Methods for programming and patient management with deep brain stimulation of the globus pallidus for the treatment of advanced Parkinson's disease and dystonia

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Abstract
Globus pallidus (GPi) deep brain stimulation can markedly improve severe medication-refractory Parkinson's disease (PD) and dystonia. Appropriate perioperative patient management can assist with electrode implantation. Optimizing stimulation settings and simultaneously adjusting medications (when appropriate) can substantially improve patient outcomes. Although there are a large number of possible stimulation settings, in clinical practice, a relatively narrow range of settings has been shown to be most efficacious. A systematic approach to determining those settings that maximally improve parkinsonism and suppress drug-induced dyskinesias is outlined following a clear algorithm that uses the observation that stimulation of the dorsal and ventral pallidum has been shown to have opposite motor effects in PD. Based on the available literature, recommendations are also made for the use of GPi deep brain stimulation in dystonia.