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Semin Neurol 2017; 37(02): 205-214
DOI: 10.1055/s-0037-1601893
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Practice and the Future of Deep Brain Stimulation Therapy in Parkinson's Disease

Leonardo Almeida
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Wissam Deeb
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Chauncey Spears
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Enrico Opri
2   Biomedical Engineering, University of Florida, Gainesville, Florida
,
Rene Molina
2   Biomedical Engineering, University of Florida, Gainesville, Florida
,
Daniel Martinez-Ramirez
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Aysegul Gunduz
2   Biomedical Engineering, University of Florida, Gainesville, Florida
,
Christopher W. Hess
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Michael S. Okun
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
› Author Affiliations
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Publication History

Publication Date:
16 May 2017 (online)

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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