Deep brain stimulation in Parkinson's disease

During the past 15 years deep brain stimulation has been established as a highly effective therapy for patients with advanced Parkinson’s disease, and stimulation of the subthalamic nucleus is particularly efficacious in treating medically refractory levodopa-induced motor complications or resistant tremor. However, patient selection, sterotactic implantation, post-operative stimulator programming and patient care means deep brain stimulation can only be undertaken with the support of a dedicated multi-disciplinary team including specialists in movement disorders, neurologists and surgeons. Deep brain stimulation results in improved motor symptoms with sustained long-term benefits and significant improvement in quality of life, but benefits must be weighed against potential adverse events including surgery-related problems, device-related complications and stimulus-induced side effects. Currently, deep brain stimulation is considered only for patients with advanced Parkinson’s disease, but there may be good reasons for advancing treatment earlier in the disease course, helping to prevent psychosocial decline and maintain quality of life for a longer period of time.