A huge question facing Parkinson’s disease patients and clinicians has been “What is the best target for deep brain stimulation (DBS)?” Over the years, two main brain regions have emerged as possibilities: the subthalamic nucleus (STN) and the globus pallidus interus (GPi). Though each target has had defenders, most centers have gravitated toward utilizing only STN DBS. A series of recent trials, however, will likely change this simple practice pattern into a more complex and tailored approach.
In this month's issue of the Lancet Neurology, the PD SURG trial results (conducted by a multicenter team of collaborative investigators from all over Britain) are including a one year follow-up of Parkinson's disease deep brain stimulation (DBS) patients. The trial was randomized, and it compared DBS to best medical therapy. The primary outcome variable was quality of life, and interestingly, patients in the best medical therapy arm had access to apomorphine pumps.
There has been a great deal of recent controversy as to whether an MRI (magnetic resonance imaging) can be safely performed in people with Parkinson’s disease (PD) with deep brain stimulation (DBS) devices. The overarching worry has been that the MRI machines will heat the DBS, and this will in turn result in an irreversible injury to the brain. Despite these worries, there have been surprisingly few cases of MRI-related heating injuries associated with DBS devices.