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Dr. Okun

New Study: Repositioning DBS Leads

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Dear Forum members,

 

There have been several recent publications including one by Ellis et.al. in Neurosurgery and now this one by Ostrem and Starr which address repositioning of DBS leads. These are important papers as they highlight the potential benefits of moving a DBS lead only a few millimeters in the brain. This group and others site tremendous improvement in select patients who did originally obtain clinical benefit (or expected benefit). Not everyone is a candidate for repositioning and only levodopa responsive symptoms have the potential to improve.

 

Here is the abstract:

 

Stereotact Funct Neurosurg. 2009 Jul 29;87(5):297-303. [Epub ahead of print] Links

Surgical Repositioning of Misplaced Subthalamic Electrodes in Parkinson's Disease: Location of Effective and Ineffective Leads.

 

Richardson RM, Ostrem JL, Starr PA.

Department of Neurological Surgery, University of California, San Francisco, Calif., USA.

There is no clear consensus regarding the optimal location for placing deep brain stimulation (DBS) electrodes within the subthalamic nucleus (STN) target region in Parkinson's disease. In cases of poor symptom control or adverse effects following lead placement, leads presumed to be inadequately positioned may be corrected by surgical revision. We retrospectively analyzed a series of 8 patients who underwent surgical lead revision, to study the anatomic boundaries of effective lead placement. Reoperation to achieve changes of 2-5 mm in DBS lead position targeting the dorsolateral part of the STN produced significant clinical improvement in these patients. Improvements were due to better symptom control, reduction of stimulation-induced adverse effects or both. In many cases, leads in a peripheral zone of the STN were repositioned to a more central location within the sensorimotor territory of the nucleus. These results are contrasted with findings in other studies demonstrating optimal lead placement in STN border zones or neighboring white-matter tracts. Copyright © 2009 S. Karger AG, Basel.

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