Citation

Williams NR, Foote KD, Okun MS. Mov. Disord. Clin. Pract. (Hoboken) 2014; 1(1): 24-35.

Copyright

(Copyright © 2014, John Wiley and Sons)

DOI

10.1002/mdc3.12004

PMID

unavailable

Abstract

When formulating a DBS treatment plan for a patient with Parkinson's disease (PD), two critical questions should be addressed: (1) Which brain target should be chosen to optimize this patient's outcome? and (2) Should this patient's DBS operation be uni- or bilateral? Over the past two decades, two targets have emerged as leading contenders for PD DBS; the STN and the globus pallidus internus (GPi). Whereas the GPi target does have a following, most centers have uniformly employed bilateral STN DBS for all PD cases. This bilateral STN "one-size-fits-all" approach was challenged by an editorial entitled "STN versus GPi: The Rematch," which appeared in the Archives of Neurology in 2005. Since 2005, a series of well-designed clinical trials and follow-up studies have addressed the question as to whether a more tailored approach to DBS therapy might improve overall outcomes. Such a tailored approach would include the options of targeting the GPi or choosing a unilateral operation. The results of the STN versus GPi "rematch" studies support the conclusion that bilateral STN DBS may not be the best option for every PD surgical patient. Off-period motor symptoms and tremor improve in both targets as well as with either uni- or bilateral stimulation. Advantages of the STN target include more medication reduction, less-frequent battery changes, and a more favorable economic profile. Advantages of GPi include more-robust dyskinesia suppression, easier programming, and greater flexibility in adjusting medications. In cases where unilateral stimulation is anticipated, the data favor GPi DBS. This review summarizes the accumulated evidence regarding use of bi- versus unilateral DBS and selection of STN versus GPi DBS, including definite and possible advantages of different targets and approaches. Based on this evidence, a more patient-tailored, symptom-specific approach will be proposed to optimize outcomes of PD DBS therapy. Finally, the importance of an interdisciplinary care team for screening and effective management of DBS patients will be reaffirmed. Interdisciplinary teams can facilitate the proposed patient-specific DBS treatment planning and provide a more thorough analysis of the risk-benefit ratio for each patient. © 2014 International Parkinson and Movement Disorder Society.

Language: en

Keywords

human; suicide; quality of life; psychiatry; behavior change; clinical practice; priority journal; neuropsychology; swallowing; brain depth stimulation; globus pallidus; Parkinson's disease; subthalamic nucleus; Article; bradykinesia; Deep brain stimulation; gait; sensorimotor cortex; Subthalamic nucleus; speech; Globus pallidus interna