Deep Brain Stimulation: Current and Future Clinical Applications

doi:10.4065/mcp.2011.0045

Mayo Clinic Proceedings

Volume 86, Issue 7, July 2011, Pages 662-672

https://doi.org/10.4065/mcp.2011.0045 Get rights and content

Deep brain stimulation (DBS) has developed during the past 20 years as a remarkable treatment option for several different disorders. Advances in technology and surgical techniques have essentially replaced ablative procedures for most of these conditions. Stimulation of the ventralis intermedius nucleus of the thalamus has clearly been shown to markedly improve tremor control in patients with essential tremor and tremor related to Parkinson disease. Symptoms of bradykinesia, tremor, gait disturbance, and rigidity can be significantly improved in patients with Parkinson disease. Because of these improvements, a decrease in medication can be instrumental in reducing the disabling features of dyskinesias in such patients. Primary dystonia has been shown to respond well to DBS of the globus pallidus internus. The success of these procedures has led to application of these techniques to multiple other debilitating conditions such as neuropsychiatric disorders, intractable pain, epilepsy, camptocormia, headache, restless legs syndrome, and Alzheimer disease. The literature analysis was performed using a MEDLINE search from 1980 through 2010 with the term deep brain stimulation, and several double-blind and larger case series were chosen for inclusion in this review. The exact mechanism of DBS is not fully understood. This review summarizes many of the current and potential future clinical applications of this technology.

Section snippets

PARKINSON DISEASE

Parkinson disease is thought to affect at least 100 persons in every 100,000. The cardinal symptoms of tremor, bradykinesia, postural instability, and rigor result in substantial disability for patients with PD. During the course of the disease, up to 50% of patients will have symptoms refractory to medication and will experience drug-induced dyskinesias. Overactivity of the globus pallidus internus (GPi) and the subthalamic nucleus (STN) is believed to be part of the pathophysiologic mechanism

ESSENTIAL TREMOR

Essential tremor (ET) is the most common form of pathologic tremor. It most frequently affects the hands but can also involve the head, voice, tongue, and lower extremities. The prevalence of ET increases with age. Many patients will have a family history of ET consistent with a Mendelian dominant genetic pattern. Essential tremor can be effectively treated with propranolol and primidone, and alcohol can markedly diminish the tremor in many patients. Stereotactic thalamotomy has been largely

Primary Dystonia

Medical treatment of dystonia does not always produce adequate symptom control and often leads to intolerable adverse effects. Initially, ablative procedures of either the thalamus or the GPi demonstrated symptomatic improvement in patients with dystonia.²³ Several reports of DBS for intractable dystonia have targeted the ventral intermedius nucleus of the thalamus²⁴ and the GPi.25, 26, 27, 28 In general, responses have been favorable with both targets. Double-blind prospective trials of

Cluster Headache

Cluster headache is a rare condition that results in severe headaches occurring cyclically and can last for weeks or months at a time. In as many as 20% of patients, cluster headaches are considered medically refractory.⁴² Positron emission tomography has identified focal increase in blood flow in the ipsilateral hypothalamus during a cluster headache attack.⁴³ In 2001, Leone et al⁴⁴ reported the first successful DBS of the posterior hypothalamus for the treatment of refractory cluster

CHRONIC PAIN

Treatment of a variety of pain syndromes using DBS initially focused on the sensory nucleus of the thalamus for neuropathic pain. The ventral posterolateral and ventroposteromedial nuclei were the most commonly targeted areas.⁵⁴ Subsequent trials found that chronic stimulation of the PAG region and periventricular gray (PVG) region at the level of the third ventricle was also effective.⁵⁵ The PAG/PVG region is generally targeted for nociceptive pain, whereas the ventral posterolateral and

Tourette Syndrome

Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder that occurs most commonly in childhood and is characterized by phonic, vocal, and motor tics; pathophysiology is poorly understood. Among patients with GTS, severity of symptoms and responsiveness to treatment vary substantially. Nearly 1% of children worldwide reportedly have GTS.⁶⁰ Many of these children have psychological comorbidities, including obsessive-compulsive disorder (OCD), anxiety, depression, attention deficit

EPILEPSY

Epilepsy is one of the most prevalent and disabling disorders across all age groups. Nearly 1% of adults and up to 5% of children are diagnosed as having epilepsy; more than 30% of cases are refractory to treatment. A study in the early 1970s by Cooper et al⁸⁸ demonstrated significant seizure reduction in more than 50% of their patients with intractable epilepsy who had undergone cerebellar electrical stimulation; improvements in visual, verbal, and memory function were noted. Salcman et al⁸⁹

CAMPTOCORMIA

Camptocormia, a posture abnormality, is characterized by involuntary truncal flexion induced by standing or sitting and has been found to be associated with other neurologic disorders, including idiopathic PD.103, 104 Nandi et al¹⁰³ reported a case of a young man who did not have PD but who underwent bilateral GPi DBS for disabling camptocormia secondary to adverse effects of neuroleptic medication. Micheli et al¹⁰⁴ targeted the GPi bilaterally in a patient with PD and camptocormia; at 14

RESTLESS LEGS SYNDROME

Restless legs syndrome (RLS) can affect up to 25% of the adult population, and the percentage of patients with PD who also have RLS may be even higher.¹⁰⁶ Although the pathophysiology is unknown, it might be related to impaired central dopaminergic transmission. Single photon emission computed tomography has revealed reduced striatal dopamine D2-receptor binding in patients with RLS; thus, central striatal dopaminergic dysfunction is a possibility.¹⁰⁷

Functional magnetic resonance imaging has

OBESITY AND ADDICTIONS

Obesity is an increasingly important health problem, and DBS has been used in obese patients.112, 113, 114, 115 The lateral hypothalamus and ventromedial hypothalamus are the appetite and satiety centers of the brain, respectively. More recent efforts have been directed toward the reward center of the brain, the NAc.¹¹² Current reports of chronic stimulation of the NAc suggest that modulation of the reward sensation may affect dietary preferences. Additional analysis has concluded that DBS for

DISORDERS Of CONSCIOUSNESS

Traumatic brain injury, a leading cause of persistent vegetative state (PVS) or minimally conscious state (MCS), has been a recent, albeit sparse, area of study of the effects of DBS. Reports of brain stimulation for PVS/MCS have been published as early as 1950. In 2010, Yamamoto et al¹¹⁸ described their experience in 21 traumatic and nontraumatic brain–injured patients who were in either a PVS or a MCS and who underwent DBS targeting primarily the thalamic CM parafascicularis complex. Eight to

ALZHEIMER DISEASE

Alzheimer disease (AD) is a progressive degenerative disorder; however, recent data suggest that the disease may also represent a disorder of the integrated cortical and subcortical pathways.¹²¹ Hamani et al¹¹⁵ reported memory improvement in a patient who underwent fornix/hypothalamus DBS for obesity. These findings led Laxton et al¹²² to develop a phase 1 trial of fornix/hypothalamus DBS in 6 patients with mild AD. The researchers used positron emission tomography to measure pre- and

CONCLUSION

Deep brain stimulation has provided substantial clinical improvement in patients with several different diseases and disorders. The understanding of how DBS works has advanced during the past 2 decades, but there is still much to be learned. Functional imaging studies and intraoperative electrophysiological monitoring have added greatly to the understanding of the effects of stimulation on the neurotransmitters and functional brain pathways. Ongoing trials and proposed studies to assess the

REFERENCES (122)

AM Kuncel et al.
Myoclonus and tremor response to thalamic deep brain stimulation parameters in a patient with inherited myoclonus–dystonia syndrome
Clin Neurol Neurosurg
(2009)
MM Kurtis et al.
Clinical and neurophysiological improvement of SGCE myoclonus-dystonia with GPi deep brain stimulation
Clin Neurol Neurosurg
(2010)
C Hamani et al.
Deep brain stimulation for chronic neuropathic pain: long-term outcome and the incidence of insertional effect
Pain
(2006)
RG Bittar et al.
Deep brain stimulation for pain relief: a meta-analysis
J Clin Neurosci
(2005)
V Vandewalle et al.
Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus
Lancet
(1999)
I Neuner et al.
Deep brain stimulation in the nucleus accumbens for intractable Tourette's syndrome: follow-up report of 36 months [letter]
Biol Psychiatry
(2009)
HS Mayberg et al.
Deep brain stimulation for treatment-resistant depression
Neuron
(2005)
WK Goodman et al.
Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design
Biol Psychiatry
(2010)
W Huff et al.
Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive compulsive disorder: outcomes after one year
Clin Neurol Neurosurg
(2010)
B Nuttin et al.
Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder
Lancet
(1999)

CC McIntyre et al.

Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both

Clin Neurophysiol

(2004)

SA Chkhenkeli et al.

Electrophysiological effects and clinical results of direct brain stimulation for intractable epilepsy

Clin Neurol Neurosurg

(2004)

J Voges et al.

Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery-experiences from a single centre

J Neurol Neurosurg Psychiatry

(2006)

AL Benabid et al.

Acute and long-term effects of subthalamic nucleus stimulation in Parkinson's disease

Stereotact Funct Neurosurg

(1994)

J Siegfried et al.

Bilateral continuous electrostimulation of ventroposterolateral pallidum: a new therapeutic approach for alleviating all Parkinsonian symptoms

Neurosurgery

(1994)

WM Schupbach et al.

Stimulation of the subthalamic nucleus in Parkinson's disease: a 5-year follow-up

J Neurol Neurosurg Psychiatry

(2005)

P Krack et al.

Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease

N Engl J Med

(2003)

R Pahwa et al.

Bilateral subthalamic stimulation with Parkinson's disease: long-term follow-up

J Neurosurg

(2003)

G Kleiner-Fisman et al.

Long-term follow-up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson's disease

J Neurosurg

(2003)

VC Anderson et al.

Pallidal vs. subthalamic nucleus deep brain stimulation in Parkinson's disease

Arch Neurol

(2005)

M Krause et al.

Deep brain stimulation for the treatment of Parkinson's disease: subthalamic nucleus versus globus pallidus internus

J Neurol Neurosurg Psychiatry

(2001)

F Weaver et al.

Deep brain stimulation in Parkinson disease: a metaanalysis of patient outcomes

J Neurosurg

(2005)

J Voges et al.

Deep brain stimulation for Parkinson's disease

Acta Neurochir Suppl

(2007)

JA Saint-Cyr et al.

Neurophysiological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease

Brain

(2000)

F Agnesi et al.

Wireless Instantaneous Neurotransmitter Concentration System-based amperometric detection of dopamine, adenosine, and glutamate for intraoperative neurochemical monitoring

J Neurosurg

(2009)

RF Young et al.

Gamma knife thalamotomy for treatment of essential tremor: long-term results

J Neurosurg

(2010)

PR Schuurman et al.

A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor

N Engl J Med

(2000)

P Limousin et al.

Multicentre European study of thalamic stimulation in parkinsonian and essential tremor

J Neurol Neurosurg Psychiatry

(1999)

JD Putzke et al.

Bilateral thalamic deep brain stimulation: midline tremor control

J Neurol Neurosurg Psychiatry

(2005)

J Murata et al.

Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor

J Neurosurg

(2003)

P Plaha et al.

Stimulation of the subthalamic region for essential tremor

J Neurosurg

(2004)

JM Schweinfurth et al.

Risk factors and demographics in patients with spasmodic dysphonia

Laryngoscope

(2002)

MK Lyons et al.

Spasmodic dysphonia and thalamic deep brain stimulation: long-term observations, possible neurophysiologic mechanism and comparison of unilateral versus bilateral stimulation

J Neurol Neurophysiol

(2010)

AJ Espay et al.

Deep brain stimulation of the ventral intermediate nucleus of the thalamus in medically refractory orthostatic tremor: preliminary observations

Mov Disord

(2008)

I Balas et al.

Staged bilateral stereotactic pallidotomy for life-threatening dystonia in a child with Hallervorden-Spatz disease

Mov Disord

(2006)

W Sako et al.

Bilateral deep brain stimulation of the globus pallidus internus on tardive dystonia

Mov Disord

(2008)

T Trottenberg et al.

Treatment of severe tardive dystonia with pallidal deep brain stimulation

Neurology

(2005)

TJ Loher et al.

Long-term follow-up study of chronic globus pallidus internur stimulation for posttraumatic hemidystonia

J Neurosurg

(2000)

CM Magarinos-Ascone et al.

Pallidal stimulation relieves myoclonus–dystonia syndrome

J Neurol Neurosurg Psychiatry

(2005)

A Kupsch et al.

Pallidal deep-brain stimulation in primary generalized or segmental dystonia

N Engl J Med

(2006)

L Timmermann et al.

Dystonia in neurodegeneration with brain iron accumulation: outcome of bilateral pallidal stimulation

Brain

(2010)

P Blomstedt et al.

Pallidal deep brain stimulation in the treatment of Meige syndrome

Acta Neurol Scand

(2008)

M Houser et al.

Meige syndrome and pallidal deep brain stimulation

Mov Disord

(2005)

C Opherk et al.

Successful bilateral pallidal stimulation for Meige syndrome and spasmodic torticollis

Neurology

(2006)

J Andrew et al.

Stereotaxic thalamotomy in 55 cases of dystonia

Brain

(1983)

HH Capelle et al.

Bilateral pallidal stimulation for blepharospasm-oromandibular dystonia (Meige syndrome)

Neurology

(2003)

R Kumar et al.

Globus pallidus deep brain stimulation for generalized dystonia: clinical and PET investigation

Neurology

(1999)

JL Ostrem et al.

Pallidal deep brain stimulation in patients with cranial-cervical dystonia (Meige syndrome)

Mov Disord

(2007)

MK Lyons et al.

Long-term follow-up of deep brain stimulation for Meige syndrome

Neurosurg Focus

(2010)

E Tolosa et al.

Meige syndrome: primary and secondary forms

Adv Neurol

(1988)

Cited by (158)

Electrophysiologic Evidence That Directional Deep Brain Stimulation Activates Distinct Neural Circuits in Patients With Parkinson Disease
2023, Neuromodulation
Deep brain stimulation (DBS) delivered via multicontact leads implanted in the basal ganglia is an established therapy to treat Parkinson disease (PD). However, the different neural circuits that can be modulated through stimulation on different DBS contacts are poorly understood. Evidence shows that electrically stimulating the subthalamic nucleus (STN) causes a therapeutic effect through antidromic activation of the hyperdirect pathway—a monosynaptic connection from the cortex to the STN. Recent studies suggest that stimulating the substantia nigra pars reticulata (SNr) may improve gait. The advent of directional DBS leads now provides a spatially precise means to probe these neural circuits and better understand how DBS affects distinct neural networks.
We measured cortical evoked potentials (EPs) using electroencephalography (EEG) in response to low-frequency DBS using the different directional DBS contacts in eight patients with PD.
A short-latency EP at 3 milliseconds originating from the primary motor cortex appeared largest in amplitude when stimulating DBS contacts closest to the dorsolateral STN (p < 0.001). A long-latency EP at 10 milliseconds originating from the premotor cortex appeared strongest for DBS contacts closest to the SNr (p < 0.0001).
Our results show that at the individual patient level, electrical stimulation of different nuclei produces distinct EP signatures. Our approach could be used to identify the functional location of each DBS contact and thus help patient-specific DBS programming.
The ClinicalTrials.gov registration number for the study is NCT04658641.
Transition dynamics and optogenetic control of epileptiform activity in a modified mean filed model of human cortex
2023, Communications in Nonlinear Science and Numerical Simulation
Citation Excerpt :
With the gradually clear understanding of epilepsy, the appropriate improvement of the computation model will help us to study some pathogenetic mechanisms more specifically. Furthermore, deep brain stimulation(DBS) has been proven to be effective in epilepsy control no matter in animal experiments [34–36], clinical applications [37–39] or theoretical models [40–42] over the past three decades. However, DBS can hardly target inhibitory neurons precisely, which limits our understanding of the role of inhibitory neurons in epileptic seizures [31,32].
Physiological experiments have shown that inhibitory interneurons can induce and maintain epileptiform activities, and different interneuron subtypes may be responsible for different types of seizures. Here we aim to link these electrophysiological experimental phenomena with theoretical dynamic mechanisms based on an improved Liley mean field model. Fascinatingly, the number of synapses between inhibitory neural populations can induce a rich state transition. Typically, the system will experience normal rhythm discharges, multispike discharges, spike wave discharges (SWD), generalized periodic discharges (GPD), the beta band oscillation, and eventually return to the normal state. Interestingly, the transition process can also be reversed. Meanwhile, disinhibition circuits can cause more epileptiform activities after taking into account the delay of synaptic information transmission. Furthermore, we are committed to designing different control strategies for epileptiform activities. As we expected, both deep brain stimulation and optogenetic technology can destroy or even eliminate pathological waves. It is need to emphasis that the cell type specificity of optogenetic regulation allows it to precisely target inhibitory neural populations, which is agree with experiment. Particularly, three different optogenetic regulatory strategies targeting inhibitory neural populations are modeled and proposed, of which the intermittent is designed to save energy. These modeling results reproduce the experimental phenomena and more significantly, help understand the mechanism of epilepsy to guide the clinical practice.
Characterizing the trends in patient demographics, complications, and short-term outcomes after deep brain stimulation procedures
2022, Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
Indications for deep brain stimulation (DBS) are rapidly growing within functional neurosurgery. The objective of this study was to characterize national trends in demographics and complications across distinct populations of DBS patients.
We identified patients from the 2008–2018 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File (PUF) who underwent an implantation or revision procedure for DBS. Summary statistics for postoperative infection rate, noninfectious complication rate, total hospital length of stay, discharge disposition, mortality, reoperation or readmission, and time from operation to readmission were obtained. Patients were categorized by diagnosis for DBS treatment. Outcomes for each diagnosis group were compared to outcomes for the total study population.
DBS patients who underwent primary implantation procedures had low rates of postoperative infections (1.2%), noninfectious complications (0.8%), and mortality (0.1%) and a high likelihood of discharge home (97.6%). In addition, a large percentage of patients presented for revision or removal of neurostimulators (34.2% of cases) or treatment of long-term hardware infection (4.5%). Compared with patients with other diagnoses, patients with Parkinson disease experienced lower rates of noninfectious complications (odds ratio 0.32; 95% CI, 0.15–0.63; p = 0.002) and fewer unplanned reoperations (odds ratio 0.60; 95% CI, 0.39–0.92; p = 0.02).
Analysis of a national database suggests that DBS is a relatively safe treatment across several different patient populations. These overall favorable results support the continued practice of DBS surgery and provide encouraging validation for increasing access to DBS therapy for new indications that are being actively investigated.
Biomarkers for Deep Brain Stimulation in Animal Models of Depression
2022, Neuromodulation
Despite recent advances in depression treatment, many patients still do not respond to serial conventional therapies and are considered “treatment resistant.” Deep brain stimulation (DBS) has therapeutic potential in this context. This comprehensive review of recent studies of DBS for depression in animal models identifies potential biomarkers for improving therapeutic efficacy and predictability of conventional DBS to aid future development of closed-loop control of DBS systems.
A systematic search was performed in Pubmed, EMBASE, and Cochrane Review using relevant keywords. Overall, 56 animal studies satisfied the inclusion criteria.
Outcomes were divided into biochemical/physiological, electrophysiological, and behavioral categories. Promising biomarkers include biochemical assays (in particular, microdialysis and electrochemical measurements), which provide real-time results in awake animals. Electrophysiological tests, showing changes at both the target site and downstream structures, also revealed characteristic changes at several anatomic targets (such as the medial prefrontal cortex and locus coeruleus). However, the substantial range of models and DBS targets limits the ability to draw generalizable conclusions in animal behavioral models.
Overall, DBS is a promising therapeutic modality for treatment-resistant depression. Different outcomes have been used to assess its efficacy in animal studies. From the review, electrophysiological and biochemical markers appear to offer the greatest potential as biomarkers for depression. However, to develop closed-loop DBS for depression, additional preclinical and clinical studies with a focus on identifying reliable, safe, and effective biomarkers are warranted.
Neuromodulation for Intractable Childhood Epilepsy
2021, Seminars in Pediatric Neurology
In the past few years significant advances made in the field of neuromodulation have led to practical therapeutic strategies for children with medically refractory epilepsy. Here, we briefly discuss the various options that are currently available including vagus nerve stimulation, responsive neurostimulation, deep brain stimulation, chronic subthreshold cortical stimulation, as well as repetitive transcranial magnetic and transcranial direct current stimulation. The current indications, proposed mechanisms, method of administration, efficacy, adverse effects, and mention of clinical trials currently in enrollment or development are discussed.
The development of an implantable deep brain stimulation device with simultaneous chronic electrophysiological recording and stimulation in humans
2021, Biosensors and Bioelectronics
Citation Excerpt :
Deep brain stimulation (DBS) has been used for decades in humans to treat disease through the direct electrical modulation of neuronal circuitry (Benabid et al., 1996; Wallace et al., 2004). In a standard open-loop DBS procedure, the surgeon uses pre-operative imaging to plan a stereotactic trajectory to place a stimulating electrode in the target structure (Lyons, 2011). The neurologist programs the stimulation parameters (pulse-width, current or voltage amplitude, and frequency) to most effectively control patient symptoms while minimizing over-stimulation that may lead to undesirable side effects, such as dyskinesia and paresthesia.
Deep brain stimulation (DBS) is used to treat a wide array of neurologic conditions. However, traditional programming of stimulation parameters relies upon short term subjective observation of patient symptoms and undesired stimulation effects while in the clinic. To gain a more objective measure of the neuronal activity that contributes to patient symptoms and response to treatment, there is a clear need for a fully-implantable DBS system capable of chronically recording patient-specific electrophysiological biomarker signals over time. By providing an objective correlate of a patient's disease and response to treatment, this capability has the potential to improve therapeutic benefit while preventing undesirable side effects. Herein, the engineering and capabilities of the Percept PC, the first FDA-approved, fully-implantable DBS device capable of nearly-simultaneous electrophysiological recordings and stimulation, are discussed. The device's ability to chronically record local field potentials (LFPs) at implanted DBS leads was validated in patients with neurological disorders. Lastly, the electrophysiological activity correlates of clinically relevant patient-reported events are presented. While FDA approved for conditions such as Parkinson's disease, essential tremor, dystonia, obsessive-compulsive disorder, and epilepsy, chronic electrophysiological recordings in humans has broad applications within basic science and clinical practice beyond DBS, offering a wealth of information related to normal and abnormal neurophysiology within distinct brain areas.

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ReviewsDeep Brain Stimulation: Current and Future Clinical Applications

Section snippets

PARKINSON DISEASE

ESSENTIAL TREMOR

Primary Dystonia

Cluster Headache

CHRONIC PAIN

Tourette Syndrome

EPILEPSY

CAMPTOCORMIA

RESTLESS LEGS SYNDROME

OBESITY AND ADDICTIONS

DISORDERS Of CONSCIOUSNESS

ALZHEIMER DISEASE

CONCLUSION

Clin Neurol Neurosurg

Clin Neurol Neurosurg

Pain

J Clin Neurosci

Lancet

Biol Psychiatry

Neuron

Biol Psychiatry

Clin Neurol Neurosurg

Lancet

Clin Neurophysiol

Clin Neurol Neurosurg

Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery-experiences from a single centre

J Neurol Neurosurg Psychiatry

Acute and long-term effects of subthalamic nucleus stimulation in Parkinson's disease

Stereotact Funct Neurosurg

Bilateral continuous electrostimulation of ventroposterolateral pallidum: a new therapeutic approach for alleviating all Parkinsonian symptoms

Neurosurgery

Stimulation of the subthalamic nucleus in Parkinson's disease: a 5-year follow-up

J Neurol Neurosurg Psychiatry

Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease

N Engl J Med

Bilateral subthalamic stimulation with Parkinson's disease: long-term follow-up

J Neurosurg

Long-term follow-up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson's disease

J Neurosurg

Pallidal vs. subthalamic nucleus deep brain stimulation in Parkinson's disease

Arch Neurol

Deep brain stimulation for the treatment of Parkinson's disease: subthalamic nucleus versus globus pallidus internus

J Neurol Neurosurg Psychiatry

Deep brain stimulation in Parkinson disease: a metaanalysis of patient outcomes

J Neurosurg

Deep brain stimulation for Parkinson's disease

Acta Neurochir Suppl

Neurophysiological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease

Brain

Wireless Instantaneous Neurotransmitter Concentration System-based amperometric detection of dopamine, adenosine, and glutamate for intraoperative neurochemical monitoring

J Neurosurg

Gamma knife thalamotomy for treatment of essential tremor: long-term results

J Neurosurg

A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor

N Engl J Med

Multicentre European study of thalamic stimulation in parkinsonian and essential tremor

J Neurol Neurosurg Psychiatry

Bilateral thalamic deep brain stimulation: midline tremor control

J Neurol Neurosurg Psychiatry

Electrical stimulation of the posterior subthalamic area for the treatment of intractable proximal tremor

J Neurosurg

Stimulation of the subthalamic region for essential tremor

J Neurosurg

Risk factors and demographics in patients with spasmodic dysphonia

Laryngoscope

Spasmodic dysphonia and thalamic deep brain stimulation: long-term observations, possible neurophysiologic mechanism and comparison of unilateral versus bilateral stimulation

J Neurol Neurophysiol

Deep brain stimulation of the ventral intermediate nucleus of the thalamus in medically refractory orthostatic tremor: preliminary observations

Mov Disord

Staged bilateral stereotactic pallidotomy for life-threatening dystonia in a child with Hallervorden-Spatz disease

Mov Disord

Bilateral deep brain stimulation of the globus pallidus internus on tardive dystonia

Mov Disord

Treatment of severe tardive dystonia with pallidal deep brain stimulation

Neurology

Long-term follow-up study of chronic globus pallidus internur stimulation for posttraumatic hemidystonia

J Neurosurg

Pallidal stimulation relieves myoclonus–dystonia syndrome

Reviews
Deep Brain Stimulation: Current and Future Clinical Applications