Deep Brain Stimulation in Movement Disorders

<h2>Abstract</h2> Deep brain stimulation is an evidence-based therapy for movement disorders. In Parkinson's disease (PD), essential tremor (ET), and dystonia, DBS offers substantial and sustained benefits when patients are carefully selected and treatment is delivered within a multidisciplinary framework. This review summarizes the current state of DBS in movement disorders, focusing on established indications, optimal patient selection, target choice, and surgical strategies. For PD, the subthalamic nucleus (STN) and globus pallidus internus (Gpi) remain the main targets, each with distinct advantages depending on clinical phenotype, therapeutic goals, and risk profiles. In ET, ventral intermediate nucleus (VIM) of thalamus stimulation continues to provide the most reliable tremor control, while caudal zona incerta (cZI) and posterior subthalamic area (PSA) stimulation represent emerging alternatives. In dystonia, GPi stimulation remains the standard of care, with growing evidence supporting the use of STN in selected cases. The variability in outcomes underscores the importance of aligning expectations with symptom responsiveness, as axial, gait, and speech problems in PD or fixed and bulbar features in dystonia often remain refractory. Recent advances are reshaping the field, including directional leads, robotic and imaging-based guidance, tele-programming, and adaptive closed-loop systems that adjust stimulation in real time based on physiological markers. Novel targets are under exploration to address unmet needs such as freezing of gait and postural instability. Together, these developments highlight a transition toward increasingly precise, personalized, and network-informed interventions, with DBS continuing to expand its role in movement disorder therapy.