Decoding DBS Target Selection in Parkinson's Disease | Functional Neurosurgery Explained – Episode 5

More than thirty percent of all DBS failures trace back to one mistake—the wrong patient, or the wrong target, chosen long before the operation even began.

Target selection is the only step in DBS that cannot be corrected after surgery.

The TARGET framework consists of six components that function as gates, not as a score: True diagnosis, Anatomy of symptoms, Response to levodopa, Goal, Evaluation of the brain, and Red lines.

Atypical parkinsonism conditions to distinguish from true Parkinson's include MSA, PSP, Lewy body dementia, and Corticobasal Degeneration.

The thirty percent levodopa response threshold is a meaningful criterion for DBS candidacy.

DBS is a biological amplifier, not a generator.

The TARGET framework can solve to STN, GPi, or Vim depending on patient characteristics.

Cognitive reserve and mood are factors that determine whether to operate at all and which target is more forgiving when the brain is vulnerable.

The EARLYSTIM trial changed the conversation about timing of DBS surgery.

Both operating too late and operating too early are mistakes in DBS timing.

There are six absolute red lines that collapse the entire TARGET equation to zero.

A confident 'no' protects the patient far more than a hesitant 'yes' in DBS decision-making.

A five-evaluation multidisciplinary workup feeds every target decision.