Keywords
Deep brain stimulation
Subthalamic nucleus
Motor symptoms
Disease progression
How to Cite
Abstract
Deep brain stimulation (DBS) is a proven intervention in the treatment of Parkinson disease (PD), which offers substantial control of motor symptoms, medication-saving and quality of life to a well-selected population. This narrative review is a summary of the current evidence on the efficacy of DBS through the PD spectrum of outcomes, with an emphasis on motor and non-motor outcomes and patient response modifiers. This narrative review provides a summary of the existing research on DBS effectiveness throughout the PD spectrum, motor outcomes, non-motor outcomes, and variables affecting patient response. Early-stage DBS, used shortly after the development of motor complications, can deliver long-term motor utility, lessening the overall load of dopaminergic drugs, and cognitive safety in the selected patients. DBS has been very effective in treating treatment-resistant motor symptoms of PD in severe forms but non-dopaminergic symptoms, including gait, balance disorders, and cognitive impairments, can end up being the determinants of the final results in the disease. The choice of the target between the subthalamic nucleus (STN) and globus pallidus internus (GPi) must be made on a case-by-case basis, given the possibility of a higher medication reduction with STN-DBS compared to more desirable neuropsychiatric profile of GPi-DBS in at-risk patients. The non-motor outcomes are not stable, and it is the reason to consider the necessity to carry out a comprehensive preoperative assessment, patient education and multidisciplinary focus. Although strong evidence is offered in support of DBS, the study has limitations such as the lack of long-term quality of life and non-motor outcomes data and standardized stimulation and assessment protocols. The future research must be devoted to large and prospective trials comparing early and delayed DBS, patient selection by neuroimaging and genetic biomarkers and by applying extensive technological breakthroughs, including adaptive and closed-loop stimulation. The optimal integration of DBS in the management of PD will be important to address the problem of underutilization, cost-effectiveness, and fair access.
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