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