Beyond the holy grail of motor symptoms: deep brain stimulation for Parkinson's disease

Abstract

Optimising non-dopaminergic and dopaminergic related motor responses, as well as cognitive and behavioural responses At a recent international movement disorders meeting, a timely question was raised: “Is dopaminergic related gambling an indication or a contra-indication for subthalamic nucleus deep brain stimulation?” The question captures not only our curiosity on complex pathophysiology but also the very real uncertainties of our clinical practice. Parkinson’s disease (PD) is a neurodegenerative disorder characterised by motor, cognitive, and behavioural symptoms. Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) has been available for the treatment for advanced PD since 1993 and has demonstrated marked and sustained efficacy in motor symptoms.1 In this issue, the papers by Czernecki et al ( pp 775 ), Colnat-Coulbois et al (pp 780 ), and Capecci et al (pp 769 ) expand the focus beyond the typical dopaminergic motor symptoms with reports on behavioural changes, balance, and overall functional improvement. These are relevant concepts to clinicians wanting to offer comprehensive advice to their patients and to health care providers who fund such resource intensive therapies. Czernecki et al address the issue of aggravation of motivational changes following STN DBS by comparing non-demented, non-depressed PD patients 10 months following surgery with a matched …