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December 2005

What Is Deep Brain Stimulation “Failure” and How Do We Manage Our Own Failures?

Arch Neurol. 2005;62(12):1938. doi:10.1001/archneur.62.12.1938-a

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.