Nucleus subthalamicus stimulation bei morbus Parkinson: Indikation, klinische effektivität und mögliche wirkmechanismen

High-frequency deep brain stimulation (DBS) within the subthalamic nucleus (STN) has become a widely-used surgical treatment for advanced stages of idiopathic Parkinson's disease (PD). Severe motor complications like fluctuations and dyskinesias ore the main indication for DBS in PD. Careful selection of patients suitable for DBS includes a good response to levodopa and a lack of major psychiatric and general medical morbidity. Longterm studies of STN DBS have reported a significant and sustained improvement of motor symptoms even 3 to 5 years post-operatively. Nevertheless, the main mechanism of action of DBS is still unclear. New data suggest that beyond simple ablation of the hyperactive STN, DBS rather allows an active modulation of neuronal circuits. Here, DBS could superimpose rhythmical activity onto pathologically oscillating neuronal networks in PD.