Review Article
Volume 12 Issue 7 - 2020
The Essentials in Deep Brain Stimulation
Sacristán HE1*, Galati AS2 and Canestrari L3
1Department of Neurology, Director of the Teaching and Research Committee, “Anselmo Marini Rehabilitation Institut”, Professor of Neurology School of Medicine University of Morón, Associate Professor of Neurology School of Medicine, UBA, Buenos Aires, Argentina
2Department of Neurosurgery Bernardo Houssay Hospital, Department of Neurosurgery Cosme Argerich Hospital, Buenos Aires, Argentina
3Hospital Teaching Unit, Bernardo Houssay Hospital, Buenos Aires, Argentina
*Corresponding Author: Sacristán HE, Department of Neurology, Director of the Teaching and Research Committee, “Anselmo Marini Rehabilitation Institut”, Professor of Neurology School of Medicine University of Morón, Associate Professor of Neurology School of Medicine, UBA, Buenos Aires, Argentina.
Received: May 19, 2020; Published: June 30, 2020


Over the last 3 decades, deep brain stimulation (DBS) has become the mayor growth area for the treatment of patients with severe Parkinson disease with motor complications (PD), dystonia and refractory tremors. More recently, interest has begun to focus on the clinical application of DBS to psychiatric disorders, particularly Tourette syndrome (TS), obsessive compulsive disorders (OCD), and depression. In this article, we reviewed seminal and currently ongoing clinical trials that support our field of knowledge in DBS. The increasing therapeutic use of DBS has created opportunities to study the physiology and pathophysiology of these diseases, by allowing intra-cerebral micro electrode recordings (MER) to be made from patients and permitting electrical stimulation of various targets (regions) within the brain to be undertaken. We review the neurophysiological techniques involved in this process and the complex issue of programming the implanted stimulator in order to optimize therapeutic efficacy and minimize stimulation induced adverse effects. This paper is intended to provide an overview of the use of DBS for movement disorders and provide an introduction to the developing area of DBS for psychiatric diseases and covers the varying surgical techniques involved in implanting electrodes into various deep nuclei within the brain. This paper describes how to select appropriate patients for DBS and the results of DBS treatment for PD, dystonia and refractory tremors, as well as psychiatric conditions like TS and OCD; finally, we consider the future of DBS in patients with refractory mayor depression.

Keywords: DBS; Parkinson; Dystonia; Tremor; OCD; Tourette; Depression


  1. AL Benabid AL., et al. “Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease”. Appl Neurophysiology 1-6 (1987): 344-346.
  2. NR Awan., et al. “Deep brain stimulation: current and future perspectives”. Neurosurgical Focus 27 (2009): E2.
  3. CC McIntyre and PJ Hahn. “Network perspectives on the mechanisms of deep brain stimulation”. Neurobiology of Disease 38 (2010): 329-337.
  4. A Stefani., et al. “Subthalamic stimulation activates internal pallidus: evidence from cGMP microdialysis in PD patients”. Annals of Neurology 57 (2005): 448-452.
  5. Chang SY., et al. “Microthalamotomy effect during deep brain stimulation: potential involvement of adenosine and glutamate efflux”. Conference proceedings, IEEE Engineering in Medicine Biology Society (2009): 3294-3297.
  6. RL Rodriguez., et al. “Pearls in patient selection for deep brain stimulation”. Neurologist 13 (2007): 253-260.
  7. HE Ward and N Hwynn MS. “Update on deep brain stimulation for neuropsychiatric disorders”. Neurobiology of Disease 38 (2010): 346-353.
  8. T Morishita., et al. “Identification and management of deep brain stimulation intra- and postoperative urgencies and emergencies”. Parkinsonism and Related Disorders 16 (2010):153-162.
  9. KE Lyons., et al. “Surgical and hardware complications of subthalamic stimulation: a series of 160 procedures”. Neurology 63 (2004): 612-616.
  10. GE Alexander and MR Delong PL. “Parallel organization of functionally segregated circuits linking basal ganglia and cortex”. The Annual Review of Neuroscience 9 (1986): 357-381.
  11. Sacristán HE., et al. “Agonistas dopaminérgicos en la Enfermedad de Parkinson”. Revista de Medicina Interna4. (2009).
  12. Sacristán HE., et al. “Complicaciones motoras en la enfermedad de Parkinson. Consideraciones clínicas”. Revista de Medicina Interna3 (2013).
  13. Sacristán HE., et al. “Complicaciones motoras en la enfermedad de Parkinson. Consideraciones quirúrgicas”. Revista de Medicina Interna1 (2012).
  14. Benabid A., et al. “Subtalamic nucleus stimulation in Parkinson’s disease”. Deep Brain Stimulation. Oxford University Press. Chapter 1 (2009): 3-10.
  15. Hariz M and Zrinzo L. “Globus pallidus stimulation”. Deep Brain Stimulation. Oxford University Press. Chapter 2 (2009): 11-18.
  16. Speelman H., et al. “Thalamic stimulation”. Deep Brain Stimulation. Oxford University Press. Chapter 3 (2009): 19-25.
  17. Plaha P and Gill SS. “Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson’s disease”. Neuroreport17 (2005): 1883-1887.
  18. G Deuschl., et al. “A randomized trial of deep-brain stimulation for Parkinson’s disease”. The New England Journal of Medicine 355 (2006): 896-908.
  19. FM Weaver., et al. “Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial”. The Journal of the American Medical Association 301 (2009): 63-73.
  20. FM Weaver., et al. “Randomized trial of DBS for Parkinson disease: thirty-six-month outcomes”. Neurology 79 (2012): 55-65.
  21. VJ Odekerken., et al. “Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson’s disease (NSTAPS study): a randomised controlled trial”. The Lancet Neurology 12 (2013): 37-44.
  22. A Williams., et al. “Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson’s disease (PD SURG trial): a randomised, open-label trial”. The Lancet Neurology 9 (2010): 581-591.
  23. MS Okun., et al. “Subthalamic deep brain stimulation with a constant-current device in Parkinson’s disease: an open-label randomised controlled trial”. The Lancet Neurology 11 (2012): 140-149.
  24. WM Schuepbach., et al. “Neurostimulation for Parkinson’s disease with early motor complications”. The New England Journal of Medicine 368 (2013): 610-622.
  25. AM Lozano., et al. “Effect of GPipallidotomy on motor function in Parkinson’s disease”. Lancet 346 (1995): 1383-1387.
  26. P Coubes., et al. “[Treatment of early-onset generalized dystonia by chronic bilateral stimulation of the internal globus pallidus. Apropos of a case]”. Neurochirurgie 45 (1999): 139-144.
  27. J Volkmann., et al. “Pallidal deep brain stimulation in patients with primary generalised or segmental dystonia: 5-year follow-up of a randomised trial”. The Lancet Neurology 11 (2012): 1029-1038.
  28. RL Alterman., et al. “Sixty hertz pallidal deep brain stimulation for primary torsion dystonia”. Neurology 69 (2007): 681-688.
  29. PM Wadia and AE Lang E. “Moro: Selecting appropiate dystonic patients for GPI stimulation. Deep Brain Stimulation. Oxford University Press. Chapter 13 (2009): 107-114.
  30. SO Riordan. “The results of GPi stimulation for generalized dystonia. Deep Brain Stimulation. Oxford University Press. Chapter 14 (2009): 115-125.
  31. AL Benabid., et al. “Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders”. Journal of Neurosurgery 84 (1996): 203-214.
  32. PR Schuurman., et al. “A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor”. The New England Journal of Medicine 7 (2000): 461-468.
  33. W Ondo., et al. “Thalamic deep brain stimulation: comparison between unilateral and bilateral placement”. Archives of Neurology 58 (2001): 218-222.
  34. CG Favilla., et al. “Worsening essential tremor following deep brain stimulation: disease progression versus tolerance”. Brain 135 (2012): 1455-1462.
  35. E Papavassiliou., et al. “Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome”. Neurosurgery2 (2008): 884-894.
  36. Bain P Tremor. “Parkinsonism and Related Disorders. 13.3 (2007): 369-374.
  37. MM Robertson. “Tourette syndrome, associated conditions and the complexities of treatment”. Brain 3 (2000):425-462.
  38. J Jankovic. “Tourette’s syndrome”. The New England Journal of Medicine 345 (2001): 1184-1192.
  39. MY Cheung., et al. “Malignant Tourette”. Journal of Movement Disorders 22 (2007): 1743-1750.
  40. JW Mink., et al. “Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome”. Journal of Movement Disorders 21 (2006): 1831-1838.
  41. MS Okun., et al. “A trial of scheduled deep brain stimulation for Tourette syndrome: moving away from continuous deep brain stimulation paradigms”. JAMA Neurology 70 (2013): 85-94.
  42. E Cannon., et al. “Deep brain stimulation of anteromedial globus pallidus interna for severe Tourette’s syndrome”. The American Journal of Psychiatry 169 (2012): 860-866.
  43. AW Flaherty., et al. “Brain stimulation of the anterior internal capsule for the treatment of Tourette syndrome: technical case report”. Neurosurgery 57 (2005): E403.
  44. Galati A., et al. “Bilateral DBS of the antero-medial GPi and GPe for the treatment of Tourette Syndrome”. EC Neurology9 (2019): 874-881.
  45. Houeto J-L. “Deep brain stimulation for Gilles de la Tourette syndrome”. Deep Brain Stimulation. Oxford University Press. Chapter 18 (2009): 171-178.
  46. SJ Tye., et al. “Disrupting disordered neurocircuitry: treating refractory psychiatric illness with neuromodulation”. Mayo Clinic Proceedings 84 (2009): 522-532.
  47. HE Ward and N Hwynn MS. “Update on deep brain stimulation for neuropsychiatric disorders”. Neurobiology of Disease 38 (2010): 346-353.
  48. BJ Nuttin., et al. “Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder”. Neurosurgery 62 (2008): 966-977.
  49. BD Greenberg., et al. “Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience”. Molecular Psychiatry 15 (2010): 64-79.
  50. Coenen VA., et al. “The medial forebrain bundle as a raget for deep brain stimulation for obsessive-compulsive disorder”. CNSS Pectr 22 (2017): 282-289.
  51. MS Okun., et al. “A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders”. Parkinsonism and Related Disorders 14 (2008): 532-538.
  52. HE Ward and N Hwynn MS. “Update on deep brain stimulation for neuropsychiatric disorders”. Neurobiology of Disease 38 (2010): 346-353.
  53. BD Greenberg., et al. “Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues”. Neurosurgery Clinics of North America 14 (2003): 199-212.
  54. Snyder B., et al. “Cingulate area 25 DBS for depression. Deep Brain Stimulation. Oxford University Press. Chapter 20 (2009): 187-192.
  55. HS Mayberg., et al. “Deep brain stimulation for treatment-resistant depression”. Neuron 45 (2005): 651-660.
  56. A Rezai. “Deep brain stimulation (DBS) for treatment-resistant depression: a randomized controlled trial. 2012. ASSFN Biennial Meeting Abstracts-Oral Presentation San Francisco, California, USA (2012).
  57. Coenen VA., et al. “Supero-lateral medial forebrain bundle deep brain stimulation in major depression: a gateway trial”. Neuropsychopharmacology 44 (2019): 1224-1232.
  59. Montgomery E B. “20 things to know about Deep Brain Stimulation. Oxford University Press. 2015. Chapter 19”. Ethical Issues of Deep Brain Stimulation (2015): 226-246.
Citation: Sacristán HE., et al. “The Essentials in Deep Brain Stimulation”. EC Neurology 12.7 (2020): 76-90.

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