Objective: Evaluate clinical benefit and safety of unilateral rescue subthalamotomy, concerning motor symptoms in Parkinson’s disease (PD) patients, with partial or total deep brain stimulation (DBS) system removal.

Background: Ablative surgery of the subthalamic nucleus is effective to treat motor complications in PD patients, although irreversible [1-3]. Unilateral subthalamotomy using previously implanted electrodes of DBS surgery could be clinically beneficial when DBS devices need to be removed, making use of the good localization of implanted electrodes [1, 3, 4]. Data concerning this procedure are scarce, with only a few publications in the literature [1-9], and there are no guidelines for its execution.

Method: Transversal observational study, with additional retrospective analysis of clinical data. Patients were evaluated after subthalamotomy, in both OFF (med off/stim off or med off) and ON (med on/stim on or med on) conditions, depending on partial or total DBS system removal.

Results: Five patients were identified, ages 58-75 years-old, one deceased. Four patients were evaluated. DBS surgeries were performed between 2011-2015, and subthalamotomies between 2015-2017. In 4 patients, subthalamotomy was performed due to electrode infection before its removal, and in 1 patient for DBS wire rejection. Contralateral electrode is maintained in 2 patients. There were no subthalamotomy side-effects. Considering both patients without electrodes, pre-DBS UPDRS part III evaluation on OFF/ON conditions was 62/28 and 45/19, with post-subthalamotomy evaluation of OFF/ON conditions of 87/61 and 57/31, maintaining current improvements of 30% and 45.6% on med on, respectively. Regarding both patients with unilateral electrodes and subthalamotomy, pre-DBS evaluation on OFF/ON conditions was 55/33 and 63/23, with post-subthalamotomy evaluation on OFF/ON conditions of 33/18 and 67/52, maintaining current improvements of 57% and 22% on med on/stim on, accordingly.

Conclusion: All patients present positive differences between their current post-subthalamotomy OFF/ON evaluations, with differences of 22-57%. Unilateral subthalamotomy through previously implanted deep electrodes was safe. Confirming these data, this technique may constitute a useful and secure option when DBS systems have to be removed.

References: 1. Pérez-Suárez J, Díaz CVT, Manzanares LL, et al. Radiofrequency Lesions through Deep Brain Stimulation Electrodes in Movement Disorders: Case Report and Review of the Literature. Stereotact Funct Neurosurg 2017;95:137–141. 2. Anheim M, Dowsey-Limousin P, Krack P. Subthalamic stimulation or subthalamic lesion for Parkinson’s disease? A case report. Parkinsonism and Related Disorders 21 (2015) 1485-1487. 3. Nagy AM, Tolleson CM. Rescue Procedures after Suboptimal Deep Brain Stimulation Outcomes in Common Movement Disorders. Brain Sci. 2016, 6, 46; doi:10.3390/brainsci6040046. 4. Alvarez L, Macias R, Pavón N, et al. Therapeutic efficacy of unilateral subthalamotomy in Parkinson’s disease: results in 89 patients followed for up to 36 months. J Neurol Neurosurg Psychiatry 2009;80:979–985. 5. Rodriguez-Rojas R, Carballo-Barreda M, Alvarez L, et al. Subthalamotomy for Parkinson’s Disease: clinical outcome and topography of lesions. J Neurol Neurosurg Psychiatry 2018;89:572–578. 6. Oh MY, Hodaie M, Kim SH, et al. Deep brain stimulator electrodes used for lesioning: proof of principle. Neurosurgery 2001; 49: 363–367, discussion 367–369. 7. Raoul S, Faighel M, Rivier I, et al. Staged lesions through implanted deep brain stimulating electrodes: a new surgical procedure for treating tremor or dyskinesias. Mov Disord 2003; 18: 933–938. 8. Marras C, Zorzi G, Lenardi C, et al. Deep brain stimulation electrode used for radiofrequency lesion of the globus pallidus internus in dystonia. Stereotact Funct Neurosurg 2009; 87:348–352. 9. Deligny C, Drapier S, Verin M, et al. Bilateral subthalamotomy through DBS electrodes: a rescue option for device-related infection. Neurology 2009; 73: 1243–1244.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/case-series-of-unilateral-subthalamotomy-through-implanted-deep-electrodes-rescue-therapy-in-parkinsons-disease-patients-submitted-to-deep-brain-stimulation-surgery/