Deep brain stimulation for movement disorders

Chronic DBS is a relatively new but promising technique for the treatment of movement disorders. The surgical targets, theoretical rationales, and localization techniques are similar to those for ablative procedures. Three target sites are currently under study: the Vim, GPi, and STN. Although high-frequency DBS at these targets has similar behavioral effects as lesioning, the cellular mechanism of DBS is not well understood and may be extremely complex. Vim stimulation may now be considered to be an established procedure for parkinsonian tremor and ET. Pallidal and STN stimulation are under active investigation as treatments for all cardinal signs of PD. These procedures offer a potential advantage over ablative therapy in that they are reversible and adjustable and may be safer for bilateral use. At present, there are too few studies reported to determine whether these procedures offer a superior clinical result in comparison with ablative surgery. Answers to this question require further study with well- controlled clinical trials in greater numbers of patients.