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The factions of functional neurosurgeons performing deep brain stimulation (DBS) for movement disorders are fairly well separated. The physiology aficionados subscribe to the doctrine that only meticulous microelectrode recording (MER) in the awake patient without any sedative interference gives optimal results. The believers in the accuracy of imaging claim that targeting the subthalamic nucleus (STN) the globus pallidum internus can be achieved precisely from MRI or MR/CT fusion alone with equally good outcomes as measured on the Unified Parkinson's Disease Rating Scale (UPDRS) and the ability to postoperatively cut the Levodopa (L-DOPA) equivalent amount of medication.
Fluchere and colleagues seem to have found a Salomonic compromise that could satisfy both camps.1 In an impressively large cohort of 126 patients they used ‘controlled …
Contributors This editorial was originally planned as a joint contribution of Dr Roy Bakay—an eminent functional neurosurgeon and mentor to many in the field—and myself. During its preparation, sadly, Dr Bakay passed away. I have tried my best to incorporate his thoughts and views as expressed in the discussions we had regarding the editorial.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.
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