Targeting the brain : considerations in 332 consecutive patients treated by deep brain stimulation (DBS) for severe neurological diseases

Deep Brain Stimulation (DBS) extends the treatment of some severe neurological diseases beyond pharmacological and conservative therapy. Our experience extends the field of DBS beyond the treatment of Parkinson disease and dystonia, including several other diseases such as cluster headache and disruptive behavior. Since 1993, at the Istituto Nazionale Neurologico "C. Besta" in Milan 580 deep brain electrodes were implanted in 332 patients. The DBS targetnacc, IC, PPN, include Stn, GPi, Voa, Vop, Vim, CM-pf, pHyp, cZi, and Broadmann areas 24 and 25s. Three hundred patients are still avaiable for follow-up and therapeutic considerations. DBS gave a new therapeutic chance to these patients affected by severe neurological diseases and in some cases controlled life-threatening pathological conditions, which would otherwise result in the death of the patient such as in status dystonicus, status epilepticus and post-stroke hemiballism. The balance of DBS in severe neurological disease is strongly positive even if further investigations and studies are needed to search for new applications and refine the selection criteria for the actual indications