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It is important that clinicians fully understand this target when considering GPi DBS for individual patients. The literature on GPi DBS in PD has been comprehensively reviewed, including the anatomy, physiology and potential pitfalls that may be encountered during surgical targeting and post-operative management.
Additionally, we provide a summary of randomized controlled clinical trials conducted on DBS in PD, together with expert commentary on potential applications of the GPi as target. Finally, we highlight future technologies that will likely impact GPi DBS, including closed-loop adaptive approaches e. Prior to and during implantation of the leads it is critical to consider the neuroanatomy, which can be defined through the combination of image-based targeting and intraoperative microelectrode recording strategies.
Understanding the GPi target can be useful in choosing between the subthalamic STN , GPi and ventralis intermedius nucleus as lead locations to address the motor symptoms and complications of PD. STN as DBS target , clinicians should keep in mind that GPi DBS has been shown to be an effective treatment strategy for a variety of symptoms, including bradykinesia, rigidity and tremor control. GPi DBS also has an important, direct anti-dyskinetic effect. GPi DBS is easier to program in the outpatient setting and will allow for more flexibility in medication adjustments e.
Emerging technologies, including GPi closed-loop systems, advanced tractography-based targeting and enhanced programming strategies, will likely be future areas of GPi DBS expansion. The online version of this article This article is published with digital features, including a summary slide, to facilitate understanding of the article. To view digital features for this article go to Patients may manifest various combinations of the typical motor symptoms, such as tremor, bradykinesia, rigidity, postural instability and gait and balance difficulties, and also non-motor symptoms, such as mood and cognitive difficulties, autonomic dysfunction, speech and swallowing difficulties and sexual dysfunction [ 1 ].
