By: Grace Huff
Researchers at the Norman Fixel Institute for Neurological Diseases at UF Health have uncovered a new brain pathway that could help explain a challenging side effect of deep brain stimulation (DBS), offering new hope for personalizing this life-changing treatment for people living with Parkinson’s disease.
The study, led by Joshua Wong, MD, and published in the International Parkinson and Movement Disorder Society journal, found that stimulation-induced dyskinesia (SID), a side effect where patients experience involuntary, uncontrollable movements, may be linked to a specific pathway in the brain. This “subthalamo-pallidal” pathway connects the subthalamic nucleus (STN) and globus pallidus internus (GPi), two key regions often targeted by DBS.
“This research gives us a more detailed roadmap of the brain circuits involved in dyskinesia, which could help guide future DBS programming and lead placement,” said Wong. “What excites me most is the possibility that we can use these findings to better personalize treatment and reduce side effects that can limit the success of DBS.”
DBS is a powerful therapy used to manage motor symptoms in Parkinson’s disease, particularly when medications are no longer effective. But for some patients, stimulation in certain areas of the brain can trigger dyskinesias, which can interfere with quality of life and complicate post-operative care.
The research team analyzed 137 stimulation observations in people with Parkinson’s who had received either GPi or STN DBS. Using advanced imaging and mapping techniques, they were able to identify a common fiber tract, the subthalamo-pallidal connection, that was consistently associated with the onset of dyskinesias.
“This study uncovered a new brain connection that may explain some of the side effects associated with DBS therapy,” said Wong, “this discovery is a significant step toward improving DBS by enhancing its benefits while reducing side effects. It supports the broader mission of the Norman Fixel Institute to optimize how DBS therapy is delivered.”
While the research is still in its early stages, the implications are promising. In the future, these findings may help DBS providers tailor stimulation settings to avoid the dyskinesia-associated pathway, without losing the treatment’s positive effects.
For patients currently undergoing DBS therapy at Fixel, this research offers hope that unwanted side effects like dyskinesia could eventually be reduced through better targeting and programming. While the team is not yet integrating this discovery into clinical workflows, the insights gained could influence future surgical planning and even real-time programming decisions.
The next steps include looking for brainwave signatures associated with these dyskinesias and comparing those caused by DBS to those caused by traditional Parkinson’s medications like levodopa. Ultimately, the team hopes this work will give clinicians more tools to deliver a higher quality of life for patients post-DBS.
“Hopefully, this will help DBS providers navigate stimulation-related side effects more easily and offer more precise, effective treatment options for every individual,” said Wong.