Up-To-Date Practice of Deep Brain Stimulation for Parkinson's Disease

Abstract

  Deep brain stimulation (DBS) is a well-established surgical treatment for patients with advanced Parkinson's disease (PD) who show on/off motor fluctuations, dyskinesia, and/or tremor. DBS therapy has been widely administered over the past two decades, and the advantages and disadvantages of this therapeutic approach have been revealed. Although various studies have proved the efficacy of DBS, advances in this therapeutic modality and a multidisciplinary clinical approach are essential for further improvements in the clinical outcomes of this treatment. Lately, various DBS devices including directional leads, as well as a pulse generator that senses real-time neurophysiological activities through the intracranial lead have become available in Japan. These novel technologies have refined the treatment paradigm ; however, an increase in stimulation parameters and greater complexity of programming necessitate further development of clinical knowledge. While adjustability and reversibility are acknowledged as advantages of DBS therapy, studies have reported that DBS surgery has failed to show the expected efficacy secondary to complications including hardware infection and intracranial lead misplacement in some cases. Notably, the advantage of conventional radiofrequency lesioning has been reconsidered as an effective treatment option, following the advent of thermoablation therapy using magnetic resonance imaging-guided focused ultrasound system. These treatment modalities have led to complexity in the treatment of PD. Among the various surgical treatment options currently available, standardized surgical procedures performed by well-trained neurosurgeons are necessary to select DBS as the first-line procedure for patients with PD.