Rescue subthalamic stimulation after unsatisfactory outcome of pallidal stimulation in Parkinson's disease: a case series and review

Zhitong Zeng; Peng Huang; Zhengyu Lin; Yixin Pan; Xiaonan Wan; Chencheng Zhang; Bomin Sun; Dianyou Li

doi:10.3389/fnagi.2023.1323541

Rescue subthalamic stimulation after unsatisfactory outcome of pallidal stimulation in Parkinson's disease: a case series and review

Front Aging Neurosci. 2024 Jan 9:15:1323541. doi: 10.3389/fnagi.2023.1323541. eCollection 2023.

Authors

Zhitong Zeng^#¹, Peng Huang^#¹, Zhengyu Lin¹, Yixin Pan¹, Xiaonan Wan¹, Chencheng Zhang¹, Bomin Sun¹, Dianyou Li¹

Affiliation

¹ Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

^# Contributed equally.

Abstract

Background: Subthalamic nucleus (STN) and globus pallidus interna (GPi) are two main structures primarily targeted by deep brain stimulation (DBS) to treat advanced Parkinson's disease (PD). A subset of cases with unsatisfactory outcomes may benefit from rescue DBS surgery targeting another structure, while these patients' characteristics have not been well described and this phenomenon has not been well reviewed.

Methods: This monocentric retrospective study included patients with PD, who underwent rescue STN DBS following an unsatisfactory outcome of the initial bilateral GPi DBS in a retrospective manner. A short review of the current literature was conducted to report the clinical outcome of rescue DBS surgeries.

Results: Eight patients were identified, and six of them were included in this study. The rescue STN DBS was performed 19.8 months after the initial GPi DBS. After 8.8 months from the rescue STN DBS, patients showed a significant off-medication improvement by 29.2% in motor symptoms compared to initial GPi DBS. Non-motor symptoms and the health-related quality of life were also significantly improved.

Conclusion: Our findings suggest that the rescue STN DBS may improve off-medication motor and non-motor symptoms and quality of life in patients with failure of initial GPi DBS. The short review of the current literature showed that the target switching from GPi to STN was mainly due to poor initial outcomes and was performed by target substitution, whereas the switching from STN to GPi was mainly due to a gradual waning of benefits, long-term axial symptoms, dyskinesia, and dystonia and was performed by target addition.

Keywords: Parkinson's disease; deep brain stimulation; globus pallidus interna; rescue therapy; subthalamic nucleus.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the Shanghai Municipal Health Commission [grant Number 202140181 to DL], the Shanghai Science and Technology Commission [grant Number 22Y11903900 to DL], Ruijin Hospital Guangci Innovative Technology Launch Program [GCQH202205 to DL], and Shanghai Health and Family Planning Commission Youth Fund [grant Number 20204Y0066 to PH].