{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:26:43Z","timestamp":1794014803352,"version":"4.8.0"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Randomized controlled trials have demonstrated that deep brain stimulation (DBS) of both the globus pallidus internus (GPI) and subthalamic nucleus (STN) for Parkinson\u2019s disease (PD) is superior to the best medical therapy. Tremor is particularly responsive to DBS, with reports of 70%\u201380% improvement. However, a small number of patients do not obtain the expected response with both STN and GPI targets. Indeed, the authors\u2019 patient population had a similar 81.2% tremor reduction with a 9.6% failure rate. In an analysis of these failures, they identified patients with preoperative on-medication tremor who subsequently received a GPI lead as a subpopulation at higher risk for inadequate tremor control. Thereafter, STN DBS was recommended for patients with on-medication tremor. However, for the patients with symptoms and comorbidities that favored GPI as the target, dual GPI and ventral intermediate nucleus of the thalamus (VIM) leads were proposed. This report details outcomes for those patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This is a retrospective review of patients with PD who met the criteria for and underwent simultaneous GPI+VIM DBS surgery from 2015 to 2020 and had available follow-up data. The preoperative Unified Parkinson\u2019s Disease Rating Scale scores were obtained with the study participants on and off their medication. Postoperatively, the GPI lead was kept on at baseline and scores were obtained with and without VIM stimulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Thirteen PD patients with significant residual preoperative tremor on medication underwent simultaneous GPI+VIM DBS surgery (11 unilateral, 2 bilateral). A mean 90.6% (SD 15.0%) reduction in tremor scores was achieved with dual GPI+VIM stimulation compared to a 21.8% (SD 71.9%) reduction with GPI stimulation alone and a 30.9% (SD 37.8%) reduction with medication. Although rigidity and bradykinesia reductions were accomplished with just GPI stimulation, 13 of the 15 hemispheres required VIM stimulation to achieve excellent tremor control.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>GPI+VIM stimulation was required to adequately control tremor in all but 2 patients in this series, substantiating the authors\u2019 hypothesis that, in their population, medication-resistant tremor does not completely respond to GPI stimulation. Dual stimulation of the GPI and VIM proved to be an effective option for the patients who had symptoms and comorbidities that favored GPI as a target and had medication-resistant tremor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2021.4.jns21502","type":"journal-article","created":{"date-parts":[[2021,10,15]],"date-time":"2021-10-15T04:46:41Z","timestamp":1634273201000},"page":"1364-1370","source":"Crossref","is-referenced-by-count":14,"title":["Utility of GPI+VIM dual-lead deep brain stimulation for Parkinson\u2019s disease patients with significant residual tremor on medication"],"prefix":"10.3171","volume":"136","author":[{"given":"Adel","family":"Azghadi","sequence":"first","affiliation":[{"name":"School of Medicine, Virginia Commonwealth University, Richmond;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan M.","family":"Rajagopal","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey A.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn L.","family":"Holloway","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Virginia Commonwealth University Health System, Richmond; and"},{"name":"Hunter Holmes McGuire VA Medical Center, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1001\/jama.2008.929","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,  Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. 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