Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary
Authors: Rughani Anand , Schwalb Jason M , Sidiropoulos Christos , Pilitsis Julie , Ramirez-Zamora Adolfo , Sweet Jennifer A , Mittal Sandeep , Espay Alberto J , Martinez Jorge Gonzalez , Abosch Aviva , Eskandar Emad , Gross Robert , Alterman Ron , Hamani Clement 
Published: February 2018

Abstract

QUESTION 1
Is bilateral subthalamic nucleus deep brain stimulation (STN DBS) more, less, or as
effective as bilateral globus pallidus internus deep brain stimulation (GPi DBS) in
treating motor symptoms of Parkinson's disease, as measured by improvements in Unified
Parkinson's Disease Rating Scale, part III (UPDRS-III) scores?

RECOMMENDATION
Given that bilateral STN DBS is at least as effective as bilateral GPi DBS in treating
motor symptoms of Parkinson's disease (as measured by improvements in UPDRS-III scores),
consideration can be given to the selection of either target in patients undergoing
surgery to treat motor symptoms. (Level I)

QUESTION 2
Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in allowing
reduction of dopaminergic medication in Parkinson's disease?

RECOMMENDATION
When the main goal of surgery is reduction of dopaminergic medications in a patient
with Parkinson's disease, then bilateral STN DBS should be performed instead of GPi DBS.
(Level I)

QUESTION 3
Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in treating
dyskinesias associated with Parkinson's disease?

RECOMMENDATION
There is insufficient evidence to make a generalizable recommendation regarding the
target selection for reduction of dyskinesias. However, when the reduction of medication
is not anticipated and there is a goal to reduce the severity of “on” medication
dyskinesias, the GPi should be targeted. (Level I)

QUESTION 4
Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in improving
quality of life measures in Parkinson's disease?

RECOMMENDATION
When considering improvements in quality of life in a patient undergoing DBS for
Parkinson's disease, there is no basis to recommend bilateral DBS in 1 target over the
other. (Level I)

QUESTION 5
Is bilateral STN DBS associated with greater, lesser, or a similar impact on
neurocognitive function than bilateral GPi DBS in Parkinson disease?

RECOMMENDATION
If there is significant concern about cognitive decline, particularly in regards to
processing speed and working memory in a patient undergoing DBS, then the clinician
should consider using GPi DBS rather than STN DBS, while taking into consideration other
goals of surgery. (Level I)

QUESTION 6
Is bilateral STN DBS associated with a higher, lower, or similar risk of mood
disturbance than GPi DBS in Parkinson's disease?

RECOMMENDATION
If there is significant concern about the risk of depression in a patient undergoing
DBS, then the clinician should consider using pallidal rather than STN stimulation,
while taking into consideration other goals of surgery. (Level I)

QUESTION 7
Is bilateral STN DBS associated with a higher, lower, or similar risk of adverse events
compared to GPi DBS in Parkinson's disease?

RECOMMENDATION
There is insufficient evidence to recommend bilateral DBS in 1 target over the other in
order to minimize the risk of surgical adverse events.
The full guideline can be found at: https://www.cns.org/guidelines/deep-brain-stimulation-parkinsons-disease.