Abstract Details

Title Globus Pallidus Stimulation to Mitigate Side Effects of Subthalamic Nucleus Stimulation

Topic Movement Disorders

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-028

Objective To evaluate outcomes of Parkinson’s patients who received pallidal rather than subthalamic deep brain stimulation.

Background

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) are common therapeutic strategies for Parkinson’s disease (PD) with reported similar efficacy in large, randomized trials. Both targets have been shown to effectively reduce levodopa-induced dyskinesia and motor fluctuations, with STN as the preferred target due to its greater potential to reduce dopaminergic therapy. However, STN-DBS has been associated with neuropsychiatric complications including suicide. There have been suggestions that GPi-DBS may be superior for dystonia or dyskinesias. Our center has selected GPi as the target for certain patients based on specific features. This review explores whether pallidal stimulation addressed these pre-determined factors.

Design/Methods

In this retrospective study, we reviewed cases of PD patients from 2014 - 2024 who received GPi-DBS at NYU. Factors that predisposed GPi selections included: prominent dyskinesia, dystonia, neuropsychiatric symptoms, or a combination of the above. Changes in these symptoms were tabulated as either worsened, no change, partial response, or improved. Chi-squared analysis with p < 0.05 was performed.

Results

47 out of 361 PD patients who received DBS between 2014-2024 received GPI-DBS, with indication being dyskinesias for 26 (55%), dystonia for 7 (15%), neuropsychiatric concerns for 7 (15%), or a combination of these factors for 7 (15%). 34 (72%) improved, 7 (15%) had partial response, 4 had no improvement (4%), and 2 were clinically worse (2%) regarding the pre-determined symptom. Patients with dyskinesia, dystonia, and combination had the best improvement (25/26) while patients with neuropsychiatric concerns had inconsistent responses (3/6 improved) with p = 0.02.

Conclusions

Our study suggests that patients with PD who were pre-selected for GPI-DBS for dyskinesias or dystonia had a high rate of successful responses whereas patients selected for neuropsychiatric concerns had variable outcomes after stimulation.

Authors/Disclosures
Michael Pourfar, MD (NYU) PRESENTER	Dr. Pourfar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Pourfar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott.
Nestor Beltre, MD	Dr. Beltre has nothing to disclose.
Gabriele Bellini, MD	Dr. Bellini has nothing to disclose.
Ilona Cazorla-Morales, Student	Miss Cazorla-Morales has nothing to disclose.
Alon Mogilner, MD, PhD	Dr. Mogilner has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for medtronic.

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