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.