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Dr. Okun

Using multiple contacts and lead migration

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> Re DBS-gait problems

> From: "Anonymous"

> 23 Feb 2007 18:17:39 -0500

> ... biDBS STN may.2005 ... Gait problems

> started as soon as they started programming, but stimulator was turned on

> a couple of days before and I became stiffer... contact points were 1 and

> 5...

> MRI in jul.2006 showed [two electrodes on each side] in subst.nigra ...

> symptoms which all disappear when stimulator is turned off...

> Loss of all "small movements" automatic in gait and rising up from sitting

> pos.,

> voice amongst others, but everything comes back when stimulator is off...

 

Anna Maria: one thing I notice in your story: you mention monopolar

settings 1 and 5, but you also imply from the MRI that contacts 0/1 and 4/5

were outside the STN and in the Substantia Nigra.

Has your hospital team tried stimulation fields inside the STN, just using

the good electrodes, monopolar or bipolar?

 

Related qn to Dr. Okun: assuming that most DBS STN placements are confirmed

by an immediately post-op MRI, what is the possibility of relative lead

movement later? Some patients have mentioned STN leads too deep by 3-5 mm,

lead retraction as late as two years post-op, as if no cell build-up around

the insert took place, while some surgeons talk of the danger of local

hemorrhage.

 

Thank you.

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Good points.

 

The team should try to reprogram multiple contacts to look for benefit and also try monopolar and bipolar settings. The actual STN cannot be seen on MRI post-operatively so there has to be an estimate made based on imaging and thresholds at each contact. The hemorrhage rate goes dramatically down after the immediate post-op period.

 

It is common to place one electrode a few mm's below the target; two in the target (or just on top of it) and one out. There are different leads that can give you different spacing (closer or further away--but the contact size is the same). Leads can rarely migrate usually due to failure of securing devices, trauma, or growth of the skull (children). Migration is rare.

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