DBS lead placement options.

[jeeves19]

Morning all. I had a zoom meeting with my neurosurgeon the other day. I’m pretty sure that she stated she was going for the STN as the site for leads. In my typical blokey way I just nodded along accepted whatever she said. But reading up on lead placing, I’m getting the distinct impression that for a PWP with no tremor but a never ending supply of bradykinesia, rigidity and dystonia, the GPi is the place.

I’m going to return to discuss this on Monday and would like some views from the community before I have this discussion.

[MBAnderson]

Well, that's a little scary.

I cannot offer an opinion on lead placement, but I do suggest you make her explain her decision to your satisfaction – because if she is wrong, you don’t get the full benefit of the DBS and not likely a 2nd chance.

Good luck.

[Bunny622023]

Hi Jeeves, placement is definitely so important. Our neuro decided on GPI for my husband because of presentation of symptoms at the time, and also GPI was kinder on cognitive. His symptoms are similar to yours. No tremor, dyskinesias but he had mild cognitive from a med (Requip) that she actually took him off once she realised the disturbing effects it had had. She didn't recommend it, it was a diff Neuro years earlier. So yesiree, definitely would be asking why they chose STN over GPI. Physically, GPI is a bigger target but that can make it harder to get lead placement totally correct - but with guided MRI which they use, there was no issue for my husband.

STN allows potentially greater medication reduction. GPI not so much reduction in meds. We found that true. There was reduction for a while but then there was the need through normal progression of the disease to up it again - but the meds have stayed stable for many years now. Also he has always been on higher stimulation, but again depends on which program on the contacts he is using.

Absolutely necessary to have a good programmer - ACTUALLY - not good, but GREAT programmer to get the best out of your settings and necessary changes to get optimum benefit. Hope that helps.

[Bunny622023]

This is only one article, but I have found it very interesting the comparisons and summation from half way down the page.

journals.plos.org/plosone/a...

[jeeves19]

Thanks for this Jules. I very much appreciate you taking the time to research this and then write your thoughts down. 👍😊