Postsurgical behavioral changes

Parkinson's disease (PD) is the second most common neurodegenerative disease (Twelves D, Perkins KS, Counsell C. Mov Disord 18:19-31, 2003) and af flicts more than four million people worldwide (Dorsey ER, Constantinescu R, Thompson JP, et al. Neurology 68:384-386, 2007). Neurosurgical treatments for the debilitating symptoms of this movement disorder are implemented when medical therapy no longer provides sufficient benefit. Lesioning techniques initially utilized decades ago have been supplanted, for the most part, by deep brain stimulation (DBS) because of its potential reversibility should DBS prove to be unsuccessful or result in undue adverse events. Additionally, stimulation parameters can be adjusted as needed to optimize benefit (from both motor and neurobehavioral standpoints), and when bilateral procedures are necessary, DBS procedures are considered a safer alternative or adjunct to ablation. Stimulation of the subthalamic nucleus (STN) is currently the target of choice because it relieves most of the cardinal symptoms of PD and greatly reduces the amount of medication needed.