Objective: To examine the clinical benefits and side effects of bilateral STN-DBS after bilateral pallidotomy for Parkinson’s disease (PD).

Background: Pallidotomy can provide an effective treatment for severe cases of intractable PD. Interest in this treatment is growing because non-craniotomy invasive surgical techniques, such as MR-guided focused ultrasound, have become available that control lesion size percisely and consequent irreversible side effects. As compared with deep brain stimulation (DBS), pallidotomy is superior in terms of no risk for complications related to device implantation or electrical stimulation. However, despite its advantages, the clinical effectiveness of pallidotomy can decline with PD progression in some cases.

Method: Here we report a case who got bilateral STN-DBS after bilateral pallidotomy 18 years later. This 69-year-old male patient exhibited upper-limb tremor and camptocormia (more than 45° thoracolumbar flexion apparent when standing or walking). PD symptoms responded to bilateral pallidotomy. However, he gradually developed PD symptoms as tremor, rigidity, motor fluctuations, and freezing of gait as the disease progressed, which substantially impaired his quality of life. As a result, the patient sought follow-up treatment. In 2018, he underwent bilateral STN-DBS. After surgery, the acute STN DBS effects on the patient’s motor symptoms were evaluated.

Results: After STN DBS, the patient showed a 36%/44% improvement in motor symptoms (med off: 57 to 32, med on: 53 to 34, UPDRS-Ⅲ). Specifically, the patient displayed no tremor (med off: 9 to 0, med on: 5 to 0, UPDRS-Ⅲ) and showed improvements in axial symptoms (med off: 16 to 8, med on: 15 to 10, UPDRS-Ⅲ), bradykinesia (med off: 18 to 13, med on: 20 to 13, UPDRS-Ⅲ) and rigidity (med off: 14 to 11, med on: 13 to 11, UPDRS-Ⅲ). Moreover, patient’s speed of performance on the 3-meter Up-and-Go Test (TUG) was remarkably improved after surgery (med off: 480s to 30s, med on: 464s to 25s).

Conclusion: STN-DBS could be a viable option as a follow-up treatment for patients with PD who no longer benefit from pallidotomy. However, it remains to be determined whether the instant motor improvements seen with STN-DBS are sustained over an extended period.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/bilateral-stn-dbs-after-bilateral-pallidotomy-for-parkinsons-disease-a-case-report/