How do the outcomes of pallidal and subthalamic deep brain stimulation (DBS) compare for the treatment of Parkinson disease (PD)?

Updated: Dec 09, 2020
  • Author: Konstantin V Slavin, MD; Chief Editor: Brian H Kopell, MD  more...
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Answer

Answer

As mentioned, there are two main anatomic targets for using DBS to treat PD – the STN and the GPi. There have been several large randomized studies comparing STN and GPi DBS in PD. It is suggested that both STN DBS and GPi DBS overall equally and successfully improve motor symptom, and are similar in cost-effectiveness. [34, 35, 36, 37, 38, 39]  However, although no differences were observed in the on phase between STN DBS and GPi DBS, significant differences were seen in the off phase; STN DBS was more effective in terms of motor function improvement in the off phase. [40] There are different opinions in terms of effects of STN DBS and GPi DBS on quality of life. Some authors have found no significant difference between the STN and GPi targets. [34] However, others agree with that greater improvements in quality-of-life measures are achieved in patients with GPi DBS. [40]

GPi DBS can be used for patients with more axial symptoms, gait issues, dyskinesias, depression, and word fluency problems. [41] STN DBS is often favored in reducing medication post surgery, and for patients with greater tremor. [41]  STN-DBS has also demonstrated an improvement in the quality of sleep for patients. [42]

The stimulation settings in patients with GPi DBS are significantly higher in amplitude and pulse width as compared to STN DBS due to the large size of GPi. [41, 42, 43] Therefore, GPi DBS requires more frequent battery changes. On the other hand, the neurostimulator battery lasts longer for patients with STN DBS due to low stimulation parameters. The small size of STN make it easier to spread DBS stimulation to neighboring circuits in the limbic or associative areas of the STN, causing greater deterioration of cognitive and psychiatric parameters in patients with STN DBS. [41, 42]


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