Deep Brain Stimulation for Fluctuations and Dyskinesia in Parkinson’s Disease

Abstract

When medication management no longer allows for consistent control of motor symptoms in PD because of the development of motor fluctuations and dyskinesia, deep brain stimulation (DBS) therapy of the subthalamic nucleus or globus pallidus has been shown to improve on time, reduce dyskinesia, and improve quality of life. Appropriate patient selection is essential for a positive outcome. Various neurostimulator system options and surgical implantation approaches/methods now exist allowing for a more individualized approach. Optimization of DBS settings is largely dictated by a trial and error approach. Antiparkinsonian medications can often be reduced after DBS. Although the motor improvement after DBS can be dramatic, non-motor PD symptoms are not well treated with current forms of stimulation and require ongoing management. Additionally, axial motor symptoms including freezing of gait and postural instability are often refractory to DBS and remain a treatment challenge.