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.

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. Clinical scores including Unified Parkinson's Disease Rating Scale (UPDRS) and Clinical Rating Scale for Tremor (CRST) were taken from chart review of visits before and after surgery.