BILATERAL SUBTHALAMOTOMY THROUGH DBS ELECTRODES: A RESCUE OPTION FOR DEVICE-RELATED INFECTION

Bilateral deep brain stimulation (DBS) in the subthalamic nucleus (STN) is a widely used surgical option for patients with severe levodopa-responsive Parkinson disease (PD).1,2 Hardware-related infection is one of the most burdensome complications of such treatment.3 Despite antiobiotherapy, the hardware usually needs to be removed, and the device with new leads cannot be reimplanted for several months. During this period, patients lose the clinical benefit of DBS and often have increased disability despite the adjustment of drug treatment. We report a patient in whom we performed a bilateral subthalamotomy in 2 steps through the DBS electrodes before removing them because of infection. ### Methods. Bilateral DBS electrodes were implanted in the STN of a 60-year-old man with a 19-year history of PD with severe disability despite optimized drug treatment (table). After adjustment of the DBS parameters and a progressive reduction of drug treatment, there was a clear improvement of PD symptoms with almost no residual motor fluctuations or dyskinesias (table). The patient complained only of a mild dysarthria. View this table: Table Clinical evolution of the patient before DBS, with DBS, and after bilateral subthalamotomy Forty days after lead implantation, he was readmitted with delirium and pyrexia (39°C). The CT scan revealed an abscess (diameter ∼0.6 …