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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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Joshua L. Golubovsky, Hong Li, Arbaz Momin, Jianning Shao, Maxwell Y. Lee, Leonardo A. Frizon, Olivia Hogue, Benjamin Walter, André G. Machado and Sean J. Nagel

subthalamic nucleus (STN) or the globus pallidus internus (GPi). Data Collection Preoperative variables collected included the following: age at surgery; sex; body mass index (BMI); handedness; PD diagnosis date; Unified Parkinson’s Disease Rating Scale (UPDRS) motor score (UPDRS-III)/Movement Disorder Society revision of UPDRS (MDS-UPDRS); patient-determined motor function (i.e., UPDRS self-evaluation score [UPDRS-II]); Patient Health Questionnaire–9 (PHQ-9) scores; EuroQol–5 Dimensions (EQ-5D) scores; median income; and ZIP code distance from the Cleveland Clinic main

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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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Timothy R. Miller, Sijia Guo, Elias R. Melhem, Howard M. Eisenberg, Jiachen Zhuo, Nathaniel Kelm, Mor Dayan, Rao P. Gullapalli and Dheeraj Gandhi

M agnetic resonance–guided focused ultrasound (MRgFUS) ablation of the thalamic ventral intermediate nucleus (VIM) has been shown to be a safe and effective treatment for medically refractory essential tremor. 1 , 2 The technique obviates the need for an open neurosurgical procedure and allows for real-time patient monitoring. Given the success with essential tremor, MRgFUS is now being investigated for the treatment of other disease entities, including advanced idiopathic Parkinson’s disease. 3 Preliminary results have been promising, and our center is

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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