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For many years the subthalamic nucleus had a poor reputation among neurosurgeons as a result of the acute movement disorders that develop after its lesion or manipulation through different surgical procedures. However, this nucleus is now considered a key structure in relation to parkinsonism, and it is currently one of the preferred therapeutic targets for Parkinson's disease. The implication of the subthalamic nucleus in the pathophysiology of chorea and in the parkinsonian state is thought to be related to its role in modulating the basal ganglia, a fundamental circuit in movement control. Indeed, recent findings have renewed interest in this anatomical structure. Accordingly, this review aims to present a history of the subthalamic nucleus, evolving from the classic surgical concepts associated with the avoidance of this structure, to our current understanding of its importance based on findings from more recent models. Future developments regarding the relationship of the subthalamic nucleus to neuroprotection are also discussed in this review. © 2018 International Parkinson and Movement Disorder Society.

The objective of this study was to assess cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed motor features of Parkinson's disease several years after the cardiac stress testing. This was a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed until May 2012 to select those who developed Parkinson's disease. Heart rate and blood pressure both at rest and at peak exercise and heart rate variability at rest were recorded. For each patient who developed Parkinson's disease, 2 matched controls who did not develop Parkinson's disease at the end of the follow-up period were selected. Patients who were diagnosed with Parkinson's disease the same day of cardiac stress testing also were selected for comparison purposes. After excluding participants who were lost to follow-up, 2739 patients remained. From this cohort, 18 (11 men) had developed Parkinson's disease 4.27 ± 2.56 years after the cardiac stress test. Thirty-six matched controls were selected. At peak exercise, the maximum heart rate and the percentage of theoretical maximum heart rate were significantly lower in patients who developed Parkinson's disease after cardiac stress testing compared with controls. The sensitivity of a maximum heart rate ≤ 143 beats per minute to predict a diagnosis of Parkinson's disease after a mean of 4.27 years was 83%, and the specificity was 62%. The results from this exploratory study demonstrate that chronotropic insufficiency may constitute an early sign of Parkinson's disease during the premotor phase, serving as potential risk factor for its diagnosis. Further investigations are needed in larger populations. © 2013 Movement Disorder Society.