DBS is an effective and relatively safe treatment for levodopa-responsive PD patients with medication resistant motor fluctuations and dyskinesia. DBS of the thalamus clearly reduces parkinsonian tremor; however, bradykinesia, rigidity, and dyskinesia are not significantly affected. Therefore, VIM DBS is reserved for disabling tremor predominant PD. DBS of the GPi and STN both significantly improve all of the cardinal symptoms of PD as well as dyskinesia. DBS of the STN often results in a significant reduction in antiparkinsonian medication, whereas PD medications are generally not significantly reduced after GPi DBS. Currently, DBS of the STN is the most commonly performed surgical procedure for PD; however, additional outcome data are necessary to determine the role for GPi DBS in PD. Finally, DBS is a relatively safe procedure; however, patients should be counseled about the surgical and hardware complications that can occur and can require additional surgeries.
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