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The paper by Okun et al1 is an excellent report about “trouble-shooting” in a non-negligible number of movement disorders patients who are not happy with the results of their surgical therapy. The authors reviewed 41 consecutive patients implanted with deep brain stimulation (DBS) elsewhere and who complained of “poor outcomes from DBS surgery,” which brought them to the University of Florida and to Beth Israel Movement Disorder Centers over a 24-month period. The article details the reasons for therapy failure, with 46% of patients having suboptimally placed electrodes, a few with infection or a fractured lead, 77% inadequately programmed, and even some patients with a wrong diagnosis in the first place. Thanks to the authors’ various postoperative interventions, 51% of those “failed” patients eventually had eventually a good outcome and 15% had a modest clinical improvement.
There are several issues that need to be clarified with respect to the “failure” of DBS. At what point in time after their surgery were the patients evaluated by the authors? Among the 19 patients (46%) who had suboptimally placed electrodes, how many had their DBS electrodes implanted based on microelectrode recording? Additionally, it would be of interest to know, during the same period of 24 months, how many of the authors’ own patients, treated with DBS at their own centers, have also expressed or shown unsatisfactory results from DBS, including the reasons for it.
This leads us to the issue concerning the criteria used to consider that a patient has suboptimal results from DBS. The authors write, “An increasing number of patients come to experienced DBS centers after unsatisfactory results from DBS surgery.”
The unsatisfactory results from DBS surgery can be related to many issues as shown in the article, but one of the issues not discussed is the patient’s and family’s expectations from surgery. Because DBS is not a cure for Parkinson disease (PD) and because many patients still would experience more or less PD symptoms in the months and years following DBS, if the expectations from surgery have been too high (as is often advertised on the Web and elsewhere), then many patients will complain of suboptimal results. from DBS surgery. The authors are thus encouraged to clarify their criteria for “unsatisfactory results.”
Correspondence: Dr Hariz, Professor of Functional Neurosurgery, Institute of Neurology, Box 146, Queen Square, London WC1N 3BG, UK (m.hariz@ion.ucl.ac.uk).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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