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Darrin J. Lee, Luka Milosevic, Robert Gramer, Sanskriti Sasikumar, Tameem M. Al-Ozzi, Philippe De Vloo, Robert F. Dallapiazza, Gavin J. B. Elias, Melanie Cohn, Suneil K. Kalia, William D. Hutchison, Alfonso Fasano, and Andres M. Lozano

C ognitive function in patients with Parkinson’s disease (PD) often deteriorates over time. Up to 75% of PD patients who have had the disease for at least 10 years develop dementia. 5 , 11 The stage between normal cognitive functioning and PD dementia (PDD) is identified as mild cognitive impairment in PD (PD-MCI) and is a prognostic factor for developing PDD, particularly when multiple domains and/or the visuospatial domain are involved. 10 Treatments to slow or reverse the progression of cognitive dysfunction are needed. A number of pharmacological and non

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Azam A. Qureshi, Jennifer J. Cheng, Abraham N. Sunshine, Adela Wu, Gregory M. Pontone, Nicola Cascella, Frederick A. Lenz, Stephen E. Grill, and William S. Anderson

D eep brain stimulation (DBS) surgery, a procedure widely used in Parkinson’s disease (PD) treatment, involves the implantation of a quadripolar electrode, an extension cable, and an implantable pulse generator, 17 which electrically alter the pathophysiological activity of specific regions of the brain. 17 When applied to the subthalamic nucleus (STN-DBS) or globus pallidus interna (GPi-DBS), this therapy has been shown to alleviate the characteristic PD motor symptoms of tremor, bradyki-nesia, and rigidity. 2 The STN is often preferred because of its

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Günther Deuschl, Kenneth A. Follett, Ping Luo, Joern Rau, Frances M. Weaver, Steffen Paschen, Frank Steigerwald, Lisa Tonder, Valerie Stoker, and Domenic J. Reda

D eep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapy for patients with Parkinson’s disease (PD). Four large studies have compared STN DBS and medical treatment in a randomized design. 2 , 5 , 18 , 19 Despite overall consistency with respect to significant improvement in major outcome parameters among the studies, the amount of improvement via STN DBS differed considerably. The US Veterans Affairs/National Institute of Neurological Disorders and Stroke (VA/NINDS) trial has been heavily criticized on the basis that improvement

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Shiro Horisawa, Atsushi Fukui, Hayato Yamahata, Yukiko Tanaka, Atsushi Kuwano, Oji Momosaki, Mutsumi Iijima, Magi Nanke, Takakazu Kawamata, and Takaomi Taira

N eurosurgical ablation and deep brain stimulation (DBS) are the current standard treatments for the cardinal motor symptoms in Parkinson’s disease (PD). 1–5 Although the mainstay surgical treatment is DBS, ablative procedures are still an important option for patients who cannot access DBS because of economic or geographic limitations. Additionally, increased attention has been paid to recent advancements in the field of minimally invasive ablative procedures, including MRI-guided focused ultrasound. 6–8 The pallidothalamic tract consists of

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Jill L. Ostrem, Nathan Ziman, Nicholas B. Galifianakis, Philip A. Starr, Marta San Luciano, Maya Katz, Caroline A. Racine, Alastair J. Martin, Leslie C. Markun, and Paul S. Larson

D eep brain stimulation (DBS) has been shown to be a highly effective treatment option for medication-refractory Parkinson’s disease (PD) patients experiencing motor fluctuations and dyskinesia. 5 , 15 , 18 , 21 , 22 , 26 , 31 Clinical outcomes with DBS are critically dependent on the exact lead placement in the intended brain target (dorsal lateral subthalamic nucleus [STN] or posterior [motor] area of the internal globus pallidus [GPi]), but surgical methods to achieve acceptable placement are not standardized. The traditional method for DBS lead

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Weiyuan Huang, Richard Ogbuji, Liangdong Zhou, Lingfei Guo, Yi Wang, and Brian H. Kopell

T he subthalamic nucleus (STN) is a glutamatergic nucleus situated in the diencephalon that is critical for the regulation of motor function through both the direct and indirect motor pathways connected to the basal ganglia and also plays a role in limbic and associative processing. 1 A hallmark of Parkinson’s disease (PD) is an increase in and abnormal synchronization of STN neuronal activity; thus, the STN is a primary target for deep brain stimulation (DBS) therapy. 2 , 3 DBS of the STN has been shown to provide significant benefit to patients

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William S. Gibson, Aaron E. Rusheen, Yoonbae Oh, Myung-Ho In, Krzysztof R. Gorny, Joel P. Felmlee, Bryan T. Klassen, Sung Jun Jung, Hoon-Ki Min, Kendall H. Lee, and Hang Joon Jo

D eep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a well-established treatment for bradykinesia, rigidity, and tremor, the cardinal motor symptoms of Parkinson’s disease (PD). Originally based on a location used for therapeutic lesioning, STN DBS was once thought to exert its clinical effects through silencing of local neuronal activity. 1 However, electrophysiological studies of basal ganglia activity, 2 as well as those that interrogate oscillations across functional networks, 3 have suggested that STN DBS partially achieves

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Olga Khazen, Marisa DiMarzio, Kelsey Platanitis, Heather C. Grimaudo, Maria Hancu, Miriam M. Shao, Michael D. Staudt, Lucy Maguire, Vishad V. Sukul, Jennifer Durphy, Era K. Hanspal, Octavian Adam, Eric Molho, and Julie G. Pilitsis

D eep brain stimulation (DBS) for Parkinson’s disease (PD) is a well-recognized treatment that provides significant improvements in motor function. 1 The impact of DBS on nonmotor symptoms, which are common at all stages of the disease and a major cause of disability, is less well described. 2 , 3 Nonmotor symptoms can significantly affect quality of life (QOL) and include pain as well as autonomic and mood symptoms. The management of nonmotor symptoms can be difficult because the mechanisms are not fully understood, and the symptoms are generally insensitive

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Olga Khazen, Marisa DiMarzio, Kelsey Platanitis, Heather C. Grimaudo, Maria Hancu, Miriam M. Shao, Michael D. Staudt, Lucy Maguire, Vishad V. Sukul, Jennifer Durphy, Era K. Hanspal, Octavian Adam, Eric Molho, and Julie G. Pilitsis

D eep brain stimulation (DBS) for Parkinson’s disease (PD) is a well-recognized treatment that provides significant improvements in motor function. 1 The impact of DBS on nonmotor symptoms, which are common at all stages of the disease and a major cause of disability, is less well described. 2 , 3 Nonmotor symptoms can significantly affect quality of life (QOL) and include pain as well as autonomic and mood symptoms. The management of nonmotor symptoms can be difficult because the mechanisms are not fully understood, and the symptoms are

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Joshua L. Golubovsky, Hong Li, Arbaz Momin, Jianning Shao, Maxwell Y. Lee, Leonardo A. Frizon, Olivia Hogue, Benjamin Walter, André G. Machado, and Sean J. Nagel

subthalamic nucleus (STN) or the globus pallidus internus (GPi). Data Collection Preoperative variables collected included the following: age at surgery; sex; body mass index (BMI); handedness; PD diagnosis date; Unified Parkinson’s Disease Rating Scale (UPDRS) motor score (UPDRS-III)/Movement Disorder Society revision of UPDRS (MDS-UPDRS); patient-determined motor function (i.e., UPDRS self-evaluation score [UPDRS-II]); Patient Health Questionnaire–9 (PHQ-9) scores; EuroQol–5 Dimensions (EQ-5D) scores; median income; and ZIP code distance from the Cleveland Clinic main