Deep brain stimulation in the treatment of idiopathic Parkinson's disease

During the past years deep brain stimulation (DBS) has been adopted as a promising therapeutic procedure for the treatment of advanced Parkinson's disease (PD). It is considered a therapeutic approach for those patients who are affected by long term complications of dopaminergic therapy as motor fluctuations and severe dyskinesias. The subthalamic nucleus (STN) and the internal part of the globus pallidus (GPi) are targeted for DBS. Several studies have proved the efficacy of STN-DBS and GPi-DBS in amelioration of off-motor-symptoms and dyskinesia. STN-DBS is considered superior since it allows a marked reduction of antiparkinsonian medication with relatively low energy consumption. However, there is no controlled clinical trial available comparing directly efficacy of STN- and GPi-DBS. Thalamic stimulation in the ventral intermediate nucleus (Vim) should be considered only for older patients with severe tremor but few other parkinsonion symptoms.