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The choice of deep brain stimulation target in advanced Parkinson disease often centres on the subthalamic nucleus (STN) versus the globus pallidus internus (GPi). A randomized blinded pilot study compared the two targets in patients with levodopa-induced dyskinesia and motor fluctuations. After implantation, motor symptoms improved substantially with both stimulation sites. STN stimulation produced a greater reduction in levodopa dose, while dyskinesia improved with both approaches. The study also raised a useful clinical consideration: cognitive and behavioural complications were observed only in the STN group in this small cohort. The authors therefore cautioned against assuming that STN stimulation should replace GPi stimulation in every patient. For HCPs, target selection should be individualized according to the dominant motor problem, medication response, dyskinesia burden, cognitive profile, psychiatric history and need to reduce dopaminergic medication. GPi may be attractive when dyskinesia is a major concern or when preserving medication flexibility is important. STN may be attractive when medication reduction is a key objective. The paper remains clinically relevant because modern DBS should be planned around the patient's phenotype rather than a default target.
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The choice of deep brain stimulation target in advanced Parkinson disease often centres on the subthalamic nucleus (STN) versus the globus pallidus internus (GPi). A randomized blinded pilot study compared the two targets in patients with levodopa-induced dyskinesia and motor fluctuations. After implantation, motor symptoms improved substantially with both stimulation sites. STN stimulation produced a greater reduction in levodopa dose, while dyskinesia improved with both approaches. The study also raised a useful clinical consideration: cognitive and behavioural complications were observed only in the STN group in this small cohort. The authors therefore cautioned against assuming that STN stimulation should replace GPi stimulation in every patient. For HCPs, target selection should be individualized according to the dominant motor problem, medication response, dyskinesia burden, cognitive profile, psychiatric history and need to reduce dopaminergic medication. GPi may be attractive when dyskinesia is a major concern or when preserving medication flexibility is important. STN may be attractive when medication reduction is a key objective. The paper remains clinically relevant because modern DBS should be planned around the patient's phenotype rather than a default target.
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