Deep Brain Stimulation (DBS) · Indications and Targets

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Disease / symptom to treat
   Disease or dominant symptom to treat? (DBS is neuromodulation, not ablation, programmable/reversible; strict preoperative selection (response prediction, cognitive and psychiatric assessment, imaging targeting).)
   • Parkinson's disease (levodopa-responsive, motor fluctuations/dyskinesia, no significant dementia/active psychosis) → Parkinson → STN or GPi
   • Essential tremor, or tremor-dominant Parkinson → Tremor → VIM thalamus
   • Primary dystonia → Dystonia → GPi
   • Drug-refractory focal epilepsy (not suitable for resective surgery) → Refractory epilepsy → ANT / RNS / CM
2. [End] Parkinson → STN or GPi
   Parkinson's disease: preoperatively confirm levodopa responsiveness and motor fluctuations/dyskinesia, exclude significant cognitive impairment and active psychosis. Targets — STN (subthalamic nucleus) improves tremor/rigidity/bradykinesia and often allows medication reduction; GPi (globus pallidus internus) strongly controls dyskinesia with fewer neuropsychiatric/cognitive effects and no expected medication reduction. Choose by symptom profile and comorbidity.
3. [End] Tremor → VIM thalamus
   Essential tremor or tremor-dominant Parkinson: VIM (ventral intermediate nucleus) target markedly controls tremor. For those unfit/unwilling to implant or with predominantly unilateral tremor, MRgFUS (MR-guided focused ultrasound) thalamotomy is a non-invasive alternative.
4. [End] Dystonia → GPi
   Primary (especially DYT1-positive) generalized/segmental dystonia: GPi target, benefit emerges over weeks to months; secondary dystonia has variable efficacy, needs individualized assessment.
5. [End] Refractory epilepsy → ANT / RNS / CM
   Drug-refractory focal epilepsy not suitable for resective surgery: anterior nucleus of thalamus (ANT) DBS (SANTE trial, approved) reduces seizure frequency; with 1–2 well-defined foci, responsive neurostimulation (RNS, closed-loop) is an option; generalized/multifocal may consider the centromedian nucleus (CM); vagus nerve stimulation (VNS) is another neuromodulation option.

Source guidelines & references

• Deep brain stimulation target selection (Parkinson STN/GPi; tremor VIM; dystonia GPi; epilepsy ANT SANTE trial, RNS closed-loop stimulation)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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