Optimal Timing of Deep Brain Stimulation for Parkinson's Disease

Deep brain stimulation (DBS) is considered the most important development in the treatment of Parkinson's disease (PD) since the introduction of levodopa. So far, DBS has been used as ultima ratio for the treatment of severe motor fluctuations and dyskinesias or refractory tremor in advanced PD. However, the disease frequently leads to considerable psychosocial consequences such as occupational disability or social isolation with consecutive impairment in quality of life already at earlier disease stages. Recent research has shown DBS of the subthalamic nucleus (STN) to be superior to best medical treatment in improving quality of life and motor symptoms in PD patient with motor complication at an earlier-disease stage. STN-DBS should be considered as treatment option earlier in the disease course after the occurrence of motor fluctuations preferably for long term maintenance of quality of life.