Sub-acute delayed failure of subthalamic DBS in Parkinson's disease: the role of micro-lesion effect.
OBJECTIVE
To study delayed failure after subthalamic nucleus (STN) deep brain stimulation in Parkinson's disease (PD) patients.


METHODS
Out of 56 consecutive bilaterally STN-implanted PD patients, we selected subjects who, after initial clinical improvement (1 month after surgery), lost benefit (delayed failure, DF).


RESULTS
Five patients developed sub-acutely severe gait disorders (DF). In 4/5 DF patients, a micro-lesion effect, defined as improvement without stimulation, was observed; immediate post-operative MRI demonstrated electrode located above or behind to the STN.


CONCLUSIONS
Patients presenting micro-lesion effect should be carefully monitored, as this phenomenon can mask electrodes misplacement and evolution in DF.
Department of Neurology, Centre Hospitalier, Universitaire Vaudois, CHUV, Rue du Bugnon, 46, 1011 Lausanne, Switzerland.
C
C
Granziera
C
C
Pollo
H
H
Russmann
C
C
Staedler
J
J
Ghika
J-G
JG
Villemure
P R
PR
Burkhard
F J G
FJ
Vingerhoets
D000203:Activities of Daily Living; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000150:complications; D006801:Humans; D018476:Hypokinesia / Q000150:complications; D008297:Male; D008839:Microelectrodes / Q000009:adverse effects*; D008875:Middle Aged; D010300:Parkinson Disease / Q000523:psychology / Q000628:therapy*; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000502:physiology*; D017211:Treatment Failure
D000978:Antiparkinson Agents