Subthalamic Nucleus Deep Brain Stimulation: Uncomplicating Motor Complications for the Long Haul

Alim Louis Benabid, Pierre Pollak, and their research group in Grenoble, France, were the first to report the therapeutic effects of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on bradykinesia and rigidity in patients with Parkinson disease (PD).1 They later demonstrated that bilateral STN DBS not only improved the cardinal features of PD (bradykinesia, rigidity, tremor) but also reduced the severity and frequency of dyskinesia as well as “off” time.2 Other benefits of STN DBS include improved activities of daily living and quality of life, reduction in the mean dopaminergic dose by 50%, and superior motor outcomes compared to best medical therapy.2-4 The US Food and Drug Administration approved DBS of the ventral intermediate nucleus of the thalamus as a treatment for tremor related to PD or essential tremor in 1997 and DBS of the STN or internal portion of the globus pallidum (GPi) as a treatment for advanced PD in 2002; these approvals gave people with PD alternatives to lead a better life. The Grenoble group has the largest number of people with PD who have lived with STN DBS for ≥15 years and are to be commended for describing the very long-term effects of STN stimulation in this issue of Neurology®.5

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