Publication details

Successful asymmetrical deep brain stimulation using right subthalamic and left pallidal electrodes in a patient with Parkinson's disease

Authors

BALÁŽ Marek FILIP Pavel BOČKOVÁ Martina FEITOVÁ Věra ŘÍHA Ivo HRABOVSKÝ Dušan CHRASTINA Jan

Year of publication 2021
Type Article in Periodical
Magazine / Source British journal of neurosurgery
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.tandfonline.com/doi/full/10.1080/02688697.2021.1876210
Doi http://dx.doi.org/10.1080/02688697.2021.1876210
Keywords Deep brain stimulation; Parkinson's disease; asymmetrical targets; subthalamic nucleus; globus pallidus internus
Description Purpose: Despite the best efforts of neurologists, the results of pharmacotherapy in the late stages of Parkinson's disease are often disappointing and accompanied by debilitating side effects. Under these circumstances, deep brain stimulation is a viable treatment option. The aim of the meticulous pre-surgical planning is not only precise electrode implantation, but also the avoidance of intraoperative vascular conflicts potentially causing intracerebral bleeding. Material and methods: In this report, we present a patient with early-onset Parkinson's disease whose cerebral vascular anatomy precluded standard bilateral subthalamic nucleus electrode implantation. Initially, right subthalamic stimulation alone provided a very mild clinical benefit that was not reflected in the patient's quality of life. In this patient, an unusual configuration of intracerebral electrodes with right subthalamic and left pallidal stimulation electrodes was applied 15 months after the initial subthalamic electrode implantation. Results: The procedure has had a highly beneficial long-term effect without any significant complications. The greatest improvement was noted using the setting 1.8 V, 130 Hz, 90 mu s at the right side (STN) and 3.7 V, 130 Hz, 120 mu s at the left side (GPi). This allowed the patient to return to his daily life activities. Conclusions: The reported case provides a new perspective of treatment possibilities in complex functional neurosurgical cases requiring exceptional individualisation of the treatment approach.

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