Abstract Details

Title Single Trajectory Dual Targeting of Subthalamic Nucleus and Ventral Intermedius Thalamic Nucleus in Patients with Severe Tremor-Predominant Parkinson's Disease

Topic Movement Disorders

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-001

Objective To describe clinical outcomes of severe tremor-predominant Parkinson's Disease (PD) patients who underwent single trajectory dual targeting of the subthalamic nucleus (STN) and ventral intermedius nucleus of the thalamus (VIM).

Background Some patients with tremor-predominant PD have a sub-optimal response to STN-DBS, whereas those that undergo VIM-DBS may have inadequate improvement of rigidity or bradykinesia. Reports on the efficacy and safety of dual target STN-VIM DBS using single trajectory are scarce.

Design/Methods We retrospectively reviewed the charts of all PD patients who underwent dual target STN-VIM DBS from 2012-2022 in one center. All patients were implanted bilaterally with the Boston Scientific 8-contact 15.5mm electrodes under general anesthesia using the parietal approach. Primary outcome measure was reduction in motor Unified Parkinson’s Disease Rating Scale (m-UPDRS). Secondary outcome measures include change in levodopa equivalent daily dose (LEDD) post-DBS, and time to reaching the minimum LEDD post-DBS.

Results 12 patients (7 men) were identified. Mean age at time of surgery was 71.58±5.21 years. Mean duration of PD was 28.50±14.84 years. Mean m-UPDRS was 30.83±34.15 preDBS and 14.91±18.26 post-DBS (p<0.00000006). Mean % reduction in m-UPDRS was 50.94±0.08 %. Mean pre-DBS LEDD was 792.85±458.64, whereas post-DBS LEDD was 14.28±37.79 (p= 0.004). 7/12 were on PD medications pre-DBS: 6/7 completely weaned off medications post-DBS, and 1/7 had 89% reduction in LEDD post-DBS. The mean time to reach minimum LEDD was 33±22.87 days. Transient side effects included dysarthria (4/12), imbalance (4/12), and headaches (2/12) which improved spontaneously. 2/12 had persistent headaches which were effectively controlled with opiates. 8/12 had neuropsychological testing (NPT) pre- and post-DBS: 4/8 had no change post-DBS, 2/8 had mild worsening and 2/8 had improvement.

Conclusions Dual target STN-VIM DBS is very effective in treating tremor/parkinsonism in tremor-predominant PD, allowing the majority of patients to wean off PD medications. Side effects are mostly transient.

Authors/Disclosures
Virgilio Gerald H. Evidente, MD, FAAN (Movement Disorders Center of Arizona) PRESENTER	Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Revance. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Evidente has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Teva. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Medtronic. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amneal. Dr. Evidente has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Evidente has received research support from CND. The institution of Dr. Evidente has received research support from Aeon. The institution of Dr. Evidente has received research support from Bukwang Pharmaceuticals. The institution of Dr. Evidente has received research support from Jazz Pharmaceuticals. The institution of Dr. Evidente has received research support from Scion Neurostim. The institution of Dr. Evidente has received research support from Theravance Biopharma. Dr. Evidente has received research support from Cerevance. Dr. Evidente has received research support from Ipsen.
Francisco Ponce (Barrow Neurological Institute)	No disclosure on file
Danica Evidente	Danica Evidente has nothing to disclose.
	No disclosure on file
	No disclosure on file

��ɫ��

��ɫ��