Evaluating Therapeutic Targets for Deep Brain Stimulation in Parkinson Disease: Alfonso Fasano, MD, PhD

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"There is a variety of experimental targets. I will start by saying that some of these targets are easily stimulated because they are in proximity of the approved targets."

Introduced in the late 1940s, the use of deep brain stimulation (DBS) has evolved significantly over time and is now considered an effective alternative treatment for patients with Parkinson disease (PD). Originally, stimulation was predominantly being used to localize areas for selective brain ablation and as a method to avoid adverse events. Over time, research on patients with tremor led to the observation that lower frequency stimulation exacerbated motor symptoms, whereas high-frequency stimulation led to a reduction in symptoms.

In 1980, DBS for the treatment of neurologic symptoms, including dystonia, tremor, and speech impairment was first reported. Years later, research by A.L. Benabid et al showed the first successful chronic electrode implantation in the ventral intermediate (VIM) nucleus of the thalamus for treating tremor with DBS, in both essential tremor (ET) and PD.1 DBS targeted to the VIM nucleus of the thalamus for use in ET and severe PD tremor received a CE mark and FDA approval in 1993 and 1997, respectively.

Since then, the knowledge and accuracy of DBS has grown exponentially, allowing for more treatment possibilities. To learn more about the specific targets of DBS and ways this treatment approach has become more personalized, NeurologyLive^® sat down with Alfonso Fasano, MD, PhD, professor of neurology at the University of Toronto. Fasano, who also serves as a staff neurologist at Toronto Western Hospital, provided commentary on the approved targets for DBS and others that have been explored, but need further validation.

REFERENCE
1. Benabid AL, Pollak P, Gao D, et al. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg. 1996;84(2):203-14. doi:10.3171/jns.1996.84.2.0203.