Objective: To clarify the the clinical background of Parkinson’s disease patients with DBS who received multiple stimulus targets.

Background: Deep brain stimulation (DBS) is an established therapeutic option for the treatment of motor complications in advanced Parkinson’s disease. The target site of electrode implantation is determined by the target symptoms and patient background. In Parkinson’s disease, the subthalamic nucleus and globus pallidus are the main target of DBS. In this study, we investigated the clinical background of Parkinson’s disease patients who received multiple stimulus targets.

Method: One hundred and sixty patients with Parkinson’s disease who underwent DBS implantation at our institution from 2016 to 2021 were included in this study. Patients who underwent DBS therapy surgery followed by additional DBS implantation which were targeting other sites and patients who were determined to be stimulating multiple targets among the implanted DBS electrodes were included.

Results: Two patients received additional GPi-DBS after STN-DBS was performed. (STN-DBS at 55.0 years old, and GPi-DBS at 61.5 years old in average) In these cases, STN-DBS was effective in improving motor symptoms and suppressing tremor, but GPi-DBS was additionally performed due to the difficulty in management of dyskinesia. In three cases (STN-DBS at 61.5 years old in average) in which STN-DBS was performed using Boston Scientific 8-pole leads, stimulation of the dorsolateral part of the STN was used in addition to stimulation of the upper part of the lead. Stimulation of the dorsolateral STN contributed to improvement of motor symptoms, but dyskinesia control was insufficient, and the more upper stimulation points were used because they had a dyskinesia-suppressing effect. These stimulation points were thought to be associated with Pallidothalamic tracts (PTT).

Conclusion: Although STN-DBS was effective in improving motor symptoms, GPi-DBS was additionally used in patients with insufficient dyskinesia suppression. In addition, there was a case in which a widespan electrode was implanted and the stimulation point above the STN was used, and it was considered that the stimulation spread to the PTT in some cases, possibly suppressing dyskinesia. The widespan electrode may be able to cover multiple stimulation targets.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characteristics-of-cases-in-which-stimulation-was-programmed-for-multiple-targets-in-deep-brain-stimulation-therapy-for-parkinsons-disease/