Objective: We aim to present our institution’s experience with simultaneous dual STN-GPi implantation in Parkinson’s disease (PD) by analyzing a case series of 3 patients. This study seeks to provide insights regarding patient selection, optimal programming strategies, and outcomes.

Background: Both STN and GPi are currently used as DBS targets in PD, and both show benefit in bradykinesia, rigidity, tremor, and quality of life. GPi DBS is often preferred for patients with bothersome dyskinesias or cognitive concerns. Target selection should be individualized based on symptom profile, medication response, and patient-specific risks. While staged dual targeting has been used as PD progresses, simultaneous early dual targeting is an emerging approach without established guidelines.

Method: We evaluated 3 PD patients with dual bilateral STN and GPi DBS implants who are currently receiving care at our movement disorders clinic. Our analysis focused on 1) Candidacy Criteria 2) Initial Programming Strategies and 3) Clinical Outcomes and Challenges.

Results: This cohort consisted of young-onset PD patients who underwent DBS implantation within 4–6 years after their initial symptoms. Candidacy was primarily driven by their young age at onset, the anticipation of long-term complications requiring additional stimulation sites, and the presence of significant dystonia or dyskinesia. GPi was programmed initially, with all four leads activated shortly after. Although each target effectively managed dystonia, rigidity, and bradykinesia, GPi was specifically effective for dyskinesia and provided significant dystonia relief. One developed dysarthria, another experienced freezing of gait, and the third, with GPi-dominant stimulation, reported difficulty with complex motor sequences, possibly due to overstimulation.

Conclusion: In this limited case series, GPi stimulation effectively controlled dystonia and dyskinesia beyond what STN alone achieved. A potential adverse effect of GPi-dominant stimulation was impaired complex motor sequencing, likely related to overstimulation and disrupted sensory-motor integration. Long-term outcomes remain to be determined, as these patients were implanted within the past year. Advances in lead design, may further optimize dual-targeting approaches. Furthermore, the challenges of adaptive DBS across four sites highlight the need for further clinical and electrophysiological studies.

References: References
Mazzone P, Brown P, Dilazzaro V, Stanzione P, Oliviero A, Peppe A, Santilli V, Insola A, Altibrandi M. Bilateral implantation in globus pallidus internus and in subthalamic nucleus in Parkinson’s disease. Neuromodulation. 2005 Jan;8(1):1-6. doi: 10.1111/j.1094-7159.2005.05214.x. PMID: 22151377.
Matias CM, Silva D, Machado AG, Cooper SE. “Rescue” of bilateral subthalamic stimulation by bilateral pallidal stimulation: case report. J Neurosurg. 2016 Feb;124(2):417-21. doi: 10.3171/2015.1.JNS141604. Epub 2015 Jul 31. PMID: 26230477.
Ramirez-Zamora A, Ostrem JL. Globus Pallidus Interna or Subthalamic Nucleus Deep Brain Stimulation for Parkinson Disease: A Review. JAMA Neurol. 2018 Mar 1;75(3):367-372. doi: 10.1001/jamaneurol.2017.4321. PMID: 29356826.
Mitchell KT, Schmidt SL, Cooney JW, Grill WM, Peters J, Rahimpour S, Lee HJ, Jung SH, Mantri S, Scott B, Lad SP, Turner DA. Initial Clinical Outcome With Bilateral, Dual-Target Deep Brain Stimulation Trial in Parkinson Disease Using Summit RC + S. Neurosurgery. 2022 Jul 1;91(1):132-138. doi: 10.1227/neu.0000000000001957. Epub 2022 Apr 7. PMID: 35383660; PMCID: PMC9514741.
Schmidt SL, Chowdhury AH, Mitchell KT, Peters JJ, Gao Q, Lee HJ, Genty K, Chow SC, Grill WM, Pajic M, Turner DA. At home adaptive dual target deep brain stimulation in Parkinson’s disease with proportional control. Brain. 2024 Mar 1;147(3):911-922. doi: 10.1093/brain/awad429. PMID: 38128546; PMCID: PMC10907084.
Cummins DD, Sandoval-Pistorius SS, Cernera S, Fernandez-Gajardo R, Hammer LH, Starr PA. Physiological effects of dual target DBS in an individual with Parkinson’s disease and a sensing-enabled pulse generator. Parkinsonism Relat Disord. 2024 May;122:106089. doi: 10.1016/j.parkreldis.2024.106089. Epub 2024 Mar 6. PMID: 38460490.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dbs-programming-in-early-simultaneous-stn-gpi-implantation-for-young-onset-parkinsons-a-mini-case-series/