Aug 2026· Annals of Indian Academy of Neurology· 0 citations
Medicine
TL;DR
This narrative review provides a concise, clinically oriented overview of DBS tailored for neurologists, residents, and trainees involved in the evaluation and longitudinal management of advanced PD.
Abstract
ABSTRACT
Deep brain stimulation (DBS) has emerged as a cornerstone therapy for people with Parkinson's disease (PD) who experience motor fluctuations and dyskinesias refractory to optimized medical treatment. This narrative review provides a concise, clinically oriented overview of DBS tailored for neurologists, residents, and trainees involved in the evaluation and longitudinal management of advanced PD. The review discusses the evolution of DBS, contemporary patient selection criteria, approved stimulation targets, including the subthalamic nucleus, globus pallidus interna, and ventral intermediate nucleus of the thalamus, and the multidisciplinary presurgical workup. Practical aspects of surgery, device programming strategies, and expected clinical outcomes are highlighted, alongside an evidence-based discussion of risks, complications, and comparative effectiveness relative to other device-aided therapies. The central role of the neurologist, from early referral to long-term device management, is emphasized, as are recent advances such as directional leads, adaptive DBS, and sensing-enabled systems that are reshaping the therapeutic landscape. This review aims to equip neurologists with essential knowledge and decision-making tools to safely and effectively integrate DBS into clinical practice.
BACKGROUND
The substantia nigra (SN) is an emerging deep brain stimulation (DBS) target for Parkinson's disease (PD). However, its independent therapeutic profile remains obscured by concurrent subthalamic nucleus (STN) stimulation in clinical practice. We systematically evaluated the frequency-dependent efficacy, longitudinal feasibility, and clinical boundaries of direct SN DBS to optimize both targeted nigral modulation and STN-SN combined stimulation.
METHODS
Phase 1 comprised an acute randomized crossover assessment in which 30 participants underwent both SN stimulation at 10, 30, and 130 Hz and standard STN stimulation at 130 Hz. Outcomes included the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), objective gait kinematics, and episodic memory. Phase 2 was an exploratory, non-randomized 3-month feasibility cohort. Seven participants initiated chronic SN stimulation; two discontinued because of treatment-limiting adverse events, and longitudinal outcomes were available for five treatment-tolerant completers, with descriptive comparison to five STN-DBS comparator participants.
RESULTS
SN-DBS produced clear, frequency-dependent acute motor improvements. High-frequency (130 Hz) stimulation yielded the most pronounced clinical benefits, including a 43.6% reduction in MDS-UPDRS III and a 13.5% increase in stride length. The motor and spatial gait effects at 130 Hz were of similar magnitude to those observed with standard STN-DBS, while episodic memory performance remained stable across stimulation conditions. Patient-specific VTA mapping identified an outcome-associated region predominantly within the dorsal SN, and greater spatial overlap was associated with greater motor improvement. In Phase 2, chronic SN stimulation was maintained for 3 months in five of seven participants; two discontinued because of treatment-limiting adverse events.
CONCLUSION
Direct SN stimulation produced a clear frequency-dependent acute response in PD, with 130 Hz yielding the strongest motor and spatial gait benefits among the tested frequencies and effects of similar magnitude to standard STN stimulation. VTA mapping localized the strongest response-associated region predominantly within the dorsal SN, and the 3-month observations provided a basis for further development of anatomically precise and individualized SN neuromodulation.
Yu-Ye Liu, Chenguan Jiang, Bingxin Li et al.· Brain Stimulation· 0 citations
Parkinson's disease (PD) involves not only dopaminergic degeneration but also pathological changes in cortico-basal ganglia-thalamocortical circuits and broader disease-relevant biological processes. Deep-brain neuromodulation has emerged as an important therapeutic strategy for motor dysfunction. Among the available approaches, deep brain stimulation (DBS) is the most established modality, whereas low-intensity focused ultrasound (LIFUS), a form of transcranial ultrasound stimulation, represents a promising but earlier-stage, non-invasive platform. This review discusses DBS and LIFUS from a shared mechanistic and translational perspective. Current evidence suggests that the two modalities may engage partially overlapping mechanistic domains associated with motor deficit improvement, including modulation of abnormal network activity, promotion of synaptic and axonal remodeling, attenuation of neuroinflammation and cellular stress, and possible interaction with α-synuclein-related pathology. At the same time, they differ substantially in evidentiary depth, clinical maturity and translational readiness. DBS remains the clinical benchmark, with durable motor benefits and an expanding mechanistic framework that now extends beyond circuit correction to neurotrophic, proteinopathic, neuroimmune and adaptive biomarker-guided mechanisms. By contrast, LIFUS offers non-invasive access to deep brain targets and shows encouraging pre-clinical effects on inflammation, apoptosis, synaptic integrity and neurovascular function, but its clinical evidence remains limited. Overall, deep-brain neuromodulation in PD should be viewed as a multi-dimensional therapeutic framework rather than a group of isolated technologies. Future progress will depend on tighter integration of circuit physiology, pathology-relevant biomarkers, model selection and standardized translational endpoints.
Jin Peng, Yu Liu, Xiaohui Wang· Ultrasound in Medicine and B...· 0 citations
ABSTRACT
Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective intervention for managing Parkinson's disease (PD) refractory to optimal medical therapy. However, conventional clinical scales often overlook subjective outcomes perceived by patients and caregivers. This study aimed to assess these perceptions using a structured questionnaire featuring 18 items evaluating motor and non-motor outcomes, rated on a visual analog scale (VAS, 0-100), where 0 = no perceived change and 100 = maximum perceived magnitude of change compared to the pre-DBS state. Participants were asked to indicate separately whether the reported change represented improvement or deterioration for directional clarity of the VAS score. This retrospective, cross-sectional pilot study evaluated long-term outcomes following DBS at variable postoperative intervals, with an inherent risk of recall bias. Thirty-one patients with idiopathic PD who had undergone STN-DBS at least one year earlier were interviewed along with their primary caregivers. Treating neurologists also provided independent assessments. While 67.7% of patients reported initial motor improvement, 45.2% retained an overall improvement in clinical course over time. Significant improvements were observed in OFF-phase duration and daily functioning in 77.4% and 61.3% of patients, respectively. Caregivers reported perceived declines in cognition, psychiatric symptoms, and speech clarity in 58.1%, 54.8%, and 71% of participants, respectively. A significant observable difference was noted between neurologist-rated global improvement (90.3%) and caregiver-reported outcomes (67.7%). These findings highlight that integrating patient and caregiver perspectives may enhance comprehensive post-DBS care.
Suchismita Majumdar, Sourav Shee, S. Choudhury et al.· Annals of Indian Academy of...· 0 citations
Dystonia is a complex movement disorder that can cause functional disability and reduce quality of life. Deep brain stimulation (DBS) provides meaningful benefits in patients with medically refractory dystonia, but clinical outcomes can vary substantially. This variability likely reflects the heterogeneity in clinical presentations, genetic background, and brain networks involved in motor control. Dystonia is a network disorder involving abnormal interactions across cortico-basal ganglia-cerebellar circuits. Therapeutic effects of DBS therefore arise from modulation of distributed motor circuits rather than a single anatomical target. Advances in non-invasive neurophysiological techniques, intraoperative recordings, and connectome-based neuroimaging have provided new insights into how DBS modulates these pathological networks. Individual response to DBS and long-term outcomes are shaped by the interaction between clinical and genetic factors, neurophysiological abnormalities, and distributed network connectivity. Combining these variables can help refine patient selection for clinical studies and support individualised neuromodulation strategies.
A. Latorre, Kathryn J. Peall, Andreas Horn et al.· Lancet Neurology· 1 citation
Introduction For people with Parkinson’s disease (PD), deciding whether to pursue deep brain stimulation (DBS) has become increasingly complex. Evidence suggests current approaches to collaborative decision-making may fall short of accepted standards. Thus, a decision support intervention, such as a patient decision aid (PtDA) may be warranted. PtDAs have been shown to improve patients’ knowledge, expectations, and participation in decision-making for other, similar healthcare decisions. We therefore sought to assess neurologists’ awareness of, and experience using, PtDAs, and to solicit their opinions on the ideal features of a PtDA for PD patients considering DBS. Methods Sixteen United States-based neurology clinicians were interviewed about their experiences in treating and counseling PD patients considering DBS. These semi-structured interviews were analyzed using qualitative content analysis. Results Seven general neurologists, eight movement disorders specialists, and one registered nurse in a movement practice participated in interviews. None of the clinicians had experience using a patient decision aid, and many were unfamiliar with the concept altogether. All largely expressed optimism about the potential utility of a PtDA for PD patients considering DBS. There was less consensus about the ideal format, content, and implementation of such a PtDA. Conclusion Healthcare providers recognize the potential benefits of a PtDA to engage PD patients considering DBS. However, input from other stakeholders—particularly the patients themselves—is essential to validate these findings.
Hillary S. King, J. Blumenthal-Barby, B. Levi et al.· Frontiers in Human Neuroscie...· 0 citations
Background Deep brain stimulation (DBS) is established for levodopa-responsive Parkinson’s disease (PD), but the outcomes of DBS in rare genetic early-onset parkinsonism remain incompletely defined. While its efficacy is documented in monogenic forms of parkinsonism (e.g., LRRK2, Parkin, PINK1, and SNCA), clinical data regarding the safety and efficacy of DBS in carriers of the SYNJ1 mutation remain scarce. Case presentation We report two patients with SYNJ1-related early-onset parkinsonism treated with bilateral DBS and place their outcomes in a single-center gene-listed EOPD DBS cohort. Case 1 carried a novel homozygous SYNJ1 c.1969A > G (p. Thr657Ala) missense variant and 46, XY disorder of sex development; GPi-DBS enabled the levodopa equivalent daily dose (LEDD) reduction from 775 to 300 mg/day, with improved dyskinesia and sleep, although motor fluctuations and neuropsychiatric symptoms persisted. Case 2 carried a SYNJ1 c.1627 + 13 T > A intronic variant; subthalamic nucleus deep brain stimulation (STN-DBS) reduced the LEDD from 955 to 605 mg/day and Unified Parkinson’s Disease Rating Scale (UPDRS-III) score from 51 to 32 at 1.5-year follow-up. In the contextual cohort, the median LEDD reduction after DBS was 35.2%. These observations support DBS as a feasible symptomatic strategy in selected genetic early-onset Parkinson’s disease (EOPD) while emphasizing genotype-specific uncertainty. Conclusion These cases illustrate heterogeneous clinical responses to DBS in patients with early-onset parkinsonism carrying SYNJ1 variants. DBS may provide symptomatic benefit in carefully selected patients, but the small sample size and variant-level uncertainty preclude conclusions regarding genotype-specific efficacy.
Jiali Liu, Youcheng Zhang, Shouxuan Chen et al.· Frontiers in Medicine· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
