オオヤマ　ゲンコウ   OYAMA Genko   大山　彦光    所属   埼玉医科大学  医学部 脳神経内科    職種   教授
論文種別	学術雑誌(原著)
言語種別	英語
査読の有無	査読あり
表題	Rescue leads: a salvage technique for selected patients with a suboptimal response to standard DBS therapy.
掲載誌名	正式名：Parkinsonism & related disorders
掲載区分	国外
巻・号・頁	17(6),451-5頁
著者・共著者	Genko Oyama,Kelly D Foote,Nelson Hwynn,Charles E Jacobson 4th,Irene A Malaty,Ramon L Rodriguez,Pamela Zeilman,Michael S Okun
発行年月	2011/07
概要	OBJECT: We present four cases where supplementary "rescue" deep brain stimulation (DBS) leads were added for patients who failed to obtain anticipated clinical benefits. METHODS: Nine patients out of 295 patients who underwent DBS between 2002 and 2009, were identified as rescue lead recipients. Of these nine cases, four cases were evaluated. Two had medication refractory tremor which was incompletely suppressed by Vim (nucleus ventralis intermedius) thalamic DBS, and supplemental rescue leads were implanted in either the VO (ventral oralis) thalamic nucleus or the STN (subthalamic nucleus). The remaining two cases were patients with severe dystonia who were initially treated with bilateral GPi (globus pallidus internus)-DBS, and following suboptimal clinical benefits, a second GPi rescue lead was added in a case, and bilateral STN rescue leads were added in the other case. Outcomes of scores collected included Fahn-Tolosa-Marin Tremor Rating Scale (TRS) for tremor cases and the Unified Dystonia Rating Scale (UDRS) for dystonia cases and the symptom specific patient global impression scales (PGIS; 7 point scale). RESULTS: In the tremor cases, the TRS scale improved by 34.1 ± 7.4% and the PGIS following rescue lead was "minimally improved" to "very much improved" (range 1-2). In dystonia cases, the UDRS improved by 50.0 ± 23.6% and the PGIS was "minimally improved" to "very much improved" (range 1-2) after rescue lead surgery. CONCLUSION: This small retrospective case series demonstrated that, in appropriately selected patients with suboptimal results of standard DBS therapy, the addition of rescue lead(s) may provide meaningful clinical benefit.
DOI	10.1016/j.parkreldis.2011.03.009
PMID	21482169