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Brain Sci. 2016, 6(4), 46; doi:10.3390/brainsci6040046

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

Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN 37232, USA
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Author to whom correspondence should be addressed.
Academic Editors: Tipu Aziz and Alex Green
Received: 3 July 2016 / Revised: 23 September 2016 / Accepted: 28 September 2016 / Published: 8 October 2016
(This article belongs to the Special Issue Deep Brain Stimulation (DBS) Applications)
View Full-Text   |   Download PDF [210 KB, uploaded 8 October 2016]

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. View Full-Text
Keywords: Parkinson’s disease; essential tremor; dystonia; deep brain stimulation; treatment failure; rescue leads Parkinson’s disease; essential tremor; dystonia; deep brain stimulation; treatment failure; rescue leads
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Nagy, A.M.; Tolleson, C.M. Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders. Brain Sci. 2016, 6, 46.

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