Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders

Abstract

Deep brain stimulation (DBS) is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in “deep” structures within the brain with targets varying depending on the surgical indication. An implanted programmable pulse generator supplies the electrodes with a chronic, high frequency electrical current that clinically mimics the effects of ablative lesioning techniques. DBS’s efficacy has been well established for its movement disorder indications (Parkinson’s disease, essential tremor, and dystonia). However, clinical outcomes are sometimes suboptimal, even in the absence of common, potentially reversible complications such as hardware complications, infection, poor electrode placement, and poor programming parameters. This review highlights some of the rescue procedures that have been explored in suboptimal DBS cases for Parkinson’s disease, essential tremor, and dystonia. To date, the data is limited and difficult to generalize, but a large majority of published reports demonstrate positive results. The decision to proceed with such treatments should be made on a case by case basis. Larger studies are needed to clearly establish the benefit of rescue procedures and to establish for which patient populations they may be most appropriate.

Levodopa‐carbidopa intestinal gel therapy after deep brain stimulation

“…In other cases, disease progression could only be managed with high stimulation amplitudes, which may result in disabling side effects. Various rescue procedures, including stimulating a different intracranial target, have been reported …”

Cost‐Effectiveness of Magnetic Resonance‐Guided Focused Ultrasound for Essential Tremor

“…In this analysis, to be conservative, we made 2 assumptions favoring DBS: () recurrence requiring reoperation does not occur after the procedure, and () stimulation‐related adverse effects are short‐lived and resolved by reprogramming, thus having no negative impact on the patient's quality of life. However, clinical studies have shown that in rare cases, people who undergo DBS may experience tremor recurrence requiring reoperation.…”

Methodological Considerations for Neuroimaging in Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease Patients

“…Of those 711 surgeries, 169 patients required the DBS system to be either replaced or removed entirely [ 29 ]. These side effects and adverse outcomes can partially be attributed to suboptimal placement of the DBS lead, which is dependent on the accuracy of the preoperative planning procedures [ 30 , 31 ].…”