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Abstract and Introduction
Abstract
Purpose of review The purpose of this review was to review the recent and future developments of deep brain stimulation (DBS) for movement disorders.
Recent findings In the last 2 years, we have gained a better understanding of established indications, particularly with respect to the debate on whether subthalamus or globus pallidus pars interna should be the target of choice for Parkinson's disease. In addition, the role of DBS for dystonia has been further defined in terms of patients' selection and outcome of surgery. Other established (e.g. essential tremor) and novel indications (e.g. Tourette syndrome) have been addressed.
Along with the evolving knowledge of the clinical aspects of DBS, technological advances are also shaping the present and the future of DBS. New implantable pulse generators (e.g. allowing storage of electrophysiological data and eventual adaptive stimulation) as well as new electrode configurations are now available. Furthermore, high-resolution structural imaging, including high-field MRI and diffusion tensor tractography, will facilitate both the planning of DBS procedures, and the optimization of postoperative outcomes by aiding stimulation programming.
Summary The recent successes of DBS along the clinical and technological directions are changing the current practice of neuromodulation and, more importantly, will also drive future developments of this fascinating treatment.
Introduction
Two years ago the 25th anniversary of deep brain stimulation (DBS) in the modern era was celebrated. Almost 3 decades after the first clinical experience, DBS has become widely accepted as a treatment for Parkinson's disease, dystonia and tremor and as an off-label treatment for many other movement disorders. To date, more than 100 000 patients have undergone DBS surgery.
DBS field is expanding exponentially along two directions: clinical and technological. We have achieved a deeper understanding of outcomes, thus facilitating the process of target and patient's selection; on the other hand, the advance of technologies has provided clinicians with new tools making targeting, programming and overall management easier. These two directions are not mutually exclusive but are the most recent advantages of neuromodulation and they have opened new avenues toward new targets and indications.
This review will focus on the recent successes of DBS along the aforementioned clinical and technological directions and will also draw the possible scenarios for the future developments of this fascinating treatment.
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