Globus Pallidus Stimulation to Mitigate Side Effects of Subthalamic Nucleus Stimulation
Nestor Beltre1, Gabriele Bellini1, Ilona Cazorla-Morales2, Alon Mogilner3, Michael Pourfar1
1NYU Langone Health, Department of Neurology, 2Department of Neurological Surgery, Hackensack Meridian School of Medicine, 3NYU Langone Health, Department of Neurosurgery
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.
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