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Vol. 89, No. 2, 2011
Issue release date: April 2011
Stereotact Funct Neurosurg 2011;89:123–127

Bilateral Subthalamic Deep Brain Stimulation after Bilateral Pallidal Deep Brain Stimulation for Parkinson’s Disease

Deogaonkar M. · Monsalve G.A. · Scott J. · Ahmed A. · Rezai A.
aCenter for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, and bDepartment of Neurosurgery, The Ohio State University, Columbus, Ohio, USA

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Background/Objective: Globus pallidus internus (GPi) and subthalamic nucleus (STN) have successfully been targeted independently for deep brain stimulator (DBS) placement in medically intractable Parkinson’s disease (PD). Bilateral implantation of STN DBS in a patient with preexisting, functioning GPi DBS to specifically treat motor fluctuations is, to our knowledge, yet unreported. Clinical Presentation: We present a case of PD who had well-placed bilateral GPi DBS that controlled dyskinesia effectively and improved the motor symptoms like rigidity and akinesia. It did not improve her motor fluctuations and failed to reduce her medications. Methods: We implanted bilateral STN DBS, which improved her ‘on’ time, reduced her medications and improved her motor scores. Results/Conclusion: In this report we discuss the rationale, technical issues, programming nuances and outcome in a patient with preexisting bilateral GPi DBS who was implanted with bilateral STN DBS.

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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