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August 2001

Subthalamic Deep Brain StimulationNeurobehavioral Concerns

Arch Neurol. 2001;58(8):1205-1206. doi:10.1001/archneur.58.8.1205

NEUROLOGISTS practicing in the last half of the 20th century have witnessed remarkable advances in the medical and surgical treatment of idiopathic Parkinson disease (PD).1 We started with only marginally effective anticholinergic preparations and now have a wide range of useful medical and surgical regimens from which to choose. Along the way, with the possible exception of our venture into adrenal medullary brain transplantation, new treatment benefits have far outweighed adverse effects. However, investigators of new treatment modalities for PD must never forget that frontal-subcortical basal ganglia circuits mediate not only motor but also oculomotor, executive, behavioral, and motivational functions.2 Most movement disorders and their treatments affect at least some of these frontal functions. Therefore, it behooves all investigators to be vigilant for unintended cognitive/behavioral effects accompanying any new treatment regimens. We now know that bilateral ablative procedures, both thalamic and pallidal, can cause unacceptable cognitive/behavioral dysfunction.3,4 Although the jury is still out on which surgical procedure is best for medically intractable PD, bilateral subthalamic deep brain stimulation (DBS) appears to be the leading choice for symmetrical appendicular or severe axial disease.3

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