The efficacy of bilateral deep brain stimulation (DBS) for the treatment of motor symptoms and levodopa-induced dyskinesias in Parkinson disease (PD) patients is well established, according to the Congress of Neurological Surgeons. However, the effectiveness of selecting different stimulation targets is less clear. To date, 2 different targets have been proposed for the treatment of motor symptoms of PD, the subthalamic nucleus (STN) and globus pallidus internus (GPi). While there is evidence to suggest that both are effective when combined with best medical treatment vs best medical treatment alone, the circumstances in which 1 target should be selected over the other are still disputed. A literature search was conducted for articles published between 1966 and February, 2017, on DBS for the treatment of PD. Key recommendations include:

1. Given that bilateral STN DBS is at least as effective as bilateral GPi DBS in treating motor symptoms of PD, consideration can be given to the selection of either target in patients undergoing surgery to treat motor symptoms.
2. When the main goal of surgery is reduction of dopaminergic medications in a patient with PD, then bilateral STN DBS should be performed instead of GPi DBS.
3. There is insufficient evidence to make a generalizable recommendation regarding the target selection for reduction of dyskinesias. However, when the reduction of medication is not anticipated and there is a goal to reduce the severity of “on” medication dyskinesias, the GPi should be targeted.
4. When considering improvements in quality of life in a patient undergoing DBS for PD, there is no basis to recommend bilateral DBS in 1 target over the other.
5. If there is significant concern about cognitive decline, particularly in regards to processing speed and working memory in a patient undergoing DBS, then the clinician should consider using GPi DBS rather than STN DBS, while taking into consideration other goals of surgery.