title: Rescue leads: a salvage technique for selected patients with a suboptimal response to standard DBS therapy.
abstract: OBJECTIVE
  We present four cases where supplementary "rescue" deep brain stimulation (DBS) leads were added for patients who failed to obtain anticipated clinical benefits.
  
  
  METHODS
  Nine patients out of 295 patients who underwent DBS between 2002 and 2009, were identified as rescue lead recipients. Of these nine cases, four cases were evaluated. Two had medication refractory tremor which was incompletely suppressed by Vim (nucleus ventralis intermedius) thalamic DBS, and supplemental rescue leads were implanted in either the VO (ventral oralis) thalamic nucleus or the STN (subthalamic nucleus). The remaining two cases were patients with severe dystonia who were initially treated with bilateral GPi (globus pallidus internus)-DBS, and following suboptimal clinical benefits, a second GPi rescue lead was added in a case, and bilateral STN rescue leads were added in the other case. Outcomes of scores collected included Fahn-Tolosa-Marin Tremor Rating Scale (TRS) for tremor cases and the Unified Dystonia Rating Scale (UDRS) for dystonia cases and the symptom specific patient global impression scales (PGIS; 7 point scale).
  
  
  RESULTS
  In the tremor cases, the TRS scale improved by 34.1 ± 7.4% and the PGIS following rescue lead was "minimally improved" to "very much improved" (range 1-2). In dystonia cases, the UDRS improved by 50.0 ± 23.6% and the PGIS was "minimally improved" to "very much improved" (range 1-2) after rescue lead surgery.
  
  
  CONCLUSIONS
  This small retrospective case series demonstrated that, in appropriately selected patients with suboptimal results of standard DBS therapy, the addition of rescue lead(s) may provide meaningful clinical benefit.
authors.affiliation: Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, FL 32610, USA.
authors.forename: Genko
authors.initials: G
authors.lastname: Oyama
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
authors.forename: Nelson
authors.initials: N
authors.lastname: Hwynn
authors.forename: Charles E
authors.initials: CE
authors.lastname: Jacobson
authors.forename: Irene A
authors.initials: IA
authors.lastname: Malaty
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Rodriguez
authors.forename: Pamela
authors.initials: P
authors.lastname: Zeilman
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D000293:Adolescent; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D003863:Depression / Q000628:therapy; D020821:Dystonic Disorders / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D014202:Tremor / Q000628:therapy*