive basic and clinical research has been performed on the use of subthalamic nucleus (STN) as the preferred deep brain stimulation (DBS) target for the treatment of Parkinson’s disease (PD). The mechanism underlying the benefit for the motor symptoms in PD is related to the modulation of firing patterns within the hyperdirect projections from motor cortical areas, as well as within the afferent and efferent fibers to the motor STN. Advancements in neuroimaging techniques allow us to identify precisely the STN optimizing surgical targeting. In this review, we provide an update on the current uses of STN-DBS as a routine therapy as well as its experimental indications in PD, the critical aspects associated with its successful implementation and recent advances in DBS technology.

Article Highlights

  1. The subthalamic nucleus (STN) is still the primary target of Deep Brain Stimulation (DBS) for Parkinson’s disease (PD).

  2. Cognitive decline and dopa refractory axial symptoms are not improved by this surgical procedure.

  3. Age, severity of PD, and lead location are important predictors of long-term improvement.

Innovative techniques, such as short pulse width stimulation and directional DBS, may allow some reduction in stimulation-related side effects.

Declaration of Interest

P Limousin, L Zrinzo, & T Foltynie have received honoraria/travel expenses from Boston Scientific, Elekta, and Medtronic for speaking at educational meetings. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.

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