I had one side redone in 2003 after my first DBS - about 2 months later.  My 
surgeon was not satisfied with the placement of the electrodes on my left 
side.   I didn't know anything was wrong.  I still don't know how I did it 
twice!!!

Ray

Rayilyn Brown
Director AZNPF
Arizona Chapter National Parkinson Foundation
[log in to unmask]

--------------------------------------------------
From: "John Cottingham" 
<[log in to unmask]>
Sent: Sunday, October 04, 2009 12:34 AM
To: <[log in to unmask]>
Subject: DBS Reoperation

> New neurosurgery teams sometime miss the target in DBS resulting in less 
> than expected outcomes. Over the years I have encountered several who had 
> their leads implanted in the wrong place to be effective.
>
> I had a MRI at the San Francisco Veterans Medical Center when I had my 
> end-of-life stimulator replaced. My leads hadn't moved from their target 
> in 8 years.
>
>
> Neurosurgery. 2008 Oct;63(4):754-60; discussion 760-1. 
> http://tinyurl.com/y8olcyd
>
> Reoperation for suboptimal outcomes after deep brain stimulation surgery.
>
> Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, 
> Jacobson CE 4th, Okun MS.
>
> Department of Neurology, Movement Disorders Center, University of Florida, 
> McKnight Brain Institute, Gainesville, Florida, USA.
>
> OBJECTIVE: To examine a case series of reoperations for deep brain 
> stimulation (DBS) leads in which clinical scenarios revealed suboptimal 
> outcome from a previous operation. Suboptimally placed DBS leads are one 
> potential reason for unsatisfactory results after surgery for Parkinson's 
> disease (PD), essential tremor (ET), or dystonia. In a previous study of 
> patients who experienced suboptimal results, 19 of 41 patients had 
> misplaced leads. Similarly, another report commented that lead placement 
> beyond a 2- to 3-mm window resulted in inadequate clinical benefit, and, 
> in 1 patient, revision improved outcome. The goal of the current study was 
> to perform an unblinded retrospective chart review of DBS patients with 
> unsatisfactory outcomes who presented for reoperation. METHODS: Patients 
> who had DBS lead replacements after reoperation were assessed with the use 
> of a retrospective review of an institutional review board-approved 
> movement disorders database. Cases of reoperation for suboptimal clinical 
> benefit were included, and cases of replacement of DBS leads caused by 
> infection or hardware malfunction were excluded. Data points studied 
> included age, disease duration, diagnosis, motor outcomes (the Unified 
> Parkinson Disease Rating Scale III in PD, the Tremor Rating Scale in ET, 
> and the Unified Dystonia Rating Scale in dystonia), quality of life 
> (Parkinson's Disease Questionnaire-39 in PD), and the Clinician Global 
> Impression scale. The data from before and after reoperation were examined 
> to determine the estimated impact of repeat surgery. RESULTS: There were 
> 11 patients with PD, 7 with ET, and 4 with dystonia. The average age of 
> the PD group was 52 years, the disease duration was 10 years, and the 
> average vector distance of the location of the active DBS contact was 
> adjusted 5.5 mm. Six patients (54%) with PD had preoperative off 
> medication on DBS Unified Parkinson Disease Rating Scale scores that could 
> be compared with postoperative off medication on DBS scores. The average 
> improvement across this group of patients was 24.4%. The Parkinson's 
> Disease Questionnaire-39 improved in the areas of mobility (28.18), 
> activities of daily living (14.77), emotion (14.72), stigma (17.61), and 
> discomfort (17.42). The average age of the ET group was 66 years, the 
> disease duration was 29 years, and the average adjusted distance was 6.1 
> mm. Five ET patients (83.3%) in the cohort had a prereplacement on DBS 
> Tremor Rating Scale and a postreplacement on DBS Tremor Rating Scale with 
> the average improvement of 60.4%. The average age of the dystonia group 
> was 39 years, the average disease duration was 7 years, and the average 
> adjusted lead distance was 6.7 mm. Three patients (75%) with dystonia had 
> prereplacement on DBS Unified Dystonia Rating Scale and postreplacement on 
> DBS Unified Dystonia Rating Scale scores. Across these 3 dystonia 
> patients, the improvement was 12.8%. Clinician Global Impression scale 
> scores (1, very much improved; 2, much improved; 3, minimally improved; 4, 
> no change; 5, minimally worse; 6, much worse; 7, very much worse) after 
> replacement revealed the following results in patients with PD: 1, 7 
> patients; 2, 3 patients; 3, 1 patient); with ET (1, 4 patients; 2, 3 
> patients); and with dystonia (1, 1 patient; 2, 2 patients; 3, 1 patient). 
> The latency from original lead placement to reoperation 
> (repositioning/revision) overall was 28.9 months (range, 2-104 mo); 
> however, in leads referred from outside institutions (n = 11 patients), 
> this latency was 48 months (range, 12-104 mo) compared with leads 
> implanted by surgeons from the University of Florida (n = 11 patients), 
> which was 9.7 months (range, 2-19 mo). The most common clinical history 
> was failure to achieve a perceived outcome; however, history of an 
> asymmetric benefit was present in 4 (18.2%) of 22 patients, and lead 
> migration was present in 3 (13.6%) of 22 patients. CONCLUSION: There are 
> many potential causes of suboptimal benefit after DBS. Timely 
> identification of suboptimal lead placements followed by reoperation and 
> repositioning/replacement in a subset of patients may improve outcomes.
>
> PMID: 18981887 [PubMed - indexed for MEDLINE]
>
> ----------------------------------------------------------------------
> To sign-off Parkinsn send a message to: 
> mailto:[log in to unmask]
> In the body of the message put: signoff parkinsn 

----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn