Abstract and Introduction
Abstract
Purpose of review Deep brain stimulation (DBS) is now widely used in the treatment of Parkinson's disease, tremor, and dystonia. This review examines recent developments in the application of DBS to the management of movement disorders.
Recent findings In Parkinson's disease, recent work has demonstrated that early DBS may have a significant benefit on quality of life and motor symptoms while permitting a decrease in levodopa equivalent dosage. Thalamic DBS continues to be a well established target for the treatment of tremor, although recent work suggests that alternative targets such as the posterior subthalamic area may be similarly efficacious. The treatment of primary dystonia with DBS has been established in multiple recent trials, demonstrating prolonged symptomatic benefit.
Summary DBS is now an established symptomatic treatment modality for Parkinson's disease and other movement disorders. Future work will undoubtedly involve establishing new indications and targets in the treatment of movement disorders with further refinements to existing technology. Ultimately, these methods combined with biologically based therapies may catalyze a shift from symptomatic treatment to actually modifying the natural history of neurodegenerative diseases such as Parkinson's disease.
Introduction
Deep brain stimulation (DBS) using chronic, high-frequency direct electrical current is now an accepted therapeutic modality for the symptomatic management of Parkinson's disease and other movement disorders such as essential tremor and dystonia. In the last two decades more than 100 000 patients have been implanted with electrodes and the field has rapidly evolved. Improvements in surgical technique, neurostimulation equipment, and optimization of stimulus parameters continue to be made. Furthermore, emerging indications for DBS are being investigated in patients with psychiatric illnesses such as depression and anorexia as well as neurodegenerative dementias such as Alzheimer's disease. Here we review current progress and discuss potential future applications of DBS in the treatment of movement disorders, with a focus on Parkinson's disease.