Abstract Details

Title Role of Electrode Location in the Development of Cognitive Impairment Following Bilateral STN DBS Surgery

Topic Movement Disorders

Presentation(s) P06 - (-)

Poster/Presentation
Number 103

Objective

Background BACKGROUND: STN DBS is considered a safe procedure from a cognitive standpoint although rare cases of significant cognitive impairment have been reported.

Design/Methods DESIGN/METHODS: We describe two patients with PD who underwent image-guided DBS implantation. Patient 1 was a 67 year-old man with a 7 year history of PD and normal cognitive function. Patient 2 was a 57 year-old man with PD for 9 years with mild cognitive impairment and remote history of medication-induced hallucinations. Neuropsychiatric testing was conducted before and after surgery, with stimulation on and off. We utilized research imaging software Cicerone to determine electrode location based on the preoperative and postoperative MRI.

Results RESULTS: Both patients had good motor response to DBS but developed immediate cognitive impairment. Post-operative neuropsychiatric testing confirmed significant interval worsening in multiple domains consistent with dementia, and discontinuation of stimulation had no effect on cognition. Imaging and medical workup were unremarkable. Using Cicerone, electrode trajectory for both patients was observed to be through the frontal lobe, lateral ventricle, and caudate into the posteromedial border of bilateral STN. In Patient 1, electrode position was unintentionally deep in the caudal midbrain. Additionally, after one year the electrode tip had migrated more caudally towards the midbrain-pontine junction. In Patient 2, the electrode was at the expected depth, but the surgical procedure itself may have accelerated an underlying cognitive process.

Conclusions CONCLUSIONS: In two patients with different pre-surgical cognitive profiles, location of electrode placement in the posteromedial (limbic) STN and caudal midbrain may have contributed to persistent cognitive impairment. Electrode location and trajectory may play a role in post-DBS cognitive decline and deserve further study.

Authors/Disclosures
Svjetlana Miocinovic, MD, PhD (Emory University) PRESENTER	Dr. Miocinovic has nothing to disclose.
Justin T. Jordan, MD, MPH, FAAN (University of Texas Southwestern Medical Center)	Dr. Jordan has received personal compensation for serving as an employee of City of Beverly. An immediate family member of Dr. Jordan has received personal compensation for serving as an employee of Genesis HR Solutions. An immediate family member of Dr. Jordan has received personal compensation for serving as an employee of Children's Hospital. Dr. Jordan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Shepherd Therapeutics. Dr. Jordan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Jordan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Springworks Therapeutics. Dr. Jordan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AstraZeneca. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Continental Casualty Company. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for HennLesperance. Dr. Jordan has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Rhoades McKee. Dr. Jordan has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Wheeler Trigg O'Donnell. Dr. Jordan has or had stock in Navio Theragnostics. An immediate family member of Dr. Jordan has or had stock in OldGate.Dr. Jordan has or had stock in Shepherd Therapeutics.Dr. Jordan has or had stock in Khora TX. The institution of Dr. Jordan has received research support from NIH. The institution of Dr. Jordan has received research support from Department of Defense. The institution of Dr. Jordan has received research support from PCORI. Dr. Jordan has received publishing royalties from a publication relating to health care. Dr. Jordan has received publishing royalties from a publication relating to health care.
Rebecca E. Whiddon, MD (The Neuromedical Center Clinic)	No disclosure on file
Aanchal Taneja, MD (Texas Parkinson and Movement Disorders)	No disclosure on file
Marcela Fiol (FLENI)	Marcela Fiol has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for merck. The institution of Marcela Fiol has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for biogen. Marcela Fiol has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck. Marcela Fiol has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Biogen. Marcela Fiol has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Novartis. Marcela Fiol has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Teva. Marcela Fiol has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Roche.
	No disclosure on file
Pravin Khemani, MD, FAAN (Swedish Neuroscience Institute)	Dr. Khemani has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cala Trio. Dr. Khemani has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Khemani has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine.
Shilpa Chitnis, MD, PhD, FANA, FAAN (UT Tyler School of Medicine)	Dr. Chitnis has received publishing royalties from a publication relating to health care.

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