{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:45:18Z","timestamp":1792806318077,"version":"4.5.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Parkinson\u2019s disease (PD) is a progressive neurological movement disorder that is commonly treated with deep brain stimulation (DBS) surgery in advanced stages. The purpose of this study was to investigate factors that affect time to placement of a second-sided DBS lead for PD when a unilateral lead is initially placed for asymmetrical presentation. The decision whether to initially perform unilateral or bilateral DBS is largely based on physician and\/or patient preference.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This study was a retrospective cohort analysis of patients with PD undergoing initial unilateral DBS for asymmetrical disease between January 1999 and December 2017 at the authors\u2019 institution. Patients treated with DBS for essential tremor or other conditions were excluded. Variables collected included demographics at surgery, time since diagnosis, Unified Parkinson\u2019s Disease Rating Scale motor scores (UPDRS-III), patient-reported quality-of-life outcomes, side of operation, DBS target, intraoperative complications, and date of follow-up. Paired t-tests were used to assess mean changes in UPDRS-III. Cox proportional hazards analysis and the Kaplan-Meier method were used to determine factors associated with time to second lead insertion over 5 years.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The final cohort included 105 patients who underwent initial unilateral DBS for asymmetrical PD; 59% of patients had a second-sided lead placed within 5 years with a median time of 34 months. Factors found to be significantly associated with early second-sided DBS included patient age 65 years or younger, globus pallidus internus (GPi) target, and greater off-medication reduction in UPDRS-III score following initial surgery. Older age was also found to be associated with a smaller preoperative UPDRS-III levodopa responsiveness score and with a smaller preoperative to postoperative medication-off UPDRS-III change.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Younger patients, those undergoing GPi-targeted unilateral DBS, and patients who responded better to the initial DBS were more likely to undergo early second-sided lead placement. Therefore, these patients, and patients who are more responsive to medication preoperatively (as a proxy for DBS responsiveness), may benefit from consideration of initial bilateral DBS.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2019.12.jns19638","type":"journal-article","created":{"date-parts":[[2020,3,6]],"date-time":"2020-03-06T09:55:50Z","timestamp":1583488550000},"page":"386-392","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of second-sided deep brain stimulation for Parkinson\u2019s disease"],"prefix":"10.3171","volume":"134","author":[{"given":"Joshua L.","family":"Golubovsky","sequence":"first","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arbaz","family":"Momin","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianning","family":"Shao","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxwell Y.","family":"Lee","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo A.","family":"Frizon","sequence":"additional","affiliation":[{"name":"Center for Neurological Restoration, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Hogue","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Walter","sequence":"additional","affiliation":[{"name":"Center for Neurological Restoration, and"},{"name":"Departments of Neurology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 G.","family":"Machado","sequence":"additional","affiliation":[{"name":"Center for Neurological Restoration, and"},{"name":"Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean J.","family":"Nagel","sequence":"additional","affiliation":[{"name":"Center for Neurological Restoration, and"},{"name":"Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Lancet Neurol","first-page":"67","article-title":"Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson\u2019s disease","volume":"8","author":"Benabid AL","year":"2009","unstructured":"Benabid AL, Chabardes S, Mitrofanis J, Pollak P: Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson\u2019s disease. Lancet Neurol 8:67\u201381, 2009"},{"key":"b2","series-title":"Mov Disord","first-page":"99","article-title":"Quality of life outcome after subthalamic stimulation in Parkinson\u2019s disease depends on age","volume":"33","author":"Dafsari HS","year":"2018","unstructured":"Dafsari HS, Reker P, Stalinski L, Silverdale M, Rizos A, Ashkan K, : Quality of life outcome after subthalamic stimulation in Parkinson\u2019s disease depends on age. Mov Disord 33:99\u2013107, 2018"},{"key":"b3","series-title":"Lancet Neurol","first-page":"525","article-title":"Epidemiology of Parkinson\u2019s disease","volume":"5","author":"de Lau LM","year":"2006","unstructured":"de Lau LM, Breteler MM: Epidemiology of Parkinson\u2019s disease. Lancet Neurol 5:525\u2013535, 2006"},{"key":"b4","series-title":"Lancet Neurol","first-page":"429","article-title":"Treatment of motor and non-motor features of Parkinson\u2019s disease with deep brain stimulation","volume":"11","author":"Fasano A","year":"2012","unstructured":"Fasano A, Daniele A, Albanese A: Treatment of motor and non-motor features of Parkinson\u2019s disease with deep brain stimulation. Lancet Neurol 11:429\u2013442, 2012"},{"key":"b5","series-title":"N Engl J Med","first-page":"2077","article-title":"Pallidal versus subthalamic deep-brain stimulation for Parkinson\u2019s disease","volume":"362","author":"Follett KA","year":"2010","unstructured":"Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, : Pallidal versus subthalamic deep-brain stimulation for Parkinson\u2019s disease. N Engl J Med 362:2077\u20132091, 2010"},{"key":"b6","series-title":"Neurosurgery","first-page":"343","article-title":"Quality of life improvement following deep brain stimulation for Parkinson disease: development of a prognostic model","volume":"85","author":"Frizon LA","year":"2019","unstructured":"Frizon LA, Hogue O, Achey R, Floden DP, Nagel S, Machado AG, : Quality of life improvement following deep brain stimulation for Parkinson disease: development of a prognostic model. Neurosurgery 85:343\u2013349, 2019"},{"key":"b7","series-title":"Mov Disord","first-page":"1239","article-title":"Calibration of unified Parkinson\u2019s disease rating scale scores to Movement Disorder Society-unified Parkinson\u2019s disease rating scale scores","volume":"27","author":"Goetz CG","year":"2012","unstructured":"Goetz CG, Stebbins GT, Tilley BC: Calibration of unified Parkinson\u2019s disease rating scale scores to Movement Disorder Society-unified Parkinson\u2019s disease rating scale scores. Mov Disord 27:1239\u20131242, 2012"},{"key":"b8","series-title":"J Neurosurg","first-page":"807","article-title":"Comparison of elderly and young patient populations treated with deep brain stimulation for Parkinson\u2019s disease: long-term outcomes with up to 7 years of follow-up","volume":"131","author":"Hanna JA","year":"2019","unstructured":"Hanna JA, Scullen T, Kahn L, Mathkour M, Gouveia E, Garces J, : Comparison of elderly and young patient populations treated with deep brain stimulation for Parkinson\u2019s disease: long-term outcomes with up to 7 years of follow-up. J Neurosurg 131:807\u2013812, 2019"},{"key":"b9","series-title":"N Engl J Med","first-page":"1044","article-title":"Parkinson\u2019s disease. First of two parts","volume":"339","author":"Lang AE","year":"1998","unstructured":"Lang AE, Lozano AM: Parkinson\u2019s disease. First of two parts. N Engl J Med 339:1044\u20131053, 1998"},{"key":"b10","series-title":"J Neurol Sci","first-page":"14","article-title":"Motor asymmetry over time in Parkinson\u2019s disease","volume":"393","author":"Miller-Patterson C","year":"2018","unstructured":"Miller-Patterson C, Buesa R, McLaughlin N, Jones R, Akbar U, Friedman JH: Motor asymmetry over time in Parkinson\u2019s disease. J Neurol Sci 393:14\u201317, 2018"},{"key":"b11","series-title":"Lancet Neurol","first-page":"37","article-title":"Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson\u2019s disease (NSTAPS study): a randomised controlled trial","volume":"12","author":"Odekerken VJ","year":"2013","unstructured":"Odekerken VJ, van Laar T, Staal MJ, Mosch A, Hoffmann CF, Nijssen PC, : Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson\u2019s disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 12:37\u201344, 2013"},{"key":"b12","series-title":"Neuromodulation","first-page":"31","article-title":"Comparison of bilateral vs. staged unilateral deep brain stimulation (DBS) in Parkinson\u2019s disease in patients under 70 years of age","volume":"19","author":"Petraglia FWIII","year":"2016","unstructured":"Petraglia FWIII, Farber SH, Han JL, Verla T, Gallis J, Lokhnygina Y, : Comparison of bilateral vs. staged unilateral deep brain stimulation (DBS) in Parkinson\u2019s disease in patients under 70 years of age. Neuromodulation 19:31\u201337, 2016"},{"key":"b13","series-title":"JAMA Neurol","first-page":"367","article-title":"Globus pallidus interna or subthalamic nucleus deep brain stimulation for Parkinson disease: a review","volume":"75","author":"Ramirez-Zamora A","year":"2018","unstructured":"Ramirez-Zamora A, Ostrem JL: Globus pallidus interna or subthalamic nucleus deep brain stimulation for Parkinson disease: a review. 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J Neurosurg 113:1224\u20131229, 2010"},{"key":"b16","series-title":"Stereotact Funct Neurosurg","first-page":"119","article-title":"Deep brain stimulation for Parkinson\u2019s disease. A critical re-evaluation of STN versus GPi DBS","volume":"78","author":"Vitek JL","year":"2002","unstructured":"Vitek JL: Deep brain stimulation for Parkinson\u2019s disease. A critical re-evaluation of STN versus GPi DBS. Stereotact Funct Neurosurg 78:119\u2013131, 2002"},{"key":"b17","series-title":"JAMA","first-page":"63","article-title":"Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial","volume":"301","author":"Weaver FM","year":"2009","unstructured":"Weaver FM, Follett K, Stern M, Hur K, Harris C, Marks WJ Jr, : Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. 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