title: Moving forward: advances in the treatment of movement disorders with deep brain stimulation.
abstract: The modern era of stereotactic and functional neurosurgery has ushered in state of the art technologies for the treatment of movement disorders, particularly Parkinson's disease (PD), tremor, and dystonia. After years of experience with various surgical therapies, the eventual shortcomings of both medical and surgical treatments, and several serendipitous discoveries, deep brain stimulation (DBS) has risen to the forefront as a highly effective, safe, and reversible treatment for these conditions. Idiopathic advanced PD can be treated with thalamic, globus pallidus internus (GPi), or subthalamic nucleus (STN) DBS. Thalamic DBS primarily relieves tremor while GPi and STN DBS alleviate a wide range of Parkinsonian symptoms. Thalamic DBS is also used in the treatment of other types of tremor, particularly essential tremor, with excellent results. Both primary and various types of secondary dystonia can be treated very effectively with GPi DBS. The variety of anatomical targets for these movement disorders is indicative of the network-level dysfunction mediating these movement disturbances. Despite an increasing understanding of the clinical benefits of DBS, little is known about how DBS can create such wide sweeping neuromodulatory effects. The key to improving this therapeutic modality and discovering new ways to treat these and other neurologic conditions lies in better understanding the intricacies of DBS. Here we review the history and pertinent clinical data for DBS treatment of PD, tremor, and dystonia. While multiple regions of the brain have been targeted for DBS in the treatment of these movement disorders, this review article focuses on those that are most commonly used in current clinical practice. Our search criteria for PubMed included combinations of the following terms: DBS, neuromodulation, movement disorders, PD, tremor, dystonia, and history. Dates were not restricted.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA.
authors.forename: Terry K
authors.initials: TK
authors.lastname: Schiefer
authors.forename: Joseph Y
authors.initials: JY
authors.lastname: Matsumoto
authors.forename: Kendall H
authors.initials: KH
authors.lastname: Lee
references.citation: Mov Disord. 2003 Apr;18(4):436-42
references.pmid: 12671953
references.citation: Neuroreport. 2005 Aug 22;16(12):1379-82
references.pmid: 16056143
references.citation: Neurology. 1996 Apr;46(4):1150-3
references.pmid: 8780109
references.citation: N Engl J Med. 2005 Sep 8;353(10):1021-7
references.pmid: 16148287
references.citation: N Engl J Med. 2006 Nov 9;355(19):1978-90
references.pmid: 17093249
references.citation: Mov Disord. 2007 Jan 15;22(2):220-5
references.pmid: 17133504
references.citation: J Psychosom Res. 1999 Mar;46(3):247-55
references.pmid: 10193915
references.citation: Ann Neurol. 2004 Jan;55(1):118-20
references.pmid: 14705120
references.citation: Neurosurgery. 2004 Dec;55(6):1361-8; discussion 1368-70
references.pmid: 15574217
references.citation: N Engl J Med. 2005 Feb 3;352(5):498-500
references.pmid: 15689590
references.citation: J Neurosurg. 2009 Oct;111(4):712-23
references.pmid: 19425890
references.citation: Neurosurgery. 2004 Mar;54(3):613-19; discussion 619-21
references.pmid: 15028135
references.citation: J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1314-9
references.pmid: 17442760
references.citation: Psychiatr Q. 1953 Apr;27(2):317-9
references.pmid: 13056063
references.citation: Arch Neurol. 1996 Sep;53(9):898-903
references.pmid: 8815855
references.citation: Brain. 2007 Jun;130(Pt 6):1596-607
references.pmid: 17251240
references.citation: Lancet. 2000 Jun 24;355(9222):2220-1
references.pmid: 10881900
references.citation: Mov Disord. 2007 Oct 15;22(13):1866-70
references.pmid: 17659634
references.citation: Lancet. 1991 Feb 16;337(8738):403-6
references.pmid: 1671433
references.citation: Neurosurgery. 2005 Feb;56(2):E415; discussion E415
references.pmid: 15670394
references.citation: J Neurosci. 2006 Oct 11;26(41):10380-6
references.pmid: 17035522
references.citation: Neurology. 2000;55(12 Suppl 6):S13-6
references.pmid: 11188968
references.citation: Ann Neurol. 1998 Feb;43(2):180-92
references.pmid: 9485059
references.citation: Ann Neurol. 2004 Jun;55(6):871-5
references.pmid: 15174022
references.citation: Eur J Neurosci. 1993 Apr 1;5(4):382-9
references.pmid: 8261116
references.citation: Mayo Clin Proc. 2009 Jun;84(6):522-32
references.pmid: 19483169
references.citation: Mov Disord. 2002 Jan;17(1):138-44
references.pmid: 11835451
references.citation: J Neurosurg. 2006 Apr;104(4):488-501
references.pmid: 16619651
references.citation: J Neurol Neurosurg Psychiatry. 2006 Apr;77(4):443-9
references.pmid: 16543519
references.citation: Acta Psychiatr Scand. 1960;35(3):358-77
references.pmid: 13835931
references.citation: Parkinsonism Relat Disord. 2008 Aug;14(6):501-4
references.pmid: 18337153
references.citation: Arch Neurol. 2001 Feb;58(2):218-22
references.pmid: 11176959
references.citation: Brain. 2007 Nov;130(Pt 11):2879-86
references.pmid: 17905796
references.citation: Mov Disord. 2008 Jan;23(1):131-4
references.pmid: 17973330
references.citation: J Neurol Neurosurg Psychiatry. 2008 Jun;79(6):694-9
references.pmid: 17898034
references.citation: Mov Disord. 2007 May 15;22(7):974-81
references.pmid: 17443691
references.citation: J Neurol Neurosurg Psychiatry. 2005 Dec;76(12):1640-4
references.pmid: 16291886
references.citation: Neurotherapeutics. 2008 Apr;5(2):320-30
references.pmid: 18394573
references.citation: Neurology. 2000;55(12 Suppl 6):S34-9
references.pmid: 11188973
references.citation: J Neurosurg. 1992 Jun;76(6):924-8
references.pmid: 1588425
references.citation: Neurology. 1998 Oct;51(4):1063-9
references.pmid: 9781530
references.citation: Adv Neurol. 2004;94:287-99
references.pmid: 14509686
references.citation: Neurology. 1989 Jan;39(1):103-6
references.pmid: 2909897
references.citation: Arch Neurol. 1999 Jan;56(1):33-9
references.pmid: 9923759
references.citation: Br J Neurosurg. 2002 Apr;16(2):102-9
references.pmid: 12046727
references.citation: Nat Neurosci. 2004 Dec;7(12):1381-6
references.pmid: 15558062
references.citation: Mov Disord. 2002;17 Suppl 3:S75-83
references.pmid: 11948759
references.citation: J Neurosurg. 1996 Feb;84(2):203-14
references.pmid: 8592222
references.citation: J Neurol Neurosurg Psychiatry. 1999 Jun;66(6):772-5
references.pmid: 10329753
references.citation: J Clin Neurosci. 2007 Mar;14(3):208-15
references.pmid: 17150360
references.citation: Eur J Neurosci. 2006 Feb;23(4):1005-14
references.pmid: 16519665
references.citation: J Neurosurg. 1998 Nov;89(5):865-73
references.pmid: 9817430
references.citation: Lancet Neurol. 2007 Mar;6(3):223-9
references.pmid: 17303528
references.citation: Am J Surg. 1948 Jan;75(1):257-63
references.pmid: 18918435
references.citation: Mov Disord. 1996 Sep;11(5):489-94
references.pmid: 8866489
references.citation: Mov Disord. 2005 Sep;20(9):1203-5
references.pmid: 15954126
references.citation: J Neurosurg. 2009 Oct;111(4):701-11
references.pmid: 19425899
references.citation: Acta Neurochir Suppl. 2003;87:125-8
references.pmid: 14518538
references.citation: J Neurol. 1999 Sep;246 Suppl 2:II42-5
references.pmid: 10526001
references.citation: Brain. 1994 Aug;117 ( Pt 4):805-24
references.pmid: 7922467
references.citation: Mov Disord. 1997 Nov;12(6):865-70
references.pmid: 9399208
references.citation: Mov Disord. 1998 Jan;13(1):78-83
references.pmid: 9452330
references.citation: J Neurosurg. 2004 Aug;101(2):195-200
references.pmid: 15309908
references.citation: Neurology. 2006 Jun 27;66(12):1811-6
references.pmid: 16801642
references.citation: Nature. 1957 Nov 30;180(4596):1200
references.pmid: 13483658
references.citation: Neurosurgery. 2006 Apr;58(4 Suppl 2):ONS-280-5; discussion ONS-285-6
references.pmid: 16582651
references.citation: Neurology. 1998 Sep;51(3):850-5
references.pmid: 9748038
references.citation: Science. 1990 Sep 21;249(4975):1436-8
references.pmid: 2402638
references.citation: J Neurosurg. 1999 Jul;91(1):68-72
references.pmid: 10389882
references.citation: Expert Rev Neurother. 2008 Jun;8(6):897-906
references.pmid: 18505355
references.citation: Arch Med Res. 2000 May-Jun;31(3):266-9
references.pmid: 11036177
references.citation: J Neurosurg. 2010 Mar;112(3):539-48
references.pmid: 19731995
references.citation: N Engl J Med. 1960 Sep 1;263:441-4
references.pmid: 13811793
references.citation: Arch Neurol. 2009 Apr;66(4):465-70
references.pmid: 19364931
references.citation: Clin Neurosurg. 1977;24:367-90
references.pmid: 303972
references.citation: Appl Neurophysiol. 1982;45(3):275-80
references.pmid: 7036857
references.citation: Neurology. 2000;55(12 Suppl 6):S29-33
references.pmid: 11188972
references.citation: Neurosurgery. 1981 Aug;9(2):190-200
references.pmid: 6973705
references.citation: Mov Disord. 2008 Nov 15;23(15):2111-21
references.pmid: 18785230
references.citation: Br J Neurosurg. 2007 Aug;21(4):349-54
references.pmid: 17676453
references.citation: Mov Disord. 2007 Jul 30;22(10):1457-1463
references.pmid: 17516457
references.citation: Brain. 1998 Mar;121 ( Pt 3):451-7
references.pmid: 9549521
references.citation: Arch Gen Psychiatry. 2007 Feb;64(2):170-6
references.pmid: 17283284
references.citation: Mov Disord. 2007 Oct 15;22(13):1885-91
references.pmid: 17618522
references.citation: Brain. 2010 Jan;133(Pt 1):205-14
references.pmid: 19773356
references.citation: Ann Neurol. 2005 May;57(5):738-41
references.pmid: 15852393
references.citation: Science. 2009 Apr 17;324(5925):354-9
references.pmid: 19299587
references.citation: Mov Disord. 2001 Jul;16(4):774-7
references.pmid: 11481713
references.citation: J Neurosurg. 1999 Mar;90(3):468-77
references.pmid: 10067915
references.citation: Arch Neurol. 2000 Apr;57(4):461-5
references.pmid: 10768618
references.citation: Nat Methods. 2011 Jan;8(1):35-8
references.pmid: 21191370
references.citation: J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1568-74
references.pmid: 15489389
references.citation: Adv Neurol. 1998;78:1-10
references.pmid: 9750897
references.citation: Neurology. 2000 Jun 13;54(11):2182-4
references.pmid: 10851392
references.citation: J Neurosci Res. 2003 Apr 15;72(2):259-67
references.pmid: 12672001
references.citation: Neurology. 2009 Feb 17;72(7 Suppl):S65-73
references.pmid: 19221317
references.citation: Ann Neurol. 1998 Dec;44(6):953-61
references.pmid: 9851441
references.citation: J Nerv Ment Dis. 1952 Dec;116(6):766-75
references.pmid: 13045144
references.citation: J Neurol Sci. 2004 Apr 15;219(1-2):119-24
references.pmid: 15050447
references.citation: J Neurosci. 2003 Sep 24;23(25):8743-51
references.pmid: 14507974
references.citation: Klin Wochenschr. 1960 Dec 15;38:1236-9
references.pmid: 13726012
references.citation: Neurosurgery. 2005 Apr;56(2 Suppl):E445; discussion E445
references.pmid: 15794849
references.citation: Neurology. 2002 Oct 22;59(8):1232-9
references.pmid: 12391352
references.citation: N Engl J Med. 2010 Jun 3;362(22):2077-91
references.pmid: 20519680
references.citation: Mov Disord. 2007 Sep 15;22(12):1790-3
references.pmid: 17579361
references.citation: Mov Disord. 2003 Feb;18(2):163-70
references.pmid: 12539209
references.citation: Brain. 2006 Jul;129(Pt 7):1732-47
references.pmid: 16720681
references.citation: Mov Disord. 2008 Oct 15;23(13):1808-11
references.pmid: 18671286
references.citation: Mov Disord. 2008 Jun 15;23(8):1146-53
references.pmid: 18442104
references.citation: N Engl J Med. 1998 Oct 8;339(15):1044-53
references.pmid: 9761807
references.citation: Mov Disord. 1998;13 Suppl 3:119-25
references.pmid: 9827607
references.citation: Neurology. 2007 Aug 14;69(7):681-8
references.pmid: 17698790
references.citation: J Neurophysiol. 2001 Apr;85(4):1351-6
references.pmid: 11287459
references.citation: Mov Disord. 2004 Dec;19(12):1482-5
references.pmid: 15390075
references.citation: Mov Disord. 1998;13 Suppl 3:2-23
references.pmid: 9827589
references.citation: N Engl J Med. 2001 Sep 27;345(13):956-63
references.pmid: 11575287
references.citation: Brain Res Brain Res Rev. 1995 Jan;20(1):91-127
references.pmid: 7711769
references.citation: N Engl J Med. 1998 Oct 15;339(16):1105-11
references.pmid: 9770557
references.citation: Ann Neurol. 2008 Dec;64 Suppl 2:S1-2
references.pmid: 19127574
references.citation: Appl Neurophysiol. 1987;50(1-6):344-6
references.pmid: 3329873
references.citation: Neurology. 1991 Dec;41(12):1982-3
references.pmid: 1745359
references.citation: Mov Disord. 2006 May;21(5):692-5
references.pmid: 16342255
references.citation: Mov Disord. 2002 Jul;17(4):803-7
references.pmid: 12210880
references.citation: Appl Neurophysiol. 1976-1977;39(3-4):257-60
references.pmid: 1052300
references.citation: Mov Disord. 2005 May;20(5):523-39
references.pmid: 15818599
references.citation: Brain. 2005 Oct;128(Pt 10):2240-9
references.pmid: 15975946
references.citation: Neurology. 2008 Nov 25;71(22):1790-5
references.pmid: 19029519
references.citation: Ann Neurol. 1997 Sep;42(3):292-9
references.pmid: 9307249
references.citation: N Engl J Med. 2006 Aug 31;355(9):896-908
references.pmid: 16943402
references.citation: Neurosci Lett. 2010 May 21;475(3):136-40
references.pmid: 20347936
references.citation: J Neurosurg. 1958 May;15(3):244-50
references.pmid: 13539666
references.citation: Mov Disord. 1993 Apr;8(2):206-8
references.pmid: 8474491
references.citation: Neurology. 1999 Jul 13;53(1):85-90
references.pmid: 10408541
references.citation: Neurology. 2000;55(12 Suppl 6):S40-4
references.pmid: 11188974
references.citation: J Neurol Neurosurg Psychiatry. 2002 Oct;73(4):395-9
references.pmid: 12235307
references.citation: Neurology. 2007 Feb 6;68(6):457-9
references.pmid: 17283323
references.citation: J Neurosurg. 1992 Jan;76(1):53-61
references.pmid: 1727169
references.citation: Neurology. 2001 Feb 27;56(4):548-51
references.pmid: 11222806
references.citation: Brain Res. 1990 Jun 4;518(1-2):47-54
references.pmid: 2390727
references.citation: Neurology. 2002 Dec 24;59(12):1976-8
references.pmid: 12499496
references.citation: Neurosurg Focus. 2010 Aug;29(2):E6
references.pmid: 20672923
references.citation: J Neurosurg. 2003 Sep;99(3):489-95
references.pmid: 12959435
references.citation: Neurotherapeutics. 2008 Apr;5(2):309-19
references.pmid: 18394572
references.citation: Eur Neurol. 2007;58(4):218-23
references.pmid: 17823535
references.citation: N Engl J Med. 2005 Feb 3;352(5):459-67
references.pmid: 15689584
references.citation: Arch Neurol. 1993 May;50(5):498-500
references.pmid: 8489406
references.citation: Surg Neurol. 1998 Feb;49(2):145-53; discussion 153-4
references.pmid: 9457264
references.citation: Acta Neurochir (Wien). 2001 Dec;143(12):1273-7; discussion 1278
references.pmid: 11810392
references.citation: Arch Neurol. 2000 Jul;57(7):983-8
references.pmid: 10891980
references.citation: Br J Neurosurg. 1998 Dec;12(6):559-62
references.pmid: 10070467
references.citation: Exp Brain Res. 1999 May;126(2):139-48
references.pmid: 10369137
references.citation: Neurology. 2007 Apr 24;68(17):1345-55
references.pmid: 17452578
references.citation: Stereotact Funct Neurosurg. 2002;79(3-4):214-20
references.pmid: 12890979
references.citation: J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):308-12
references.pmid: 10945804
references.citation: Mov Disord. 1999 Sep;14(5):847-50
references.pmid: 10495050
references.citation: J Neurol Neurosurg Psychiatry. 2004 Aug;75(8):1210; author reply 1210-1
references.pmid: 15258245
references.citation: J Neurophysiol. 2006 Sep;96(3):1569-80
references.pmid: 16738214
references.citation: Prog Brain Res. 2009;175:379-91
references.pmid: 19660668
references.citation: Mov Disord. 2008 Dec 15;23(16):2357-62
references.pmid: 18759339
references.citation: Arch Neurol. 2005 Apr;62(4):554-60
references.pmid: 15824252
references.citation: Parkinsonism Relat Disord. 2008;14(2):114-9
references.pmid: 17822940
references.citation: Neuroscience. 2002;115(4):1109-17
references.pmid: 12453483
references.citation: Neurology. 1996 Jul;47(1):264-5
references.pmid: 8710092
references.citation: Eur J Neurosci. 2000 Nov;12(11):4141-6
references.pmid: 11069610
references.citation: J Neurosurg. 1998 Nov;89(5):713-8
references.pmid: 9817406
references.citation: Adv Neurol. 2004;94:301-8
references.pmid: 14509687
references.citation: Mov Disord. 2002;17 Suppl 3:S188-97
references.pmid: 11948776
references.citation: J Neurol Neurosurg Psychiatry. 1995 Dec;59(6):641-2
references.pmid: 7500109
references.citation: J Neurosci. 2003 Mar 1;23(5):1916-23
references.pmid: 12629196
references.citation: Adv Neurol. 1998;78:211-9
references.pmid: 9750917
references.citation: J Neurol Neurosurg Psychiatry. 2005 May;76(5):684-90
references.pmid: 15834027
references.citation: Sleep Med. 2004 Mar;5(2):207-10
references.pmid: 15033145
references.citation: Parkinsonism Relat Disord. 2009 Dec;15 Suppl 3:S17-21
references.pmid: 20082983
references.citation: J Neurosurg. 2003 Apr;98(4):785-92
references.pmid: 12691403
references.citation: Mov Disord. 2003 Nov;18(11):1332-7
references.pmid: 14639676
references.citation: J Clin Neurosci. 2005 Aug;12(6):638-42
references.pmid: 16098758
references.citation: Mov Disord. 2005 Sep;20(9):1194-200
references.pmid: 15895426
references.citation: Lancet. 1999 Sep 4;354(9181):837-8
references.pmid: 10485734
references.citation: J Neurosurg. 1994 May;80(5):810-9
references.pmid: 8169619
references.citation: J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):834-9
references.pmid: 15145995
references.citation: J Neurol Neurosurg Psychiatry. 2005 Feb;76(2):246-8
references.pmid: 15654041
references.citation: Neurology. 1997 Dec;49(6):1564-9
references.pmid: 9409347
references.citation: J Neural Transm (Vienna). 1999;106(7-8):693-709
references.pmid: 10907728
references.citation: Neuroepidemiology. 2009;32(3):208-14
references.pmid: 19169043
references.citation: N Engl J Med. 1967 Feb 16;276(7):374-9
references.pmid: 5334614
references.citation: Neurol Res. 1995 Dec;17(6):409-16
references.pmid: 8622792
references.citation: Stereotact Funct Neurosurg. 2002;79(3-4):221-7
references.pmid: 12890980
references.citation: Neurosurgery. 1995 Oct;37(4):680-6; discussion 686-7
references.pmid: 8559296
references.citation: Neurology. 1999 Oct 22;53(7):1447-50
references.pmid: 10534249
references.citation: J Neurosurg. 2006 Apr;104(4):506-12
references.pmid: 16619653
references.citation: Mov Disord. 2007 Sep 15;22(12):1729-34
references.pmid: 17557355
references.citation: Lancet. 1995 Jan 14;345(8942):91-5
references.pmid: 7815888
references.citation: Nat Neurosci. 2010 Mar;13(3):387-92
references.pmid: 20081849
references.citation: N Engl J Med. 2003 Nov 13;349(20):1925-34
references.pmid: 14614167
references.citation: J Neurol Neurosurg Psychiatry. 2003 Oct;74(10):1387-91
references.pmid: 14570831
references.citation: J Neurol Neurosurg Psychiatry. 1999 Mar;66(3):289-96
references.pmid: 10084526
references.citation: Neurology. 2000 Dec 26;55(12):1921-3
references.pmid: 11134399
references.citation: J Neurol Neurosurg Psychiatry. 2001 Apr;70(4):464-70
references.pmid: 11254768
references.citation: J Neurosurg. 2005 Aug;103(2):252-5
references.pmid: 16175854
references.citation: J Neurol Neurosurg Psychiatry. 1984 Jun;47(6):596-9
references.pmid: 6376713
references.citation: Eur J Neurol. 2004 Jul;11(7):451-4
references.pmid: 15257682
references.citation: Mov Disord. 2002 Mar;17(2):372-7
references.pmid: 11921126