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.
Granziera
C
C
Department of Neurology, Centre Hospitalier, Universitaire Vaudois, CHUV, Rue du Bugnon, 46, 1011 Lausanne, Switzerland.
Pollo
C
C
Russmann
H
H
Staedler
C
C
Ghika
J
J
Villemure
J-G
JG
Burkhard
P R
PR
Vingerhoets
F J G
FJ
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