Secondary failure after ten years of pallidal neurostimulation in a patient with advanced Parkinson’s disease
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Deep-brain stimulation of the subthalamic nucleus and internal globus pallidus are both surgical options in advanced Parkinson’s disease. The best target is still debated with data suggesting better motor outcome in subthalamic stimulation but higher rates of psychiatric problems. Failure of pallidal stimulation within the first 2 years has been described. Here, we report a patient with good response to pallidal neurostimulation who developed a secondary failure after 10 years of treatment which was successfully reversed by reimplanting the electrodes into the subthalamic nucleus. This case suggests that a controlled comparison of treatment efficacy of pallidal and subthalamic neurostimulation may require a very long follow-up period to yield reliable results.
KeywordsDeep-brain stimulation Subthalamic nucleus Globus pallidus internus
The video depicts the medication ON/stimulation OFF state (0:00-0:15 min) and the medication ON/stimulation ON state (0:16-0:55 min) after 3 years of GPi stimulation, followed by the medication OFF/stimulation ON state (0:56-1:17 min) and medication ON/stimulation ON state (1:18-1:49 min) after 10 years of GPi stimulation and finally the medication OFF/stimulation ON state after 1 year of STN stimulation (1:50-2:25 min). (MPG 15,286 KB)