Objective: To describe patients with Parkinson’s disease (PD) who underwent a second deep brain stimulation (DBS) surgery with a different target as rescue therapy for refractory symptoms, and to perform a systematic review of the literature.

Background: DBS is a well-established treatment for advanced PD, most commonly targeting the subthalamic nucleus (STN) or the globus pallidus internus (GPi). However, a subset of patients experience persistent or recurrent symptoms despite optimal stimulation parameters and medical management. In selected cases, implantation of additional electrodes in an alternative target has been proposed as a rescue strategy.

Method: We conducted a retrospective study of PD patients who underwent rescue electrode implantation after prior DBS surgery at our center. In parallel, a systematic review of published cases describing DBS rescue procedures targeting a different nucleus was performed.

Results: Between 2023 and 2025, four rescue procedures involving implantation of additional electrodes were performed at our center in PD patients previously treated with DBS. Three patients with prior STN-DBS underwent implantation of a unilateral GPi electrode due to refractory unilateral symptoms (dyskinesia in 2/3 and dystonia in 2/3). In the fourth patient, initially treated with GPi-DBS, bilateral STN electrodes were implanted due to suboptimal symptom control. All patients showed clinical improvement following the second intervention.

In the literature review, 20 cases of GPi-DBS performed after prior STN-DBS were identified. Previous electrodes were preserved in 13 cases, and 75% of procedures were bilateral. The main indications for the second surgery were dyskinesia (15/20), dystonia (5/20), and other symptoms (3/20). Additionally, 22 cases of bilateral STN-DBS after GPi-DBS were identified, with preservation of the initial electrodes in 5/22 cases. The primary indication was insufficient or loss of efficacy of the initial stimulation.

Conclusion: Rescue DBS targeting a different anatomical nucleus is an uncommon but potentially effective strategy in selected PD patients with symptoms refractory to medical therapy and initial DBS surgery.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/rescue-electrode-implantation-after-deep-brain-stimulation-in-parkinsons-disease/