Practical approach to deep brain stimulation therapy and troubleshooting

Abstract

Deep brain stimulation (DBS) is an effective treatment for advanced Parkinson disease (PD). To maximize its benefits, selecting appropriate candidates and stimulation targets is crucial.

In general, STN DBS improves a wide range of PD symptoms, including tremor, rigidity, and bradykinesia, while also reducing the need for medication. Therefore, it is typically the first choice unless there is a high risk of cognitive decline or psychiatric complications. In contrast, GPi DBS is associated with a lower risk of cognitive and psychiatric side effects and strongly suppresses dyskinesia and dystonia. If cognitive impairment or psychiatric symptoms are a concern, levodopa–carbidopa enteral continuous infusion therapy (LCIG) or foslevodopa–foscarbidopa continuous subcutaneous infusion therapy (LDp/CDp) should be considered as alternatives.

In addition to preoperative evaluation, a standardized surgical technique and postoperative programming also play vital roles in DBS outcomes. Errors in any of these steps can lead to postoperative problems. Even at highly experienced centers, complications and unforeseen issues cannot be completely avoided. Furthermore, while patients may do well immediately after surgery or for years thereafter, problems may still arise over time. Therefore, ongoing troubleshooting is essential for maintaining effective long–term treatment.