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Replacing a lead

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One of my patients has been told by his MDS that he needs to have a lead replaced on one side, because it is not functioning optimally. The other side is functioning well.

His surgeon has moved from St. Louis, and he has been told through some initial calls that other surgeons may not be willing to "redo" this.

 

What course of action would you suggest, and what testing or imaging will help a team further evaluate his options?

 

He will have to travel several hours (at best) to reach an experienced surgical team. Thanks.

 

Janice McCauley

Parkinson's Clinic of the Ozarks

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Lead replacements are not uncommon, but an experienced team is crucial.

 

I suggest travelling of necessary and in PD I suggest a full multidisciplinary evaluation (neurology, neurosurgery, psychology, psychiatry), and all UPDRS conditions after optimization of medications and stimulation...off/on DBS, off/on meds so that you can sort out DBS and medication issues. You neeed to determine what is medication responsive and then image the leads for location and precise measurement. A programmer then should test the leads for clinical benefit and side effects at each contact.

 

After all the information is gathered then the team should meet and decide on the best course of action which may or may not be lead replacement.

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