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Surgery Insight: deep brain stimulation for movement disorders

Nature Clinical Practice Neurology volume 2, pages 310–320 (2006)Cite this article

Abstract

Over the past two decades, deep brain stimulation (DBS) has supplanted lesioning techniques for the treatment of movement disorders, and has been shown to be safe and efficacious. The primary therapeutic indications for DBS are essential tremor, dystonia and Parkinson's disease. In the case of Parkinson's disease, DBS is effective for treating the primary symptoms—tremor, bradykinesia and rigidity—as well as the motor complications of drug treatment. Progress has been made in understanding the effects of stimulation at the neuronal level, and this knowledge should eventually improve the effectiveness of this therapy. Preliminary studies also indicate that DBS might be used to treat Tourette's syndrome, obsessive-compulsive disorder, depression and epilepsy. As we will discuss in this review, the success of DBS depends on an appropriate rationale for the procedure, and on collaborations between neurologists and neurosurgeons in defining outcomes.

Key Points

  • In the 1950s, surgeons noted that stimulation used to localize thalamic targets to be lesioned for the relief of pain also improved the symptoms of movement disorders

  • Deep brain stimulation (DBS) is currently used to treat Parkinson's disease, essential tremor and dystonia, and patients with psychiatric disorders might also benefit from DBS therapy

  • A multidisciplinary team is required for evaluation and clinical decision-making in patients with movement disorders who are being considered for surgery

  • The neural elements that are most excitable in response to externally applied electric fields are the myelinated axons

  • Preoperative planning and target localization by most clinical teams currently relies on MRI localization, and microelectrode recording has an important role in improving the accuracy of targeting in stereotactic placement procedures

  • The long-term improvement and development of DBS will depend on our ability to understand its mechanism of action

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Figure 1: Effects of deep brain stimulation on disability in patients with Parkinson's disease.
Figure 2: Effects of deep brain stimulation in patients with essential tremor.
Figure 3: Effects of deep brain stimulation in patients with dystonia.
Figure 4: Two types of electrophysiologic response to deep brain stimulation in rat ventral thalamic neurons.
Figure 5: Axial and coronal views of structures around the third ventricle, showing how targeting coordinates are obtained preoperatively.

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  1. neurosurgery resident,

    William S Anderson & Frederick A Lenz

  2. professor of neurosurgery at the Johns Hopkins University School of Medicine, Baltimore, MA, USA

    William S Anderson & Frederick A Lenz

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Correspondence to Frederick A Lenz.

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Anderson, W., Lenz, F. Surgery Insight: deep brain stimulation for movement disorders. Nat Rev Neurol 2, 310–320 (2006). https://doi.org/10.1038/ncpneuro0193

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