title: Bilateral subthalamic deep brain stimulation after bilateral pallidal deep brain stimulation for Parkinson's disease.
abstract: OBJECTIVE
  Globus pallidus internus (GPi) and subthalamic nucleus (STN) have successfully been targeted independently for deep brain stimulator (DBS) placement in medically intractable Parkinson's disease (PD). Bilateral implantation of STN DBS in a patient with preexisting, functioning GPi DBS to specifically treat motor fluctuations is, to our knowledge, yet unreported.
  
  
  METHODS
  We present a case of PD who had well-placed bilateral GPi DBS that controlled dyskinesia effectively and improved the motor symptoms like rigidity and akinesia. It did not improve her motor fluctuations and failed to reduce her medications.
  
  
  METHODS
  We implanted bilateral STN DBS, which improved her 'on' time, reduced her medications and improved her motor scores.
  
  
  CONCLUSIONS
  In this report we discuss the rationale, technical issues, programming nuances and outcome in a patient with preexisting bilateral GPi DBS who was implanted with bilateral STN DBS.
authors.affiliation: Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. deoganm@ccf.org
authors.forename: Milind
authors.initials: M
authors.lastname: Deogaonkar
authors.forename: Guillermo A
authors.initials: GA
authors.lastname: Monsalve
authors.forename: Jenera
authors.initials: J
authors.lastname: Scott
authors.forename: Anwar
authors.initials: A
authors.lastname: Ahmed
authors.forename: Ali
authors.initials: A
authors.lastname: Rezai
mesh_terms: D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D020820:Dyskinesias / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005917:Globus Pallidus / Q000473:pathology / Q000502:physiology*; D006801:Humans; D058542:Implantable Neurostimulators; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D010300:Parkinson Disease / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000473:pathology / Q000502:physiology*; D016896:Treatment Outcome