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Darrin J. Lee, Luka Milosevic, Robert Gramer, Sanskriti Sasikumar, Tameem M. Al-Ozzi, Philippe De Vloo, Robert F. Dallapiazza, Gavin J. B. Elias, Melanie Cohn, Suneil K. Kalia, William D. Hutchison, Alfonso Fasano and Andres M. Lozano

C ognitive function in patients with Parkinson’s disease (PD) often deteriorates over time. Up to 75% of PD patients who have had the disease for at least 10 years develop dementia. 5 , 11 The stage between normal cognitive functioning and PD dementia (PDD) is identified as mild cognitive impairment in PD (PD-MCI) and is a prognostic factor for developing PDD, particularly when multiple domains and/or the visuospatial domain are involved. 10 Treatments to slow or reverse the progression of cognitive dysfunction are needed. A number of pharmacological and non

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Azam A. Qureshi, Jennifer J. Cheng, Abraham N. Sunshine, Adela Wu, Gregory M. Pontone, Nicola Cascella, Frederick A. Lenz, Stephen E. Grill and William S. Anderson

D eep brain stimulation (DBS) surgery, a procedure widely used in Parkinson’s disease (PD) treatment, involves the implantation of a quadripolar electrode, an extension cable, and an implantable pulse generator, 17 which electrically alter the pathophysiological activity of specific regions of the brain. 17 When applied to the subthalamic nucleus (STN-DBS) or globus pallidus interna (GPi-DBS), this therapy has been shown to alleviate the characteristic PD motor symptoms of tremor, bradyki-nesia, and rigidity. 2 The STN is often preferred because of its

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Günther Deuschl, Kenneth A. Follett, Ping Luo, Joern Rau, Frances M. Weaver, Steffen Paschen, Frank Steigerwald, Lisa Tonder, Valerie Stoker and Domenic J. Reda

D eep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapy for patients with Parkinson’s disease (PD). Four large studies have compared STN DBS and medical treatment in a randomized design. 2 , 5 , 18 , 19 Despite overall consistency with respect to significant improvement in major outcome parameters among the studies, the amount of improvement via STN DBS differed considerably. The US Veterans Affairs/National Institute of Neurological Disorders and Stroke (VA/NINDS) trial has been heavily criticized on the basis that improvement

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Jill L. Ostrem, Nathan Ziman, Nicholas B. Galifianakis, Philip A. Starr, Marta San Luciano, Maya Katz, Caroline A. Racine, Alastair J. Martin, Leslie C. Markun and Paul S. Larson

D eep brain stimulation (DBS) has been shown to be a highly effective treatment option for medication-refractory Parkinson’s disease (PD) patients experiencing motor fluctuations and dyskinesia. 5 , 15 , 18 , 21 , 22 , 26 , 31 Clinical outcomes with DBS are critically dependent on the exact lead placement in the intended brain target (dorsal lateral subthalamic nucleus [STN] or posterior [motor] area of the internal globus pallidus [GPi]), but surgical methods to achieve acceptable placement are not standardized. The traditional method for DBS lead

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Paolo Belardinelli, Ramin Azodi-Avval, Erick Ortiz, Georgios Naros, Florian Grimm, Daniel Weiss and Alireza Gharabaghi

characteristics Pt No. Age (yrs), Sex Recording Side UPDRS III: Score w/ Med Off/On Active DBS Contacts DBS Frequency (Hz)/Amp (V)/Pulse Width (µsec) 1 69, M Rt 22/7 10−/G+ (rt), 2−/G+ (lt) 130/2.5/60 (rt), 130/1.7/60 (lt) 2 80, M Lt 29/20 10−/G+ (rt), 2−/G+ (lt) 130/3.0/60 (rt), 130/1.0/60 (lt) 3 53, M Rt 36/23 10−/G+ (rt), 2−/G+ (lt) 130/1.2/60 (rt), 130/2.0/60 (lt) Amp = amplitude; Med = medication; Pt = patient; UPDRS III = Unified Parkinson’s Disease Rating Scale part III. Data Collection and Preprocessing Cortical and subcortical electrophysiological signals were recorded

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Leonardo A. Frizon, Sean J. Nagel, Francis J. May, Jianning Shao, Andres L. Maldonado-Naranjo, Hubert H. Fernandez and Andre G. Machado

D eep brain stimulation (DBS) is an established surgical treatment for Parkinson’s disease (PD), essential tremor, and dystonia. 2 , 4 , 8 , 10 Patient selection, target choice, and surgical accuracy are the foundation for a successful DBS outcome. However, in some cases, revision or reimplantation is needed due to limited benefits, device failure, or infection involving the hardware. There are relatively few published series describing the outcomes after lead revision or reimplantation. 5 , 15 Thus, little is known about the potential risks and benefits of

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Frederick L. Hitti, Ashwin G. Ramayya, Brendan J. McShane, Andrew I. Yang, Kerry A. Vaughan and Gordon H. Baltuch

T he natural history of Parkinson’s disease (PD) has been well studied. In addition to the well-known motor symptoms such as rigidity, bradykinesia, and resting tremor, nonmotor symptoms such as dementia, sleep-wake dysregulation, and autonomic failure are major features of the illness. Several studies have found that patients with PD have a higher mortality than the age-matched population, approximately 44% after 9.4 years with the disease 11 , 14 (although see the study by Diem-Zangerl and colleagues 6 ). There is a high prevalence (50%–80%) of dementia

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Zaman Mirzadeh, Kristina Chapple, Margaret Lambert, Virgilio G. Evidente, Padma Mahant, Maria C. Ospina, Johan Samanta, Guillermo Moguel-Cobos, Naomi Salins, Abraham Lieberman, Alexander I. Tröster, Rohit Dhall and Francisco A. Ponce

O ver the past 30 years, deep brain stimulation (DBS) has evolved into a mainstream therapy for patients with Parkinson’s disease (PD) that is supported by Level 1 evidence. 5 , 6 , 25 , 31 , 32 The clinical efficacy of DBS depends on appropriate lead placement within the targeted structure. 3 , 7 , 20 , 22 Stereotactic targeting was initially performed via “indirect” methods using Cartesian coordinates of the targeted structure (ventral intermediate nucleus, subthalamic nucleus [STN], 25 or globus pallidus internus [GPi]) relative to the midcommissural

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Gwanhee Ehm, Han-Joon Kim, Ji-Young Kim, Jee-Young Lee, Hee Jin Kim, Ji Young Yun, Young Eun Kim, Hui-Jun Yang, Yong Hoon Lim, Beomseok Jeon and Sun Ha Paek

B ilateral electrode implantation is regarded as the standard procedure for subthalamic nucleus (STN) deep brain stimulation (DBS) for patients with advanced Parkinson’s disease (PD). 1 This is based on the fact that PD affects both sides of the body and bilateral surgery provides greater motor benefits than unilateral surgery. 2 , 6 , 11 Under certain conditions, such as patients with prominently asymmetrical motor symptoms, several studies have suggested that unilateral surgery is a reasonable treatment option because it can provide significant bilateral and

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Ryul Kim, Han-Joon Kim, Chaewon Shin, Hyeyoung Park, Aryun Kim, Sun Ha Paek and Beomseok Jeon

F reezing of gait (FOG) is an inability to generate effective stepping, with an unpredictable and transient nature. 22 In advanced Parkinson’s disease (PD), FOG is a common and disabling motor symptom that has a considerable impact on patients’ quality of life. 21 It can occur during both off- and on-medication states, 22 and occasionally pure on-medication FOG may be induced by an increase in the dose of dopaminergic medication. 31 Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment for patients with advanced PD with motor