Bilateral Pallidotomy by Using Deep Brain Stimulation Electrode in Parkinson's Disease

Deep brain stimulation (DBS) is a safe and effective treatment in alleviating motor symptoms and complications in advanced Parkinson’s disease (PD). However, in some patients, the DBS system may need to be removed due to recurrent hardware infection. Here we report a case of a patient who had frequent internal pulse generator (IPG) site infections and eventually underwent bilaterally pallidotomy using previously implanted globus pallidus interna (GPi) DBS electrodes. A 57-yearold woman with advanced PD and was implanted bilateral subthalamic nucleus (STN) DBS. 18 months after she suffered from new onset loss of postural reflexes and frequent falls that were directly related with STN stimulation. Therefore, the STN electrodes were swithched to GPiand one year after switching to GPi DBS, she developed severe infection and skin erosion over the DBS hardware. The hardware had to be removed due to recurrent infections and before explanting the electrodes, bilateral pallidotomy with radiofrequency was performed by using the existing DBS electrodes. Two years after the bilateral posteroventral pallidotomy, the patient had good and stable control of PD. To our knowledge, this is the first case report where existing DBS electrodes were used for bilateral pallidotomy by RF. This technique is safe and efficient, but further studies and large series are needed to confirm its long-term benefits.