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April 2005

Subthalamic Nucleus vs Globus Pallidus Interna Deep Brain Stimulation, the Rematch: Will Pallidal Deep Brain Stimulation Make a Triumphant Return?

Arch Neurol. 2005;62(4):533-536. doi:10.1001/archneur.62.4.533

The field of Parkinson disease (PD) surgery has reemerged as an important area of research and clinical advancement. The notion of a surgical treatment for PD and tremors probably originated in 1909 with Horsley and in 1937 with Bucy, both of whom excised regions of motor cortex. The introduction in the 1950s of Speigel and Wycis’s stereotaxic head frame was an important development, and over the next several years, lesioning techniques in the thalamus and pallidum were refined. By the late 1960s, however, surgical treatment of PD halted with the introduction of levodopa. After the complications and failures of levodopa therapy were realized, PD surgery and lesion therapy reemerged. In the past decade, however, most centers using lesion therapy have switched to deep brain stimulation (DBS). Rapid and important advances in our understanding of basal ganglia physiology and neuroanatomy1,2 have led to controversy about the best target for DBS. The thalamic target has proven effective only for tremor, but the controversy over which is the best overall target for PD continues.