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Mov Disord. 2019 Oct 3. doi: 10.1002/mds.27860. [Epub ahead of print]

Deep Brain Stimulation in Movement Disorders: From Experimental Surgery to Evidence-Based Therapy.

Author information

1
Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland.
2
Department of Neurology, University Hospital and Julius-Maximilian-University, Wuerzburg, Germany.
3
Department of Neurology, University Hospital Schleswig Holstein (UKSH), Kiel Campus; Christian-Albrechts-University Kiel, Germany.

Abstract

Deep brain stimulation (DBS) of 3 different targets is the most important therapeutic innovation of the past 30 years for patients with fluctuating Parkinson's disease (PD), disabling dystonia, tremors, and refractory Gilles de la Tourette syndrome. When compared with medical treatment alone, controlled studies have shown better motor, nonmotor, and particularly quality-of-life outcomes with large effect sizes for advanced complicated PD that cannot be improved with medication, and also for PD patients with only early fluctuations. Class 1 studies have also shown superiority over medical treatment for generalized, segmental, and botulinum-toxin refractory focal cervical dystonia. Long-term efficacy is established for all indications with open studies. For tremors, open studies have shown that DBS is remarkably effective on PD and essential tremor, but efficacy on severe essential tremor and cerebellar tremors is limited by a tendency for tolerance/habituation, including concerns about long-term efficacy. Open studies of disabling Gilles de la Tourette syndrome show an improvement in tics. New developments hold a promise for further improvement. New hardware with directional stimulation and new stimulation paradigms are further areas of research. The targets of DBS are refined with new imaging processing that will help to diversify the surgical targets. New indications are being explored. Closed-loop DBS using brain or peripheral sensor signals have shown favorable clinical short-term results. Long-term data are lacking, and it is hoped that similar approaches for other movement or behavioral disorders may be developed. Exciting new developments carry the hope for a more pathophysiology-based approach for DBS for various brain circuit disorders.

KEYWORDS:

closed-loop DBS; deep brain stimulation; movement disorders

PMID:
31580535
DOI:
10.1002/mds.27860

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