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Novel targets in deep brain stimulation for movement disorders

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Abstract

The neurosurgical treatment of movement disorders, primarily via deep brain stimulation (DBS), is a rapidly expanding and evolving field. Although conventional targets including the subthalamic nucleus (STN) and internal segment of the globus pallidus (GPi) for Parkinson’s disease and ventral intermediate nucleus of the thalams (VIM) for tremor provide substantial benefit in terms of both motor symptoms and quality of life, other targets for DBS have been explored in an effort to maximize clinical benefit and also avoid undesired adverse effects associated with stimulation. These novel targets primarily include the rostral zona incerta (rZI), caudal zona incerta (cZI)/posterior subthalamic area (PSA), prelemniscal radiation (Raprl), pedunculopontine nucleus (PPN), substantia nigra pars reticulata (SNr), centromedian/parafascicular (CM/PF) nucleus of the thalamus, nucleus basalis of Meynert (NBM), dentato-rubro-thalamic tract (DRTT), dentate nucleus of the cerebellum, external segment of the globus pallidus (GPe), and ventral oralis (VO) complex of the thalamus. However, reports of outcomes utilizing these targets are scattered and disparate. In order to provide a comprehensive resource for researchers and clinicians alike, we have summarized the existing literature surrounding these novel targets, including rationale for their use, neurosurgical techniques where relevant, outcomes and adverse effects of stimulation, and future directions for research.

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Adapted from: Camalier CR, Konrad PE, Gill CE, Kao C, Remple MR, Nasr HM, Davis TL, Hedera P, Phibbs FT, Molinari AL, Neimat JS, Charles D (2014) Methods for surgical targeting of the STN in early-stage Parkinson’s disease. Front Neurol 5, and Klein JC, Barbe MT, Seifried C, Baudrexel S, Runge M, Maarouf M, Gasser T, Hattingen E, Liebig T, Deichmann R, Timmermann L, Weise L, Hilker R (2012) The tremor network targeted by successful VIM deep brain stimulation in humans. Neurology 78:787–795

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Authors and Affiliations

  1. Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA

    Alexander J. Baumgartner, John A. Thompson, Drew S. Kern & Steven G. Ojemann

  2. University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA

    John A. Thompson, Drew S. Kern & Steven G. Ojemann

Authors
  1. Alexander J. Baumgartner
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  2. John A. Thompson
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  3. Drew S. Kern
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  4. Steven G. Ojemann
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All authors contributed to the review conception and design. JAT, DSK, and SGO conceived the review. All authors performed literature search and review. AJB drafted the manuscript. All authors critically revised the work.

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Correspondence to Steven G. Ojemann.

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Conflict of interest

AJB received grants from the University of Colorado. JAT received research support from Medtronic and Boston Scientific. DSK served as an advisor for Colorado Clinical and Translational Sciences Institute (CCTSI) Data Safety Monitoring Board, Boston Scientific, and AbbVie Pharmaceutics; received honorarium from AbbVie Pharmaceutics and Boston Scientific, received grants from Boston Scientific, Medtronic, University of Colorado Department of Neurology, and the Parkinson’s Foundation. SGO served on the Data Safety Monitory Board for Askbio Therapeutics, site principal investigator for research collaborations with Abbott, received grants from Medtronic, Abbott, and Boston Scientific.

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Baumgartner, A.J., Thompson, J.A., Kern, D.S. et al. Novel targets in deep brain stimulation for movement disorders. Neurosurg Rev 45, 2593–2613 (2022). https://doi.org/10.1007/s10143-022-01770-y

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