title: Update on deep brain stimulation in Parkinson's disease.
abstract: Deep brain stimulation (DBS) is considered a safe and well tolerated surgical procedure to alleviate Parkinson's disease (PD) and other movement disorders symptoms along with some psychiatric conditions. Over the last few decades DBS has been shown to provide remarkable therapeutic effect on carefully selected patients. Although its precise mechanism of action is still unknown, DBS improves motor functions and therefore quality of life. To date, two main targets have emerged in PD patients: the globus pallidus pars interna and the subthalamic nucleus. Two other targets, the ventralis intermedius and zona incerta have also been selectively used, especially in tremor-dominant PD patients. The main indications for PD DBS have traditionally been motor fluctuations, debilitating medication induced dyskinesias, unpredictable "off time" state, and medication refractory tremor. Medication refractory tremor and intolerable dyskinesia are potential palliative indications. Besides aforementioned targets, the brainstem pedunculopontine nucleus (PPN) is under investigation for the treatment of ON-state freezing of gait and postural instability. In this article, we will review the most recent literature on DBS therapy for PD, including cutting-edge advances and data supporting the role of DBS in advanced neural-network modulation.
authors.affiliation: Department of Neurology, University of Florida, College of Medicine, Center for Movement Disorders and Neurorestoration, 3450 Hull Road, Gainesville, FL 32607 USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martinez-Ramirez
authors.affiliation: Department of Neurology, University of Florida, College of Medicine, Center for Movement Disorders and Neurorestoration, 3450 Hull Road, Gainesville, FL 32607 USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery, Psychiatry, and History, University of Florida, College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, FL 32610 USA.
authors.forename: Alberto R
authors.initials: AR
authors.lastname: Bona
authors.affiliation: Department of Neurology, University of Florida, College of Medicine, Center for Movement Disorders and Neurorestoration, 3450 Hull Road, Gainesville, FL 32607 USA ; Department of Neurosurgery, Psychiatry, and History, University of Florida, College of Medicine, Center for Movement Disorders and Neurorestoration, Gainesville, FL 32610 USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
authors.affiliation: Department of Neurology, University of Florida, College of Medicine, Center for Movement Disorders and Neurorestoration, 3450 Hull Road, Gainesville, FL 32607 USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Wagle Shukla
keywords: Brain modulation; Closed-loop; Globus pallidus; Movement disorders; Neural network; Subthalamic nucleus