title: Globus pallidus internus deep brain stimulation as rescue therapy for refractory dyskinesias following effective subthalamic nucleus stimulation.
abstract: BACKGROUND
  Deep brain stimulation (DBS) at the subthalamic nucleus (STN) or globus pallidus internus (GPi) can effectively treat the motor symptoms of Parkinson's disease, but dual implantation is rare. We report the first cases of additional GPi stimulation as rescue therapy for disabling dyskinesias following successful STN stimulation.
  
  
  METHODS
  Two patients, initially treated with bilateral STN DBS, underwent subsequent bilateral GPi DBS after the development of refractory dyskinesias within 1 and 6 years of STN surgery. Patients were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) before and after surgeries for STN and GPi DBS.
  
  
  RESULTS
  GPi DBS effectively suppressed dyskinesias in these patients and improved their quality of life, as demonstrated by their videos and UPDRS scores.
  
  
  CONCLUSIONS
  Additional bilateral GPi DBS may be considered in the rare instance of patients who develop refractory dyskinesias early or late after bilateral STN DBS.
authors.affiliation: Sydney DBS, North Shore Private Hospital, St. Leonards, N.S.W., Australia.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Jones
authors.forename: George
authors.initials: G
authors.lastname: Fracchia
authors.forename: Nathan
authors.initials: N
authors.lastname: Anderson
authors.forename: Jenny
authors.initials: J
authors.lastname: Miu
authors.forename: Linton J
authors.initials: LJ
authors.lastname: Meagher
authors.forename: Peter A
authors.initials: PA
authors.lastname: Silburn
authors.forename: Paul
authors.initials: P
authors.lastname: Silberstein
mesh_terms: D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D004351:Drug Resistance; D004567:Electrodes, Implanted; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D020734:Parkinsonian Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D016879:Salvage Therapy / Q000379:methods*; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
chemical_list: D000978:Antiparkinson Agents