Skip to main content

Advertisement

SpringerLink
Log in

Deep brain stimulation in Parkinson’s disease

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Throughout the past decade, there has been a marked increase in surgical therapies, primarily deep brain stimulation (DBS), for the treatment of advanced Parkinson’s disease (PD). DBS of the thalamus has been shown to be effective in reducing parkinsonian tremor; however, it is not the treatment of choice for PD given the progression of other symptoms such as rigidity and bradykinesia. Stimulation of the globus pallidus or the subthalamic nucleus is safe and efficacious in the long-term treatment of all cardinal symptoms of PD, and they are currently the surgeries of choice. Serious adverse events with DBS can occur in 1% to 2% of patients, infection in 5% to 8% of patients, and hardware complications in approximately 25% of patients. Complications associated with DBS are related to the experience of the surgical center. Referring physicians and patients should be aware of the number of surgical procedures and complication rates of any prospective surgical center.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Olanow CW, Watts RL, Koller WC: An algorithm (decision tree) for the management of Parkinson’s disease (2001): Treatment guidelines. Neurology 2001, 56(suppl 5):S1-S88.

    PubMed  CAS  Google Scholar 

  2. Samuel M, Lang AE: Lesion surgeries. In Handbook of Parkinson’s Disease. Edited by Pahwa R, Lyons KE, Koller WC. New York: Marcel Dekker; 2003:463–495.

    Google Scholar 

  3. Alesch F, Pinter MM, Helscher RJ, et al.: Stimulation of the ventral intermediate thalamic nucleus in tremor dominated Parkinson’s disease and essential tremor. Acta Neurochir 1995, 136:75–81.

    Article  CAS  Google Scholar 

  4. Benabid AL, Pollak P, Gao D, et al.: Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg 1996, 84:203–214.

    PubMed  CAS  Google Scholar 

  5. Pollak P, Benabid AL, Limousin P, Benazzouz A: Chronic intracerebral stimulation in Parkinson’s disease. Adv Neurol 1997, 74:213–220.

    PubMed  CAS  Google Scholar 

  6. Koller W, Pahwa R, Busenbark K, et al.: High-frequency unilateral thalamic stimulation in the treatment of essential and parkinsonian tremor. Ann Neurol 1997, 42:292–299.

    Article  PubMed  CAS  Google Scholar 

  7. Limousin P, Speelman JD, Gielen F, Janssens M: Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 1999, 66:289–296.

    PubMed  CAS  Google Scholar 

  8. Albanese A, Nordera GP, Caraceni T, Moro E: Long-term ventralis intermedius thalamic stimulation for parkinsonian tremor. Italian Registry for Neuromodulation in Movement Disorders. Adv Neurol 1999, 80:631–634.

    PubMed  CAS  Google Scholar 

  9. Kumar K, Kelly M, Toth C: Deep brain stimulation of the ventral intermediate nucleus of the thalamus for control of tremors in Parkinson’s disease and essential tremor. Stereotact Funct Neurosurg 1999, 72:47–61.

    Article  PubMed  CAS  Google Scholar 

  10. Hariz MI, Shamsgovara P, Johansson F, et al.: Tolerance and tremor rebound following long-term chronic thalamic stimulation for Parkinsonian and essential tremor. Stereotact Funct Neurosurg 1999, 72:208–218.

    Article  PubMed  CAS  Google Scholar 

  11. Lyons KE, Koller WC, Wilkinson SB, Pahwa R: Long term safety and efficacy of unilateral deep brain stimulation of the thalamus for parkinsonian tremor. J Neurol Neurosurg Psychiatry 2001, 71:682–684. This study demonstrates the long-term tremor control provided by DBS of the thalamus while also illustrating that other symptoms continue to progress, reducing the functional ability of patients. This paper highlights the fact that thalamic DBS is not the treatment of choice for typical Parkinson’s disease.

    Article  PubMed  CAS  Google Scholar 

  12. Rehncrona S, Johnels B, Widner H, et al.: Long term efficacy of thalamic deep brain stimulation for tremor: double blind assessments. Mov Disord 2003, 18:163–170. This study demonstrates the long-term tremor control provided by DBS of the thalamus while also illustrating that other symptoms continue to progress, reducing the functional ability of patients. This paper highlights the fact that thalamic DBS is not the treatment of choice for typical Parkinson’s disease.

    Article  PubMed  Google Scholar 

  13. Kumar R, Lang AE, Rodriguez-Oroz MC, et al.: Deep brain stimulation of the globus pallidus pars interna in advanced Parkinson’s disease. Neurology 2000, 55:S34-S39.

    PubMed  CAS  Google Scholar 

  14. The Deep Brain Stimulation for Parkinson’s Disease Study Group: Deep brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med 2001, 345:956–963.

    Article  Google Scholar 

  15. Ghika J, Villemure JG, Fankhauser H, et al.: Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson’s disease with severe motor fluctuations: a 2-year follow-up review. J Neurosurg 1998, 89:713–718.

    Article  PubMed  CAS  Google Scholar 

  16. Volkmann J, Sturm V, Weiss P, et al.: Bilateral high-frequency stimulation of the internal globus pallidus in advanced Parkinson’s disease. Ann Neurol 1998, 44:953–961.

    Article  PubMed  CAS  Google Scholar 

  17. Loher TJ, Burgunder JM, Pohle T, et al.: Longterm pallidal deep brain stimulation in patients with advanced Parkinson’s disease: 1 year follow-up study. J Neurosurg 2002, 96:844–853.

    PubMed  Google Scholar 

  18. Lyons KE, Wilkinson SB, Troster AI, Pahwa R: Long-term efficacy of globus pallidus stimulation for the treatment of Parkinson’s disease. Stereotact Funct Neurosurg 2002, 79:214–220. This study demonstrates that the benefits obtained from DBS of the GPi are sustained for at least 48 months.

    Article  PubMed  Google Scholar 

  19. Limousin P, Krack P, Pollak P, et al.: Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 1998, 339:1105–1111.

    Article  PubMed  CAS  Google Scholar 

  20. Kumar R, Lozano AM, Kim YJ, et al.: Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease. Neurology 1998, 51:850–855.

    PubMed  CAS  Google Scholar 

  21. Rodriguez-Oroz MC, Gorospe A, Guridi J, et al.: Bilateral deep brain stimulation of the subthalamic nucleus in Parkinson’s disease. Neurology 2000, 55:S45-S51.

    PubMed  CAS  Google Scholar 

  22. Thobois S, Mertens P, Guenot M, et al.: Subthalamic nucleus stimulation in Parkinson’s disease: clinical evaluation of 18 patients. J Neurol 2002, 249:529–534.

    Article  PubMed  CAS  Google Scholar 

  23. Moro E, Scerrati M, Romita LM, et al.: Chronic subthalamic nucleus stimulation reduces medication requirements in Parkinson’s disease. Neurology 1999, 53:85–90.

    PubMed  CAS  Google Scholar 

  24. Molinuevo JL, Valldeoriola F, Tolosa et al.: Levodopa withdrawal after bilateral subthalamic nucleus stimulation in advanced Parkinson disease. Arch Neurol 2000, 57:983–988.

    Article  PubMed  CAS  Google Scholar 

  25. Tavella A, Bergamasco B, Bosticco E, et al.: Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: longterm follow-up. Neurol Sci 2002, 23(suppl 2):S111-S112.

    Article  PubMed  Google Scholar 

  26. Figueiras-Mendez R, Regidor I, Riva-Meana C, Magarinos-Ascone CM: Further supporting evidence of beneficial subthalamic stimulation in Parkinson’s patients. Neurology 2002, 58:469–470.

    PubMed  CAS  Google Scholar 

  27. Vingerhoets FJ, Villemure JG, Temperli P, et al.: Subthalamic DBS replaces levodopa in Parkinson’s disease: two-year follow-up. Neurology 2002, 58:396–401.

    PubMed  Google Scholar 

  28. Romito LM, Scerrati M, Contarino MF, et al.: Long-term follow up of subthalamic nucleus stimulation in Parkinson’s disease. Neurology 2002, 58:1546–1550.

    PubMed  CAS  Google Scholar 

  29. Pahwa R, Wilkinson SB, Overman J, Lyons KE: Bilateral subthalamic stimulation in patients with Parkinson disease: long-term follow up. J Neurosurg 2003, 99:71–77.

    PubMed  Google Scholar 

  30. Kleiner-Fisman G, Fisman DN, Sime E, et al.: Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease. J Neurosurg 2003, 99:489–495.

    Article  PubMed  Google Scholar 

  31. Krack P, Batir A, Van Blercom N, et al.: Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003, 349:1925–1934. This study demonstrates that significant benefits obtained from DBS of the subthalamic nucleus are sustained up to 5 years after surgery.

    Article  PubMed  CAS  Google Scholar 

  32. Krack P, Pollak P, Limousin P, et al.: Subthalamic nucleus or internal pallidal stimulation in young onset Parkinson’s disease. Brain 1998, 121:451–457.

    Article  PubMed  Google Scholar 

  33. Burchiel KJ, Anderson VC, Favre J, Hammerstad JP: Comparison of pallidal and subthalamic nucleus deep brain stimulation for advanced Parkinson’s disease: results of a randomized, blinded pilot study. Neurosurgery 1999, 45:1375–1382.

    Article  PubMed  CAS  Google Scholar 

  34. Volkmann J, Allert N, Voges J, et al.: Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD. Neurology 2001, 56:548–551.

    PubMed  CAS  Google Scholar 

  35. Scotto di Luzio AE, Ammannati F, Marini P, et al.: Which target for DBS in Parkinson’s disease? Subthalamic nucleus versus globus pallidus internus. Neurol Sci 2001, 22:87–88.

    Article  PubMed  CAS  Google Scholar 

  36. Krause M, Fogel W, Heck A, et al.: Deep brain stimulation for the treatment of Parkinson’s disease: subthalamic nucleus versus globus pallidus internus. J Neurol Neurosurg Psychiatry 2001, 70:464–470.

    Article  PubMed  CAS  Google Scholar 

  37. Beric A, Kelly PJ, Rezai A, et al.: Complications of deep brain stimulation surgery. Stereotact Funct Neurosurg 2001, 77:73–78.

    Article  PubMed  CAS  Google Scholar 

  38. Kondziolka D, Whiting D, Germanwala A, Oh M: Hardwarerelated complications after placement of thalamic deep brain stimulator systems. Stereotact Funct Neurosurg 2002, 79:228–233.

    Article  PubMed  Google Scholar 

  39. Umemura A, Jaggi JL, Hurtig HI, et al.: Deep brain stimulation for movement disorders: morbidity and mortality in 109 patients. J Neurosurg 2001, 98:779–784.

    Google Scholar 

  40. Oh MY, Abosch A, Kim SH, et al.: Long-term hardware-related complications of deep brain stimulation. Neurosurgery 2002, 50:1268–1276. This paper demonstrates a hardware complication rate of approximately 25% with DBS.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Boulevard, Mailstop 2012, 66160, Kansas City, KS, USA

    Kelly E. Lyons PhD & Rajesh Pahwa MD

Authors
  1. Kelly E. Lyons PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajesh Pahwa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lyons, K.E., Pahwa, R. Deep brain stimulation in Parkinson’s disease. Curr Neurol Neurosci Rep 4, 290–295 (2004). https://doi.org/10.1007/s11910-004-0054-0

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-004-0054-0

Keywords

Search

Navigation