Data from: Clinical scores before and after multi-nodal DBS

Background Mixed and complex movement disorders represent significant challenges for surgical treatment. These disease states are likely the result of combined or complex network pathologies affecting multiple pathways1-4. Until recently, attempts to treat complex movement disorders with deep brain stimulation (DBS) have primarily focused on stimulating a single deep target to address patients’ most severe symptoms5-14. However, a multi-nodal targeting approach for DBS by simultaneously stimulating more than one pair of homologous nuclei could be a more effective treatment strategy. Here, we present the technique and initial case series of utilizing multi-nodal stimulation for mixed and complex movement disorders. Methods An initial cohort of fifteen mixed and complex movement disorder patients presenting to Stanford University underwent a multi-nodal stimulation approach. In these patients, the multiple (i.e. > 2) simultaneous deep targets were implanted through only 2 burr holes and connected to a single 32-channel pulse generator. Results There were no intra- or post-operative complications. With the addition of multi-nodal stimulation, complex PD patients demonstrated a significant reduction in Unified Parkinson’s Disease Rating Scale (p = 0.0039) and complex tremor patients demonstrated a significant reduction in Clinical Rating Scale for Tremor (p = 0.0312). Conclusion We present the largest initial case series demonstrating the safety, feasibility, and added efficacy of single system multi-nodal DBS for treating mixed and complex movement disorders. This approach is safe, provides additional benefit, and warrants further investigation for treating mixed and complex movement disorders.