Sub-acute delayed failure of subthalamic DBS in Parkinson's disease: The role of micro-lesion effect

Abstract Objective To study delayed failure after subthalamic nucleus (STN) deep brain stimulation in Parkinson's disease (PD) patients. Methods Out of 56 consecutive bilaterally STN-implanted PD patients, we selected subjects who, after initial clinical improvement (⩾1 month after surgery), lo...

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Bibliographic Details
Published in:Parkinsonism & related disorders 2008-01, Vol.14 (2), p.109-113
Main Authors: Granziera, C, Pollo, C, Russmann, H, Staedler, C, Ghika, J, Villemure, J.-G, Burkhard, P.R, Vingerhoets, F.J.G
Format: Article
Language:English
Subjects:
Activities of Daily Living
Aged
Antiparkinson Agents - therapeutic use
Cohort Studies
Combined Modality Therapy
Deep brain stimulation
Electrodes, Implanted - adverse effects
Female
Follow-Up Studies
Gait Disorders, Neurologic - complications
Humans
Hypokinesia - complications
Male
Microelectrodes - adverse effects
Middle Aged
Neurology
Parkinson Disease - psychology
Parkinson Disease - therapy
Parkinson's disease
Stereotaxic Techniques
Subthalamic Nucleus - physiology
Treatment Failure
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Summary:Abstract Objective To study delayed failure after subthalamic nucleus (STN) deep brain stimulation in Parkinson's disease (PD) patients. Methods Out of 56 consecutive bilaterally STN-implanted PD patients, we selected subjects who, after initial clinical improvement (⩾1 month after surgery), lost benefit (delayed failure, DF). Results Five patients developed sub-acutely severe gait disorders (DF). In 4/5 DF patients, a micro-lesion effect, defined as improvement without stimulation, was observed; immediate post-operative MRI demonstrated electrode located above or behind to the STN. Conclusions Patients presenting micro-lesion effect should be carefully monitored, as this phenomenon can mask electrodes misplacement and evolution in DF.
ISSN:1353-8020
1873-5126
DOI:10.1016/j.parkreldis.2007.06.013