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March 2018

Globus Pallidus Interna or Subthalamic Nucleus Deep Brain Stimulation for Parkinson Disease: A Review

Author Affiliations
  • 1Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville
  • 2Department of Neurology, Movement Disorder and Neuromodulation Center, University of California, San Francisco
JAMA Neurol. 2018;75(3):367-372. doi:10.1001/jamaneurol.2017.4321

Importance  Selection of the best deep brain stimulation (DBS) target—subthalamic nucleus (STN) or globus pallidus interna (GPi)—for treatment of motor complications in Parkinson disease remains a matter of debate.

Observations  Increasing evidence from randomized clinical trials indicates that motor benefit is similar between both targets, including an effect on dyskinesia and improvement in quality of life. Deep brain stimulation of the STN offers consistently greater dopaminergic medication reduction, possible mild benefit in nonmotor domains, and potential economic advantage. Deep brain stimulation of the GPi provides a probable advantage in dyskinesia suppression, management of symptoms with unilateral leads, and flexibility in medications and programming adjustments. Overall, STN DBS is at potentially higher or equal risk for neuropsychiatric changes compared with GPi DBS.

Conclusions and Relevance  Both GPi and STN DBS provide similar, consistent, marked motor benefits, but subtle target differences exist. Target selection should be tailored to each patient’s clinical presentation, neuropsychiatric profile, and goals of surgery, allowing customization of this therapy and improved individual outcomes.

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