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December 2005

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

Arch Neurol. 2005;62(12):1938-1939. doi:10.1001/archneur.62.12.1938-b

In reply

We appreciate the insightful comments of Dr Hariz, 1 of the leaders in the field of stereotactic neurosurgery and a scrupulous observer of surgical outcomes and adverse effects. Additional information may further clarify our recent article on referred “DBS failures” in the ARCHIVES.1 Undoubtedly, the most important issue raised by Dr Hariz is what constitutes an unsatisfactory result. These criteria are difficult to strictly define, in part because of the syndromic nature of Parkinson disease. In fact, while objective success of DBS therapy has been classically measured in terms of Unified Parkinson’s Disease Rating Scale improvement and levodopa-equivalent reduction, the disabling role of Parkinson disease goes beyond motor impairment and medication adverse effects. This impairment includes features that are not considered a therapeutic target of DBS (eg, depression, sleep disturbance, dysarthria, autonomic dysfunction, and sensory symptoms). Paradoxically, a successful motor outcome could in some cases unmask problems that were not a priority to patients prior to surgery. The renewed physical abilities offered by DBS may thus inspire unrealistic goals that were not possible prior to surgery. (“I am doing great, doctor; what’s next?” asked 1 of our patients 3 months following successful DBS.)