Mitchell, k.T., schmidt, s.L., cooney, j.W., grill, w.M., peters, j., rahimpour, s., lee, h.J., jung, s.H., mantri, s., scott, b., lad, s.P.,& turner, d.A.(2022).Initial clinical outcome with bilateral, dual-target deep brain stimulation trial in parkinson disease using summit rc + s.Neurosurgery, publish ahead of print.Https://doi.Org/10.1227/neu.0000000000001957 background: deep brain stimulation (dbs) is an effective therapy in advanced parkinson disease (pd).Although both subthalamic nucleus (stn) and globus pallidus (gp) dbs show equivalent efficacy in pd, combined stimulation may demonstrate synergism.Objective: to evaluate the clinical benefit of stimulating a combination of stn and gp dbs leads and to demonstrate biomarker discovery for adaptive dbs therapy in an observational study.Methods: we performed a pilot trial (n = 3) of implanting bilateral stn and gp dbs leads, connected to a bidirectional implantable pulse generator (medtronic summit rc + s; nct03815656, ide no.G180280).Initial 1-year outcome in 3 patients included unified pd rating scale on and off medications, medication dosage, hauser diary, and recorded beta frequency spectral power.Results: combined dbs improved pd symptom control, allowing >80% levodopa medication reduction.Therewas a greater decrease in off-m edication motor unified pd rating scale with multiple electrodes activated (mean difference from off stimulation off medications 18.2, range 25.5 to 12.5) than either stn ( 12.8, range 20.5 to 0) or gp alone ( 9, range 11.5 to 4.5).Combined dbs resulted in a greater reduction of beta oscillations in stn in 5/6 hemispheres than either site alone.Adverse events occurred in 2 patients, including a small cortical hemorrhage and seizure at 24 hours postoperatively, which resolved spontaneously, and extension wire scarring requiring revision at 2 months postoperatively.Conclusion: patients with pd preferred combined dbs stimulation in this preliminary cohort.Future studies will address efficacy of adaptive dbs as we further define biomarkers and control policy.Reported events: 1.One patient had one small, delayed (24 hours) postoperative cortical hemorrhage 1 cm diameter) at the lead entry point.The small hemorrhage was not present on intraoperative or postoperative ct scans within 12 hours but presented after an isolated generalized seizure at 24 hours postoperatively.The patient was placed on levetiracetam for 3 months without seizure recurrence.A postoperative scan at 2 weeks showed resolution of the hemorrhage.2.Another patient developed tightness of extensions in theneck at 6 weeks postoperatively (related to the bulky, dual 40-cm forked extensions needed to connect 4 leads to a single summit rc + s ins).They were fully treated by extension revision surgery to longer (60 cm) extensions with no long-term sequelae and no effect on stimulation benefit.This patient also developed postoperative, unilateral leg dyskinesia off all parkinson's disease medications, which resolved after 2 weeks.The following device specifics were provided: lead model 3387, lead model 3389, ins model b35300r (summit rc+s).
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