title: Bilateral subthalamic deep brain stimulation in a patient with Parkinson's disease who had previously undergone thalamotomy and autologous adrenal grafting in the caudate nucleus: case report.
abstract: OBJECTIVE
  Subthalamic (Stn) deep brain stimulation (DBS) is a valid surgical therapy for the treatment of severe Parkinson's disease. In recent years, StnDBS has been proposed for patients who previously received other surgical treatments, such as thalamotomy and pallidotomy. Nonetheless, there is no consensus about the indications of DBS in patients who previously underwent surgery. To the best of our knowledge this is the first reported case of a patient treated with DBS after previous thalamotomy and adrenal grafting.
  
  
  METHODS
  A 62-year-old man with a long history (more than 30 yr) of Parkinson's disease received unilateral thalamotomy and autologous adrenal graft on two independent occasions. Thalamotomy led to a significant improvement, although limited to the control of contralateral tremor. The autologous adrenal graft was of no benefit. For the subsequent occurrence of L-dopa related dyskinesias and severe "off" periods, the patient was referred to our center for StnDBS.
  
  
  METHODS
  The patient underwent bilateral StnDBS, obtaining a satisfactory improvement of rigidity and bradykinesia on both sides. The 1-year follow-up evaluation showed a 46% improvement in the Unified Parkinson's Disease Rating Scale motor section, along with a noticeable reduction in antiparkinsonian therapy (81%).
  
  
  CONCLUSIONS
  This case is consistent with previous reports from the literature, suggesting that StnDBS is feasible and safe, even in patients who previously received other surgical treatments for Parkinson's disease, such as thalamotomy or cell grafting.
authors.affiliation: Department of Neurosciences and Biomedical Technology, University of Milano-Bicocca, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vergani
authors.forename: Andrea
authors.initials: A
authors.lastname: Landi
authors.forename: Angelo
authors.initials: A
authors.lastname: Antonini
authors.forename: Erik P
authors.initials: EP
authors.lastname: Sganzerla
mesh_terms: D000311:Adrenal Glands / Q000637:transplantation; D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000601:surgery / Q000628:therapy*; D013788:Thalamus / Q000601:surgery; D017211:Treatment Failure; D016896:Treatment Outcome