Are two leads always better than one: an emerging case for unilateral subthalamic deep brain stimulation in Parkinson's disease.

Experimental Neurology
J L AlbertsMichael S Okun

Abstract

Bilateral subthalamic (STN) deep brain stimulation (DBS) provides significant symptom relief for the majority of well-screened patients suffering with Parkinson's disease (PD). Implantation of stimulating electrodes bilaterally in a single session has become standard in most operating theaters worldwide. There is, however, limited evidence-based support for this approach. Although bilateral surgical procedures have been shown, using standardized clinical ratings, to provide greater motor benefits compared to unilateral procedures, bilateral procedures are more likely to be associated with increased acute and long-term complications including post-operative confusion, speech difficulties and cognitive dysfunction. Unilateral stimulation has been shown to provide significant benefits for appendicular and axial symptoms. The relative benefit of implanting one versus two sides and whether the degree of benefit associated with the second side is worth the potential risk of doing so have not been examined systematically. The relative magnitude of benefit associated with unilateral versus bilateral procedures is likely to vary from patient to patient, particularly in those patients with asymmetric symptomatology. As such, there are li...Continue Reading

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Citations

Jan 24, 2012·Journal of the International Neuropsychological Society : JINS·Rickard L SjöbergPatric Blomstedt
Oct 19, 2012·The New England Journal of Medicine·Michael S Okun
Jan 1, 2010·Neuromodulation : Journal of the International Neuromodulation Society·Peter A Pahapill, Barbara O'Connell
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Nov 8, 2013·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Aparna Wagle Shukla, Michael Scott Okun
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Feb 5, 2011·Stereotactic and Functional Neurosurgery·Ludvic ZrinzoMarwan I Hariz
Dec 1, 2017·Surgical Neurology International·Karlo J LizarragaAlfonso Fasano
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Mar 10, 2011·Expert Review of Neurotherapeutics·Michael S Okun, Kelly D Foote
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Nov 13, 2013·Expert Review of Neurotherapeutics·Anna Castrioto, Elena Moro
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Jul 27, 2021·World Journal of Clinical Cases·Zhao-Sheng LiGuo-Hua Zhao

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