Surgical repositioning of misplaced subthalamic electrodes in Parkinson’s disease: location of effective and ineffective leads.
Richardson RM, Ostrem JL, Starr PA Surgical repositioning of misplaced subthalamic electrodes in Parkinson’s disease: location of effective and ineffective leads. , 2009;87(5):297-303. Epub 2009 Jul 29
The purpose of this article was to look at repositioning lead placements in people with Parkinson’s disease (PWP) that experienced suboptimal results after their initial DBS surgery. It is notable that the researchers had patients from within their own practice as well as from other practices, suggesting that suboptimal surgical results happen at various facilities and more importantly that those suboptimal results should be individually reviewed in order to improve the effects of the DBS as well as reduce adverse events for such patients. It should be noted that none of the patients in this study had surgical complications at either the initial or repositioning surgery that explained the suboptimal results. We would refer the reader to the article for detailed and specific locations of each patient’s initial lead as well as where the revised lead was placed (typically 2-5mm change towards the central zone of the dorsolateral STN). All 8 of the PWP that underwent revision experienced improvement in their motor and nonmotor symptoms observed after the initial surgery and none reported any adverse events (improvements included general motor symptoms, gait, tremor, dystonia, depression, dysarthria, freezing of gait, and rigidity).
There continues to be mixed findings regarding the best lead placement site for DBS in PWP and this article contributes to that debate. It is promising, that there is a large research study soon to come out that may best address the lack of consensus. Although the debate continues, articles such as this remain important because there are individuals out there that are having suboptimal results from their initial surgery that may feel that there is nothing else to be done for them. Research should and will continue regarding the best neuroanatomical lead placement sites but we cannot forget or ignore those PWP that are out there that did not benefit as much from the surgery as hoped. This article is a great example that one option, lead repositioning, was appropriate for specific patients and those patients showed improvement after the second surgery.