Abstract:

Background: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder affecting over 10 million people globally, characterized by debilitating motor and non-motor symptoms. Deep Brain Stimulation (DBS) has emerged as a pivotal neurosurgical intervention for advanced PD refractory to pharmacotherapy, modulating aberrant neural activity in target regions like the subthalamic nucleus (STN) and globus pallidus interna (GPi). This review provides a comprehensive analysis of DBS in PD, encompassing its mechanisms, clinical efficacy, associated risks, comparative effectiveness, technological advancements, and global accessibility.

Methods: A systematic review of the literature was conducted, synthesizing evidence from randomized controlled trials, meta-analyses, and authoritative reviews on DBS for PD. Data were extracted regarding motor and non-motor symptom outcomes, quality of life, medication reduction, surgical and stimulation-related complications, comparative therapies, and emerging technologies. Special attention was paid to European implementation and accessibility data.

Results: DBS significantly improves motor symptoms (tremor, rigidity, bradykinesia), reduces medication dependency, and enhances quality of life in well-selected PD patients, with benefits sustained for over a decade. While primarily targeting motor symptoms, DBS can also positively influence certain non-motor symptoms like sleep and pain, though effects on cognition and some psychiatric aspects are variable and require careful patient selection. Surgical risks (e.g., hemorrhage, infection) and stimulation-induced side effects necessitate a multidisciplinary approach. Emerging adaptive and closed-loop DBS systems promise enhanced precision, reduced side effects, and improved battery longevity by dynamically adjusting stimulation based on real-time brain signals. Despite Europe’s leadership in DBS implementation, significant disparities in cost and accessibility persist across regions.

Conclusion: DBS remains a transformative, yet complex, therapeutic option for advanced PD. Future advancements in adaptive technologies, personalized programming, and equitable global access are crucial to maximize its potential and improve outcomes for a broader patient population. Ongoing research into novel stimulation paradigms and biomarkers will further refine patient selection and optimize therapeutic benefits while minimizing adverse effects.

Keywords:

PARKINSON’S DISEASE, DEEP BRAIN STIMULATION, DBS, MOTOR SYMPTOMS, NON-MOTOR SYMPTOMS, <br /> EUROPE, TREATMENT OPTIONS, ADAPTIVE DBS, CLOSED-LOOP DBS, NEUROSURGERY, QUALITY OF LIFE, PATIENT <br /> SELECTION, ACCESSIBILITY, ETHICS, GENE THERAPY, STEM CELL THERAPY