BACKGROUND:Huntington's disease (HD) presents a unique clinical challenge with coexisting hyperkinetic and hypokinetic symptoms, yet the underlying neural oscillatory mechanisms remain poorly understood. OBJECTIVE:The aim of this study was to characterize pathological pallidal neural activity in HD and identify biomarkers for therapeutic optimization. METHODS:We investigated pallidal oscillatory patterns in 15 patients with HD undergoing deep brain stimulation, recording video-synchronized local field potentials during symptom fluctuations and comparing findings with patients with Parkinson's disease and dystonia. RESULTS:HD exhibited distinct pallidal oscillatory signatures that differed from PD and dystonia. Theta power (2-8 Hz) increased during hyperkinetic states, whereas high beta power (20-30 Hz) elevated during hypokinetic states, both correlating significantly with clinical symptom severity. These patterns were not modulated by voluntary movement. Electrophysiological connectivity analysis integrated with neuroimaging analysis showed that globus pallidum externus-globus pallidus internus theta coherence correlated with indirect pathway structural connectivity, whereas pallidal high beta power associated with direct pathway functional connectivity, reflecting HD's dual circuit pathology. Spatial mapping localized theta oscillations to the posterior globus pallidus, with fibers projecting to motor cortical areas. CONCLUSIONS:We establish an electrophysiological framework explaining HD's complex symptomatology through dual oscillatory signatures. These findings provide circuit-specific biomarkers for disease monitoring and anatomical targets for optimizing deep brain stimulation in patients with HD. © 2026 International Parkinson and Movement Disorder Society.

BACKGROUND:Deep brain stimulation for Parkinson's disease is often performed under conscious sedation or general anesthesia. However, anesthetic agents may influence intraoperative microelectrode recording, and the optimal anesthesia method for microelectrode recording remains unclear. This study compared general anesthesia and conscious sedation in preserving microelectrode recording signal intensity during deep brain stimulation. METHODS:In this prospective, noninferiority randomized controlled trial, patients with Parkinson's disease (United Kingdom Brain Bank criteria) undergoing elective bilateral surgery were randomized 1:1 to the conscious sedation or the general anesthesia group. During surgery, a desflurane anesthetic titrated against the quality of the electrophysiologic signal was applied in the general anesthesia group, whereas patients in the conscious sedation group received dexmedetomidine anesthesia. The primary outcome was the proportion of patients with high-quality microelectrode recording (normalized root mean square greater than 2.0), assessed postoperatively off-line. Secondary outcomes included operation and recording duration, 6-month clinical efficacy, and complication rates. RESULTS:Of 188 randomized patients (94 general anesthesia, 93 conscious sedation), desflurane anesthesia was noninferior for high normalized root mean square proportion (89.4% vs . 90.3%; difference, -0.96%; 95% CI, -9.62 to 7.70). The general anesthesia group had shorter operative time (difference, -9.07 min; 95% CI, -13.99 to -4.14; P < 0.001). At 6 months, changes in Unified Parkinson's Disease Rating Scale score (difference, -2.50; 95% CI, -7.20 to 2.20; P = 0.297), levodopa equivalent daily dose (difference, -58.4 mg; 95% CI, -133.56 to 16.75; P = 0.128), and complication rates (general anesthesia: 10.9% vs . conscious sedation: 8.9%; P = 0.655) were comparable between the groups. CONCLUSIONS:General anesthesia is noninferior to conscious sedation for microelectrode-guided subthalamic nucleus deep brain stimulation, providing equivalent signal intensity and clinical outcomes while improving procedural efficiency, supporting its use as a valid clinical option.

We investigated the impact of visual states on basal ganglia oscillatory biomarkers, comparing local field potentials (LFPs) dynamics between Parkinson’s disease (PD) and dystonia and developing a decoding model for state identification. Simultaneous LFPs recordings from the subthalamic nucleus (STN) or globus pallidus internus (GPi), and cortex were obtained from 18 PD and 18 dystonia patients. In the eyes-closed state, theta and alpha power increased in the basal ganglia, with stronger coherence to the central cortex, more pronounced in the STN than in the GPi. Machine learning models identified the eyes-closed state with 88% accuracy for STN and 77% for GPi. The sensorimotor STN and GPi were most informative. The present findings provide proof-of-concept that basal ganglia LFPs can reliably predict a physiological state, highlighting the potential influence of physiological oscillatory activity on pathological bands and its relevance for adaptive stimulation paradigms.

BACKGROUND:The substantia nigra (SN) is an emerging deep brain stimulation (DBS) target for Parkinson's disease (PD). However, its independent therapeutic profile remains obscured by concurrent subthalamic nucleus (STN) stimulation in clinical practice. We systematically evaluated the frequency-dependent efficacy, longitudinal feasibility, and clinical boundaries of direct SN DBS to optimize both targeted nigral modulation and STN-SN combined stimulation. METHODS:Phase 1 comprised an acute randomized crossover assessment in which 30 participants underwent both SN stimulation at 10, 30, and 130 Hz and standard STN stimulation at 130 Hz. Outcomes included the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III), objective gait kinematics, and episodic memory. Phase 2 was an exploratory, non-randomized 3-month feasibility cohort. Seven participants initiated chronic SN stimulation; two discontinued because of treatment-limiting adverse events, and longitudinal outcomes were available for five treatment-tolerant completers, with descriptive comparison to five STN-DBS comparator participants. RESULTS:SN-DBS produced clear, frequency-dependent acute motor improvements. High-frequency (130 Hz) stimulation yielded the most pronounced clinical benefits, including a 43.6% reduction in MDS-UPDRS III and a 13.5% increase in stride length. The motor and spatial gait effects at 130 Hz were of similar magnitude to those observed with standard STN-DBS, while episodic memory performance remained stable across stimulation conditions. Patient-specific VTA mapping identified an outcome-associated region predominantly within the dorsal SN, and greater spatial overlap was associated with greater motor improvement. In Phase 2, chronic SN stimulation was maintained for 3 months in five of seven participants; two discontinued because of treatment-limiting adverse events. CONCLUSION:Direct SN stimulation produced a clear frequency-dependent acute response in PD, with 130 Hz yielding the strongest motor and spatial gait benefits among the tested frequencies and effects of similar magnitude to standard STN stimulation. VTA mapping localized the strongest response-associated region predominantly within the dorsal SN, and the 3-month observations provided a basis for further development of anatomically precise and individualized SN neuromodulation.

BACKGROUND:Though deep brain stimulation (DBS) has emerged as a promising treatment for idiopathic cranio-cervical dystonia (iCCD), the best location at which to stimulate remains unclear at a granular level. This study aimed to identify optimal sites and related white matter pathways of globus pallidus internus (GPi) and subthalamic nucleus (STN) for DBS therapy. METHODS:We analyzed a total of 70 iCCD patients treated with bilateral DBS, targeting the STN (n = 40) or GPi (n = 30). A retrospective cohort (n = 48) was utilized for training, while a prospective cohort (n = 22) was used for out-of-sample validation. We identified optimal stimulation sites, validating their spatial specificity and reproducibility. Target-specific and convergent "sweet tracts" for STN and GPi-DBS were identified based on a human axonal pathway model (the Basal Ganglia Pathway Atlas). RESULTS:Optimal stimulation in both GPi and STN targeted distinct subregions mapped to cranio-cervical motor control-specifically, the posterior ventrolateral GPi and dorsolateral STN. Therapeutic "sweet tracts" engaged craniocervical- and dystonia-specific fiber pathways within the basal ganglia-thalamo-cortical loop, including the GPi-specific lenticular fasciculus, the STN-specific hyperdirect pathway and corticospinal tract, and the convergent posterior subthalamo-pallidal connections pathway. This convergent pathway was independently validated using a streamline-level analysis. CONCLUSION:Our work provides a network-based explanation for the comparable efficacy of GPi and STN stimulation, suggesting that therapeutic benefit is driven by modulating specific pathways rather than the nucleus alone. This provides a new framework for refining and personalizing therapy.

Deep Brain Stimulation (DBS) is a well-established surgical therapy for advanced Parkinson’s disease (PD), effectively alleviating motor symptoms and complications associated with long-term levodopa treatment. This review provides a comprehensive synthesis of current evidence, analyzing the efficacy of the two primary targets, the subthalamic nucleus (STN) and the globus pallidus internus (GPi), on both motor and non-motor symptoms. While STN-DBS allows significant medication reduction and GPi-DBS may better manage dyskinesias and axial symptoms, outcomes are highly dependent on careful patient selection. Key prognostic factors include preoperative levodopa responsiveness, disease duration, motor phenotype, and cognitive status. The review also critically evaluates technological advancements, such as adaptive closed-loop systems and novel targets, which aim to personalize therapy and address treatment-resistant symptoms. Ultimately, DBS represents a transformative intervention whose success hinges on integrated clinical decision-making and continued innovation.

Closed-loop deep brain stimulation (DBS) relies on continuous neural biomarker sensing, yet clinical utility is often limited by signal dropout, stimulation artifacts, and hardware constraints in subcortical recordings. Here, we develop a deep learning framework combining spectral processing with generative diffusion models to digitally reconstruct deep brain signals from cortical electrocorticography (ECoG), enabling continuous subcortical biomarker inference without direct deep brain sensing. We validate this approach across 723 h of simultaneous cortico-subcortical recordings from 49 patients with movement disorders (Parkinson’s disease, dystonia, Tourette syndrome) across three international centers. The framework decodes subcortical activity across multiple deep brain targets (subthalamic nucleus, globus pallidus internus, thalamus), behavioral states (rest, movement, sleep), and therapeutic conditions (medication and stimulation ON and OFF), with performance remaining above chance in every condition tested. Using generative diffusion models, we achieve raw signal reconstruction that preserves clinically relevant neural features, including beta burst dynamics that correlate with motor symptom severity (UPDRS-III R² = 0.70). We demonstrate clinical utility by showing that cortically-derived signals can rescue state detection during DBS recording failures and augment limited sensing configurations. This digital approach to deep brain inference could expand the applicability of adaptive neuromodulation therapies and enable closed-loop control for emerging non-invasive stimulation techniques.

Deep brain stimulation (DBS), the most widely adopted form of chronic intracranial neuromodulation, has become a standard treatment for movement disorders, yet how patients and practitioners perceive associated safety risks, data security concerns, and ethical implications remains poorly understood. Misalignment between patient expectations and clinical reality can undermine informed consent, compromise treatment adherence, and erode public trust. We conducted a multi-center study combining (1) a cross-sectional survey of 327 DBS patients and 161 practitioners (123 Chinese, 38 international) across 30 Chinese provinces and 11 countries, including factual knowledge assessment and information source items, (2) semi-structured interviews with 18 patients and 12 practitioners, and (3) an informed consent process audit at 6 DBS centers. Ordinal logistic regression controlled for age, gender, and education. Qualitative data were analyzed using reflexive thematic analysis. After adjusting for demographic confounders, significant perception gaps persisted between patients and practitioners for surgical risk (adjusted OR 1.89, 95

AimDeep brain stimulation of the nucleus basalis of Meynert (NBM-DBS) represents an emerging therapeutic strategy for Alzheimer’s disease (AD), yet clinical outcomes have been inconsistent and its mechanistic underpinnings are not fully elucidated. This study aimed to assess the cognitive and psychobehavioral effects of NBM-DBS and to explore its potential impact on systemic inflammatory markers.MethodsIn this open-label trial, nine individuals with moderate-to-severe AD underwent bilateral NBM-DBS. Six participants (four with moderate and two with severe AD) completed the full 12-month protocol, which included serial neuropsychiatric assessments and serum cytokine profiling.ResultsStratification by baseline disease severity revealed divergent cognitive trajectories. Patients with moderate AD (CDR = 2) maintained their preoperative performance on the Montreal Cognitive Assessment (MoCA) and Boston Naming Test (BNT) over the 12-month follow-up. In contrast, patients with severe AD (CDR = 3) experienced significant decline on these measures. Serum analyses demonstrated a significant immunomodulatory effect, characterized by elevated levels of the anti-inflammatory cytokines IL-10 and IL-27, and reduced levels of the pro-inflammatory chemokines CXCL10 and RANTES at the 12-month timepoint.ConclusionOur findings indicate that NBM-DBS may be associated with stabilization of cognitive function in patients with moderate AD, potentially through the modulation of inflammation. The therapeutic benefit appears to be more pronounced in the moderate stage of the disease.

Current levodopa challenge test (LCT) for deep brain stimulation (DBS) candidate screening in Parkinson’s disease (PD) relies on subjective clinical scales, limiting its predictive capacity for postoperative motor outcomes. We developed video-based machine learning models using quantified kinematic metrics during preoperative LCT in seventy PD patients who underwent DBS surgery. Objective multi-domain motor features were extracted via validated motor assessment software. Binary classification defined patients’ outcomes as DBS+ (≥30

Abstract Episodic memory plays a critical role in supporting adaptive behavior; however, whether it can be causally regulated in humans via deep subcortical stimulation remains unclear. In the present study, we investigated the differential effects of substantia nigra (SN) and subthalamic nucleus (STN) stimulation on episodic memory, as well as the underlying mechanisms of its associated brain networks, using a recognition memory task combined with concurrent functional magnetic resonance imaging in patients with Parkinson’s disease. SN-DBS increased recognition sensitivity and reduced false alarms at both frequencies, whereas 10 Hz STN-DBS reduced sensitivity and increased false alarms. Functional connectivity analyses in the absence of DBS stimulation identified a false recognition-related network linking nigral, pallidal, subthalamic, medial temporal, frontal, and occipital regions. SN-DBS-related false alarm reduction tracked modulation of this circuit and was marked by its baseline vulnerability state. These behavioral effects mapped onto target-dependent parieto-occipital and SN–visual retrieval pathways, supporting a model in which DBS bidirectionally regulates recognition memory through target- and frequency-dependent subcortical–cortical circuits.

Background:Subthalamic deep brain stimulation (STN-DBS) has emerged for Parkinson's disease (PD), but its long-term effects on levodopa-induced dyskinesia (LID) remain poorly understood. Objective:To assess the long-term LID outcomes and prognostic factors of STN-DBS. Methods:A single-blind longitudinal cohort study was conducted in evaluating 84 PD patients with LID (mean age 61.89 years; 46.4% female; mean disease duration 10.30 years; and mean baseline levodopa-equivalent dose 854.16 mg/day) who underwent STN-DBS at Beijing Tiantan Hospital, Capital Medical University between 2019 and 2021. Assessments at baseline, 1-year (short-term), and 3-year (long-term) regarding motor symptoms, quality of life, neuropsychological status, and cognitive function were analyzed. Primary outcomes focused on LID symptoms (Unified Dyskinesia Rating Scale [UDysRS]). Multivariable linear regression identified prognostic factors. Results:At 1-year, the UDysRS score improved significantly (74.4% reduction, P<0.001), with sustained but diminished benefits at 3-year (64.9% reduction vs baseline, P<0.001; 36.9% decline vs 1 year, P=0.012). The time and functional impact of LID also improved initially (62.5% and 64.3% reduction) but worsened over time (38.8% and 33.3% decline). Motor function and quality of life showed similar trends, while neuropsychological symptoms improved stably even after long-term follow-up; and cognitive function remained unchanged. Multivariable regression identified diphasic dyskinesia as a negative prognostic factor (short-term std.β=-0.296; long-term std.β=-0.239), whereas a higher levodopa-equivalent dose (short-term std.β=0.275; long-term std.β=0.261) and greater levodopa responsiveness (short-term std.β=0.215; long-term std.β=0.216) predicted better short- and long-term results. A longer disease duration correlated with worse long-term outcomes (std.β=-0.212). Conclusion:STN-DBS was associated with significant long-term improvements in LID, although the effectiveness gradually declined. The identified prognostic factors help in patient selection and counseling.

To conduct a network meta-analysis to compare the efficacy and safety of various surgical strategies for refractory obsessive-compulsive disorder (OCD), including ablative surgery (ABL) and deep brain stimulation (DBS), with the aim to guide clinical treatment. We searched major electronic databases for different surgical interventions of OCD. The primary outcomes were changes in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at 1 year and at the longest follow-up (LFU); the secondary outcomes included responder rates of Y-BOCS (≥35

AbstractBackground: Dentate nucleus deep brain stimulation (DN-DBS) is a promising approach for post-stroke motor impairments, yet human single-unit firing properties of the DN after stroke remain poorly characterized.Objective: To characterize intraoperative DN single-unit activity after stroke, examine its association with motor impairment and stroke etiology, and explore whether intrinsic firing dynamics relate to early post-implantation motor changes before stimulation activation.Methods: Patients with ischemic (IS) or hemorrhagic stroke (HS) undergoing unilateral DN-DBS completed preoperative and 1-month postoperative FMA assessments with stimulation off. Intraoperative microelectrode recordings were spike-sorted. Firing rate (FR) and ISI–Gamma–based firing patterns were computed, and neurons were classified as tonic, burst-like, or irregular. Group differences were tested using the Mann–Whitney U and chi-square tests (with adjusted residuals), and associations were evaluated using Spearman correlation with false discovery rate correction.Results: 16 out of 17 participants contributed 130 quality-controlled units. Mean FR did not differ between IS and HS (p = 0.753), but firing-pattern distribution differed (χ² = 8.596, p = 0.0136), driven by fewer tonic units in HS. Across patients, higher FR correlated with worse FMA-UE (ρ = −0.596, p = 0.0149), while a higher proportion of irregular firing correlated with better preserved FMA-UE (ρ = 0.690, FDR p = 0.0372). At 1 month after surgery with stimulation off, FMA-UE improved (+3.19 points, p = 0.00318), indicating a microlesion effect. Firing-pattern composition differed between improved and non-improved patients (χ² = 6.814, p = 0.0331).Conclusions: Dentate nucleus single-unit firing dynamics are associated with post-stroke motor impairment and support a pathophysiological framework that may guide individualized DN-DBS targeting strategies.

Background:Stroke remains the leading cause of long-term disability worldwide. Approximately 60% of individuals with chronic ischemic stroke experience persistent upper limb impairment that limits daily activities. The Repair Study aims to evaluate the safety and efficacy of vagus nerve stimulation (VNS) paired with rehabilitation in patients with chronic ischemic stroke in developing countries, including those with severe upper limb dysfunction, thereby generating evidence to support broader global application. Methods:It is a multicenter, triple-blinded, randomized controlled trial conducted across 13 centers in China. Up to 99 participants with upper limb motor impairment, 9 months to 10 years post-stroke, will be enrolled. All participants will undergo VNS implantation (Model G115R/G115, PINS Medical, Beijing, China) and be randomized 2:1 by a central randomization system to active stimulation (0.8 mA) or sham stimulation (0 mA) paired with standardized upper limb rehabilitation. The blinded phase includes 6 weeks of clinical therapy (three sessions/week, 90-120 min/session, ≥300 stimulation-movement repetitions) followed by 6 weeks of home-based therapy (30 min/day). Post-unblinding, the active VNS group continues home-based therapy, while the sham group receives 6 weeks of clinic-based therapy. Discussion:The primary outcome is the between-group difference in Fugl-Meyer Assessment for Upper Extremity scores at the end of 6 weeks of clinical therapy. Secondary outcomes include additional motor, functional, and quality-of-life measures. Safety will be assessed through adverse event monitoring. The Repair Study is a multicenter randomized controlled trial targeting chronic ischemic stroke populations in developing countries. It supplements the existing clinical evidence by enrolling patients with more servere motor dysfunction and being conducted in a developing country. Trial Registration:ClinicalTrials.gov: NCT06722677.

Deep brain stimulation (DBS) is an established therapy for Parkinson’s disease, yet conventional onsite programming mandates frequent travel to specialized centres, imposing substantial burdens on patients. Here we present a large real-world analysis of remote programming (RP) for DBS in China, drawing on 20,383 patients with Parkinson’s disease and 42,163 RP sessions (2012–2024). RP achieves comparable satisfaction and effectiveness to onsite programming while reducing the healthcare access inequality index by 30%. These access gains translate into disproportionate economic benefits for the most vulnerable groups, with cost savings two to ten times greater among low-income, remote and advanced-disease populations. Integrated clinical–labour–economy modelling projects annual direct economic benefits of ¥1.09 billion from reduced domestic medical tourism and ¥8.15 billion from labour-cost savings, with cumulative benefits of ¥115–270 billion by 2050 (3.9–9.2% of China’s 2024 basic medical insurance fund). These findings suggest that RP could be a clinically equivalent, more equitable and economically advantageous approach for postoperative DBS management worldwide. After more than 10 years of real-world deployment involving 20,383 patients, this analysis reports on the cost-effectiveness of remote programming of deep brain stimulation, outlining the implications for reducing inequalities in healthcare access and projecting scenarios of large-scale implementation in the context of an ageing population.

BACKGROUND:Cognitive decline in Parkinson's disease (PD) is associated with pathological alterations within the thalamus. Nevertheless, volumetric changes in the specific subnuclei of the thalamus in PD patients with dementia (PD-D) remain inadequately characterized. Furthermore, the clinical challenges of diagnosing PD-D at an individual level and forecasting the trajectory of cognitive decline persist. METHODS:This study acquired structural magnetic resonance imaging (MRI) data from 60 healthy normal controls (NC), 63 PD patients without dementia (PD-nD), and 57 PD-D patients. The volumes of 25 thalamic subnuclei were quantified using FreeSurfer and a novel thalamic segmentation algorithm. Subsequently, individual PD-D diagnosis and severity prediction of cognitive impairment were performed using support vector machines (SVMs). RESULTS:Our findings demonstrated atrophy in seven out of 25 left and two out of 25 right thalamic subnuclei in PD-D patients relative to PD-nD patients. When compared to NC subjects, the PD-D group exhibited volume reductions in two left and one right subnuclei, alongside enlargement in several others. Within the PD cohort, the volumes of four left thalamic subnuclei showed a negative correlation with cognitive impairment severity. Machine learning models achieved high accuracy in differentiating PD-nD from NC (89.19%), PD-D from NC (94.29%), and PD-D from PD-nD (83.33%). Moreover, the prediction of Mini-Mental State Examination (MMSE) scores yielded a Pearson correlation coefficient of 0.7568. CONCLUSION:Specific thalamic subnuclei undergo atrophy in PD-D, and these morphological changes are linked to cognitive deficit severity. Leveraging these features with machine learning enables accurate individual diagnosis and severity prediction.

OBJECTIVE:Research on freezing of gait (FOG) in Parkinson's disease (PD) has identified relevant electrophysiological markers. However, their brief temporal windows limit their utility for individualized deep brain stimulation (DBS). This study explored gait performance and neural features in freezing-susceptible walking to develop novel FOG-predictive biomarkers. METHODS:Gait kinematics and local field potentials (LFP) from the cortex and subthalamic nucleus (STN) were simultaneously acquired in FOG patients during walking. Using the gait cycle as the analytic unit, we compared freezing trials (FOGT) and non-freezing trials (nFOGT) under the no-intervention condition (OFF) to identify gait parameters and neural features associated with FOG risk. Subsequently, we assessed the modulatory effects of high-frequency (HFS) and low-frequency (LFS) STN-DBS on abnormal gait and cortical power. Finally, we analyzed changes in abnormal gait and cortico-STN coherence after levodopa administration. RESULTS:FOGT showed aberrant gait parameters compared to nFOGT, along with disrupted lowbeta oscillations in primary somatosensory cortex (S1) and superior parietal lobule (SPL). Both HFS and LFS mitigated gait impairment and freezing severity, with LFS exerting broader effects: HFS reversed pathological lowbeta power reduction in SPL during the double support phase, while LFS restored phase-dependent oscillations between the stance phase and swing phase in S1. Additionally, abnormal theta coherence between S1 and STN could be modulated by levodopa, accompanied by gait recovery. CONCLUSION:This study identifies gait-cycle-locked cortico-STN signatures for FOG, which have extended temporal windows and are modulable by DBS, suggesting the gait cycle as a promising intervention target.

Parkinson’s disease (PD) is associated with disrupted neural activity in the substantia nigra, but its electrophysiological changes remain underexplored. This study investigates the oscillatory patterns of substantia nigra pars reticulata (SNr) in PD, compared to dystonia (DT). Intraoperative recordings of the SNr were obtained from 20 PD and 16 DT patients during DBS surgery. Spectral power, neuronal firing rate, beta burst dynamics, and correlation analysis of the SNr signal were analyzed. PD patients exhibited increased alpha and beta power, elevated firing rates, and reduced aperiodic exponent values in SNr compared to DT. PD beta bursts showed prolonged durations and fewer short bursts. Beta power negatively correlated with motor symptom improvement rates in PD but not in DT patients. These findings highlight pathological beta power in SNr of PD, which indicates that SNr-DBS may offer a future therapeutic avenue for PD.

Objective: To evaluate the safety and efficiency of deep brain stimulation (DBS) in the treatment of primary cervical dystonia (CD) and to compare the difference between the STN (subthalamic nucleus)-DBS and GPi (Globus Pallidus internus)-DBS. Study Design: Experimental study. Place and Duration of the Study: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, from January 2012 to December 2021. Methodology: This study analysed the effects of DBS on 34 patients with primary cervical dystonia (CD) based on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). It included 15 STN-DBS and 19 GPi-DBS cases, with TWSTRS scores collected at baseline and the final follow-up. Stimulation parameters and adverse events were also recorded. Results: The mean follow-up time was 42.77 +/- 27.46 months. A significant improvement in TWSTRS total scores was observed in all patients (p <0.001), with no significant difference between STN-DBS and GPi-DBS groups (p = 0.481). The amplitude of stimulation in the GPi group was found to be higher than that in the STN group (p <0.001). Adverse events included one case of electrode breakage in the STN-DBS group, mild dyskinesias in 14 patients (twelve from the STN-DBS group and two from the GPi-DBS group), and other stimulation-related complications in four patients (one from the STN-DBS group and three from the GPi-DBS group). All stimulation-related complications were manageable with parameter adjustments. Conclusion: DBS can significantly improve the symptoms of primary CD patients, with no significant difference in outcomes between STN-DBS and GPi-DBS. It has a good long-term therapeutic effect and surgical safety.