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DBS Positioning

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I have a diognosis of Parkinson's disease but also have some action tremor like Essential tremor. Tremor on right side is my primary symptom but am begining to experience Bradykinesia, dyskinesea, and dystonia. I had DBS implant in 2002 in the thalamus. I had battery replacement in 2005 and today I need battery replacement again. My question is, will repositioning the DBS to the sub thalamic nucleus lower the voltage requirements therefore extendeding the battery life?

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The answer is a firm maybe.

 

Three to five years on a battery change is pretty typical, however it may also reflect lead location in the thalamus. People are very different in terms of stiumulation parameter needs. The parameters can be quite similar between targets, and the bigger issue is whether lead location is off in your thalamic lead.

 

The safer alternative is of course to start with an STN DBS for PD-ET. We actually published on this in the Archives of neurology a few years back (Stover et. al.). One target and two tremors.

 

In your case if you need DBS (i.e. meds cannot control your symptoms--and I would be sure you are medically optimized), then get a full multidisciplinary workup with on-off UPDRS testing and also testing on and off your DBS. Make sure you understand that DBS will only help levodopa responsive symptoms with the possible exceptions being tremor and dyskinesia. DBS is good for on-off fluctuations.

 

Playing it safe you may want to leave your thalamic DBS in place and just add a STN DBS if you need it.

 

Again, see a specialist as this would be a complex scenario and you need to be sure you are a good candidate.

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