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Adel Azghadi, Megan M. Rajagopal, Kelsey A. Atkinson, and Kathryn L. Holloway

motor symptoms in both early and advanced PD. 6 Patients report severe embarrassment and social anxiety and complain of the deleterious effects that tremor has on performing their daily tasks. 7 , 8 Thus, in order for surgery to be considered successful, it must address this critical symptom. Parkinsonian tremor reduction can be achieved by stimulation of all three classic movement disorder target nuclei: ventral intermediate nucleus of the thalamus (VIM), globus pallidus internus (GPI), and subthalamic nucleus (STN). In current practice, the VIM is primarily

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Katherine Leaver, Aaron Viser, Brian H. Kopell, Roberto A. Ortega, Joan Miravite, Michael S. Okun, Sonya Elango, Deborah Raymond, Susan B. Bressman, Rachel Saunders-Pullman, and Marta San Luciano

(STN) and the internal segment of the globus pallidus (GPi). Both targets have been shown to be safe and effective in IPD, 12 although there is a paucity of target-specific information, especially as it relates to genotype. 13 The objectives of the current study were to compare baseline clinical characteristics driving decisions to pursue DBS among G2019S LRRK2-PD. We also aimed to compare longitudinal motor and medication DBS outcomes between LRRK2-PD and IPD and to gather preliminary information about target-specific differences. Methods Participants

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Takashi Tsuboi, Janine Lemos Melo Lobo Jofili Lopes, Kathryn Moore, Bhavana Patel, Joseph Legacy, Adrianna M. Ratajska, Dawn Bowers, Robert S. Eisinger, Leonardo Almeida, Kelly D. Foote, Michael S. Okun, and Adolfo Ramirez-Zamora

D eep brain stimulation (DBS) targeting the globus pallidus internus (GPi) and subthalamic nucleus (STN) provides similar benefits for motor symptoms and health-related quality of life (HRQoL) in Parkinson’s disease (PD) patients with medically refractory motor fluctuations. 1 In large randomized trials, bilateral GPi DBS significantly improved activities of daily living (ADLs) and dyskinesia as well as motor symptoms in the off-medication state when measured at different follow-up intervals following DBS implantation (1–3 years). 2 , 3

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Takashi Tsuboi, Janine Lemos Melo Lobo Jofili Lopes, Kathryn Moore, Bhavana Patel, Joseph Legacy, Adrianna M. Ratajska, Dawn Bowers, Robert S. Eisinger, Leonardo Almeida, Kelly D. Foote, Michael S. Okun, and Adolfo Ramirez-Zamora

D eep brain stimulation (DBS) targeting the globus pallidus internus (GPi) and subthalamic nucleus (STN) provides similar benefits for motor symptoms and health-related quality of life (HRQoL) in Parkinson’s disease (PD) patients with medically refractory motor fluctuations. 1 In large randomized trials, bilateral GPi DBS significantly improved activities of daily living (ADLs) and dyskinesia as well as motor symptoms in the off-medication state when measured at different follow-up intervals following DBS implantation (1–3 years). 2 , 3 Additionally, one of

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Wei Liu and Jian-Guo Zhang

TO THE EDITOR: In their case report, Liu et al. 1 reported on a woman with urinary incontinence following deep brain stimulation of the globus pallidus internus (GPi) ( Liu FT, Lang LQ, Zhou RY, et al: Urinary incontinence following deep brain stimulation of the globus pallidus internus: case report. J Neurosurg [epub ahead of print February 22, 2019. DOI: 10.3171/2018.11.JNS181513] ). In this report, the authors suggested that the urinary incontinence was induced by fibers projecting from the cortex to pontine micturition centers. Although this hypothesis is

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Antonella Peppe, Mariangela Pierantozzi, Andrea Bassi, Maria Grazia Altibrandi, Livia Brusa, Alessandro Stefani, Paolo Stanzione, and Paolo Mazzone

D eep brain stimulation of both the STN and the GPi is reported to be effective in patients with advanced PD. Since the DBS method has been used in PD, the effect of this stimulation in the STN compared with DBS of the GPi has only been compared in relatively small numbers of patients. When differences in presurgical clinical status related to disease expression are considered as well as the variability of DBS effects in patients, 10, 11, 24 it is clear that a small number of individuals may severely bias study results. 2 Therefore, in this study we set out

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Suzhen Lin, Yiwen Wu, Hongxia Li, Chencheng Zhang, Tao Wang, Yixin Pan, Lu He, Ruinan Shen, Zhengdao Deng, Bomin Sun, Jianqing Ding, and Dianyou Li

isolated dystonia involves dysfunction of the corticostriato-thalamocortical circuits. 13 Deep brain stimulation (DBS) is a minimally invasive procedure that has been recognized worldwide for the medical treatment of refractory dystonia. 7 Currently, the globus pallidus internus (GPi) and subthalamic nucleus (STN) are both viable therapeutic targets. Recent studies have demonstrated that bilateral stimulation of either the GPi 25 or the STN 7 , 11 , 29 is effective and safe in improving clinical symptoms and quality of life for patients with dystonia. To our knowledge

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Xavier Vasques, Laura Cif, Olivier Hess, Sophie Gavarini, Gerard Mennessier, and Philippe Coubes

D eep brain stimulation of the GPi is now a commonly used and effective treatment for primary DDSs. 5–7 , 12 , 14 A wide range of factors can influence the outcome of DBS including clinical, anatomical, surgical, and electrical variables. To give prominence to one of these factors, we decided to compare the actual GPi volumes as well as stimulated GPi volumes between highly and less improved patients with primary DDS. The stimulated GPi volume is quantified by calculating each electric field value generated by the DBS lead. The stereotactic protocol

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Lisbeth Schjerling, Lena E. Hjermind, Bo Jespersen, Flemming F. Madsen, Jannick Brennum, Steen R. Jensen, Annemette Løkkegaard, and Merete Karlsborg

treatment for Parkinson's disease (PD), deep brain stimulation (DBS) has become an effective alternative or supplement to medical treatment of dystonia. 6 , 16–20 , 23 , 24 , 28 , 30 , 31 It is based on implantation of electrodes into specific target areas in the brain, which deliver low-voltage stimulation with high frequency. Deep brain stimulation is assumed to disrupt pathological signals and perhaps also influence the release of neurotransmitters. 13 At most centers, the preferred DBS target for patients with dystonia has been the globus pallidus internus (GPi

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Frances Weaver, Kenneth Follett, Kwan Hur, Dolores Ippolito, and Matthew Stern

within the brain have been stimulated to treat PD: the STN and the GPI. The first reports of DBS for the management of PD were published in the mid 1990s. Studies published since then have documented significant improvement in patient motor functioning 12, 27, 35, 54 and quality of life following STN DBS. 10, 31 Serious adverse events have also been reported including infections, 12, 33, 76 depression, mood changes, and psychosis requiring intervention 5, 72, 76, 81 as well as equipment issues such as lead fractures and dislodgements. 12, 54, 81 Authors of studies