The role of functional neurosurgery in Parkinson’s disease: a focus on deep brain stimulation
OA Version
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Abstract
Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms that significantly impair quality of life. While pharmacologic therapies such as levodopa remain the first-line treatment, their efficacy diminishes over time, and long-term use is often associated with adverse effects such as motor fluctuations and dyskinesias. Deep brain stimulation (DBS), a functional neurosurgical technique, has emerged as a powerful intervention for advanced PD, particularly for patients whose symptoms are refractory to medication. This thesis explores the clinical role and optimization of DBS by comparing it to pharmacologic therapies and lesional procedures, and by evaluating surgical approaches (awake vs. asleep) and target nuclei (subthalamic nucleus [STN] vs. globus pallidus internus [GPi]). The analysis draws upon standardized motor and non-motor assessment tools, complication profiles, and quality-of-life outcomes. Findings suggest that DBS consistently provides superior motor benefits compared to pharmacological and lesional treatments, particularly in terms of reducing tremors, bradykinesia, and medication burden. STN targeting offers greater potential for medication reduction, while GPi may be preferable in patients with pre-existing psychiatric vulnerabilities.Additionally, emerging evidence supports the safety and efficacy of asleep DBS, offering similar long-term outcomes to traditional awake surgery with improved patient comfort. Finally, the thesis emphasizes the importance of individualized treatment planning, incorporating factors such as patient age, disease duration, brain atrophy, and baseline symptom profile to enhance DBS outcomes. These insights contribute to a growing body of evidence supporting DBS as a personalized, adaptable treatment modality for managing advanced Parkinson’s disease.
Description
2025