Deep brain stimulation for Parkinson's disease Sound asleep or wide awake?

Parkinson's disease (PD) presents a growing global health challenge due to its increasing incidence among an aging population. While medication initially helps manage symptoms, patients often face complications as the disease progresses. Deep brain stimulation (DBS) surgery, targeting the subthalamic nucleus (STN), offers relief, but is not without risks. This thesis aims to optimize STN DBS by refining imaging, enhancing patient comfort, and assessing risks to broaden its accessibility and positive impact (Chapter 1).
Chapter 2 shows that the introduction of Intraoperative imaging streamlines the DBS procedure by enhancing efficiency and patient comfort. Chapter 3 introduces the study protocol for the GALAXY trial, comparing STN DBS under general anesthesia with local anesthesia. In Chapter 4 the results of this study are revealed showing no significant differences in cognitive or mood effects post-surgery. Both methods significantly improve motor symptoms and quality of life.
Chapter 5 is an in-depth analysis of the neuropsychological and psychiatric outcomes of the Galaxy study, indicating minor differences in memory between anesthesia methods. Chapter 6 proposes a novel targeting strategy for electrode placement based on patient specific MRI landmarks, creating a targeting ‘hotspot’, and thereby reducing variability in therapeutic response.
Lastly, Chapter 7 evaluates surgical complications of STN DBS over 25 years, showing a decline in risk with evolving techniques.
To conclude, we should continuously evaluate whether we can further improve an already established treatment. For this, we should not only be guided by the treatment effects, but also by the burden of the treatment and the possible risks.