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Repositioning DBS Lead

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Our 48 year old Son had single side DBS in 2000 in the sub thalamic nucleus area for dyskinesia, which helped a great deal,however, he was the first to have it done by his surgical team and they did not hit the exact target area for maximum benefit. His surgeon is now suggesting that they reposition the lead. His parkinsons has progressed after 20+ years. I have two questions:

 

1. In your opinion, is this a good idea?

 

2. Could the other side be done at the same time and would this be a good idea? He also is due for battery replacement.

Thanks for your thoughts.

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This is a complex question and I usually recommend a full evaluation by a team before making this decision inclusing at a minimum a movement neurologist, a neurosurgeon, a neuropsychologist and possibly even a psychiatrist. You need a very high quality image with measurements of the x,y,z location of each of the four lead contacts.

 

You will then need 4 scales:

On med on DBS

Off med on DBS

Off med off DBS

On med off DBS

 

The UPDRS scales in each condition after optimization of medications and DBS will tell you what the meds and DBS are improving. Knowing this information should allow your team the facts they will need to decide the utility of replacement.

 

Finally, the second lead. Well, again you need the above information and you need to ask the "team" what based on this information you may expect to improve.

 

If you are not comfortable get a 2nd opinion from another team, if only to reinforce.

 

Remember, other medical conditions can also increase the risk, and the risks of a repeat surgery will be the same---perhaps with an added risk of infection as you go through an old burr hole.

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