Postmortem Proof of Effectiveness of Zona Incerta Stimulation in Parkinson Disease

High frequency stimulation (HFS) of the subthalamic nucleus (STN) is recognized as a therapeutic choice for advanced forms of Parkinson disease (PD) with motor fluctuations.1 However, the location of the best target remains a matter of debate. Although the STN is considered as the gold standard, good therapeutic results have been obtained using electrode contacts located outside the STN, within adjacent structures such as the zona incerta (ZI).2–4 In this study, we report the first pathologically proven case of direct bilateral ZI stimulation which dramatically improved the cardinal symptoms of PD in a patient implanted for severe PD 6 years previously and who suddenly died. ### Clinical data. A 52-year-old man was proposed deep brain stimulation (DBS) because he had severe PD for 13 years that had reached the stage of motor fluctuations with incapacitating levodopa-induced dyskinesia. He was operated under local anesthesia. Peroperative single-unit activity recordings could not be completed in this patient for technical reasons. However, the surgical procedure was the same as that used for patients reported in a previous article.5 The position of the active contacts was determined in relation to the mid-commisural point and revealed that the right electrode was located more anteriorly and less deep compared to the left one. In this article, we focus on the …