Restless legs syndrome and polyneuropathy

✍ Scribed by Franco Gemignani; Francesca Brindani; Anna Negrotti; Francesca Vitetta; Sara Alfieri; Adriana Marbini

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 63 KB
• Volume: 21
• Category: Article
• ISSN: 0885-3185
• DOI: 10.1002/mds.20928

✦ Synopsis

of a levodopa-nonresponsive PD patient who failed to improve after pallidotomy also failed to improve after DBS STN. 10 Our patients were all levodopa-responsive and, aside from a single patient, improved after their pallidotomy.

There are several reasons why postpallidotomy STN DBS may result in less robust motor improvement. First, there is an obvious referral bias toward patients who were not satisfied after their pallidotomy, either for objective or subjective reasons. This may represent a more aggressive disease process or more atypical course. The pre-and postpallidotomy off drug UPDRS scores, however, were similar in this group of pallidotomy DBS patients compared to our pallidotomy population in general (n ϭ 89). 1 Dyskinesia scores were also similar. Second, electrophysiological recordings, on which we greatly rely for placement, can be altered in the STN following GPi ablation, possibly resulting in suboptimal placement. 11 Random suboptimal placement is possible in either group. Third, there could be redundant physiological effects that would mitigate against subsequent improvement after the second procedure. A single study that simultaneously implanted GPi and STN DBS found that combined stimulation was no more effective than STN stimulation alone. 12 Fourth, we present a relatively small number of patients and the results could be different with a larger sample.

Overall, the small corpus of literature on the efficacy and safety of postpallidotomy STN DBS is mixed. We recommend prudence when considering DBS in this population.