Objective: The goal of this paper is to compare the time required to achieve the maximum possible quality of life (i.e. number of programming visits), cognitive functions, and surgical risks (i.e. tissue damage) when patients undergo a stepwise unilateral or bilateral approach.

Background: Deep Brain stimulation (DBS), which is a well established alternative treatment for patients with Parkinson’s disease (PD), has been used to treat medically refractory tremors in PD patients since 1996. Depending on the severity of disease, age, cognitive status, and absence or presence of bilateral PD tremors, stimulation may vary: stepwise unilateral and simultaneous bilateral electrode placement. The stepwise unilateral option is typically chosen for older individuals with neurocognitive concerns on preoperative screening. Staging is considered in order to minimize loss of cognitive function and for those with lateralizing tremor. Conversely, younger, more cognitively robust patients who have bilateral PD tremors choose the bilateral stimulation option.

Method: Twelve patients with Parkinson’s Disease (PD) that had stepwise unilateral stimulation (Group 1) were matched with twelve patients with PD that had bilateral stimulation (Group 2) according to similar surgical year, demographics, PD diagnosis year, and Unified Parkinson’s Disease Rating Scales (UPDRS). All patients completed their surgical procedure and treatment for PD at Virginia Mason Medical Center by the same neurosurgeon and two neurologists from 2007 until 2021. The subjective patient assessments done by the neurologists were taken into consideration and accounted for using subjective assessment tools. The mean age for Group 1 (69 years old) was matched to the mean age for Group 2 having 48 – 84 age range.

Results: In comparison to patients who underwent stepwise unilateral electrode insertion, patients who underwent simultaneous bilateral DBS are expected to demonstrate fewer programming visits and reduced tissue damage to reach a similar cognitive status and motor skills.

Conclusion:

​​​​​​This study is expected to reveal that patients will comparatively benefit from bilateral stimulation options by reducing hospital visits while increasing health outcomes. Furthermore, the efficiency of healthcare professionals as well as resources could be maximized.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comparative-analysis-of-stepwise-unilateral-and-simultaneous-bilateral-deep-brain-stimulator-electrode-placement-for-parkinosns-disease/