Improving outcomes of subthalamic nucleus deep brain stimulation in Parkinson’s disease

Abstract

The subthalamic nucleus (STN) has been a major target of deep brain stimulation (DBS) for Parkinson’s disease (PD) over the past 20 years. The benefits of DBS of the STN include: decreased motor fluctuations and bradykinesia, tremor reduction and a reduction in dopaminergic drug requirements and dyskinesias. Despite these overall positive effects, the outcomes of STN DBS can be variable, contributing to the debate over the best DBS target for PD. Here, the authors review the current practice of STN DBS and also review both the existing and emerging technologies that are likely to improve the accuracy and effectiveness of STN DBS for PD. The authors emphasize patient selection, accuracy of electrode placement within the brain and the selection of appropriate stimulation parameters to optimize clinical benefits.

Keywords:

• deep brain stimulation
• neuromodulation
• optimization
• Parkinson’s disease
• subthalamic nucleus

Financial & competing interests disclosure

AA Bari has previously received fellowship support from Medtronic. A Fasano has received honoraria from Abbvie, Boston Scientific, Medtronic, UCB, TEVA Canada, Novartis, Chiesi. A Fasano has also received research grants from the University of Toronto, McLaughlin Institute and the Michael J Fox Foundation. AM Lozano has served as a consultant to Medtronic, St Jude and Boston Scientific and is co-founder of Functional Neuromodulation Inc. 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.

Notes

PD: Parkinson’s disease.