title: Deep Brain Stimulation Target Selection for Parkinson's Disease.
abstract: During the "DBS Canada Day" symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to discuss three main questions on target selection for deep brain stimulation (DBS) of patients with Parkinson's disease (PD). First, is the subthalamic nucleus (STN) or the globus pallidus internus (GPi) the ideal target? In summary, both targets are equally effective in improving the motor symptoms of PD. STN allows a greater medications reduction, while GPi exerts a direct antidyskinetic effect. Second, are there further potential targets? Ventral intermediate nucleus DBS has significant long-term benefit for tremor control but insufficiently addresses other motor features of PD. DBS in the posterior subthalamic area also reduces tremor. The pedunculopontine nucleus remains an investigational target. Third, should DBS for PD be performed unilaterally, bilaterally or staged? Unilateral STN DBS can be proposed to asymmetric patients. There is no evidence that a staged bilateral approach reduces the incidence of DBS-related adverse events.
authors.affiliation: 1Division of Neurosurgery,University of British Columbia,Vancouver,British Columbia.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Honey
authors.affiliation: 2Research Imaging Centre,Centre for Addiction and Mental Health,Toronto.
authors.forename: Clement
authors.initials: C
authors.lastname: Hamani
authors.affiliation: 3Department of Surgery,Division of Neurosurgery,University of Toronto.
authors.forename: Suneil K
authors.initials: SK
authors.lastname: Kalia
authors.affiliation: 5Division of Neurosurgery,Walter C. MacKenzie Health Sciences Centre,University of Alberta,Edmonton,Alberta.
authors.forename: Tejas
authors.initials: T
authors.lastname: Sankar
authors.affiliation: 4Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,Ontario.
authors.forename: Marina
authors.initials: M
authors.lastname: Picillo
authors.affiliation: 4Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,Ontario.
authors.forename: Renato P
authors.initials: RP
authors.lastname: Munhoz
authors.affiliation: 4Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease,Toronto Western Hospital,University Health Network,Toronto,Ontario.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.affiliation: 6Division of Neurology,Department of Medicine,Hôpital Notre-Dame,University of Montreal Health Centre,Montréal,Québec,Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Panisset
mesh_terms: D001921:Brain / Q000033:anatomy & histology / Q000502:physiology*; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D010300:Parkinson Disease / Q000628:therapy*
keywords: Parkinson’s disease; deep brain stimulation; globus pallidus internus; movement disorder; movement disorder surgery; subthalamic nucleus; surgical target; ventral intermediate nucleus