New targets for deep brain stimulation treatment of Parkinson's disease.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the globus pallidus pars interna (GPi) has been shown to be an effective treatment for patients with Parkinson's disease. Strong clinical evidence supports the improvement of motor and non-motor complications and quality of life, with some data suggesting that GPi DBS might be less effective than STN DBS. However, neither STN nor GPi stimulation provides a satisfactory control of non-dopaminergic symptoms, such as gait and balance impairment and cognitive decline, which are frequent and disabling symptoms in advanced Parkinson's disease patients. Therefore, several efforts have been made to discover alternative and new targets to overcome these current DBS limitations. Among these new targets, the stimulation of the pedunculopontine nucleus has initially appeared encouraging. However, findings from different double-blind trials have mitigated the enthusiasm. A multi-target strategy aimed at improving symptoms with different pathogenetic mechanisms might be a promising approach in the next years.
Movement Disorders Centre, Department of Psychiatry and Neurology, CHU de Grenoble - CS10217, 38043 Grenoble Cedex 09, France.
Anna
A
Castrioto
Elena
E
Moro
D000818:Animals; D003071:Cognition; D046690:Deep Brain Stimulation / Q000379:methods; D006801:Humans; D010300:Parkinson Disease / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome