Surgery Insight: deep brain stimulation for movement disorders

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Abstract
Over the past few years, deep brain stimulation has replaced lesioning as the neurosurgical treatment of choice for movement disorders such as Parkinson's disease, essential tremor and dystonia. In this review, Anderson and Lenz describe the original experiments that demonstrated the efficacy and safety of deep brain stimulation, and consider the technical aspects that need to be taken into account as the procedure continues to evolve. Over the past two decades, deep brain stimulation (DBS) has supplanted lesioning techniques for the treatment of movement disorders, and has been shown to be safe and efficacious. The primary therapeutic indications for DBS are essential tremor, dystonia and Parkinson's disease. In the case of Parkinson's disease, DBS is effective for treating the primary symptoms—tremor, bradykinesia and rigidity—as well as the motor complications of drug treatment. Progress has been made in understanding the effects of stimulation at the neuronal level, and this knowledge should eventually improve the effectiveness of this therapy. Preliminary studies also indicate that DBS might be used to treat Tourette's syndrome, obsessive-compulsive disorder, depression and epilepsy. As we will discuss in this review, the success of DBS depends on an appropriate rationale for the procedure, and on collaborations between neurologists and neurosurgeons in defining outcomes.