Using Multinodal Deep Brain Stimulation for Treatment of Complex Movement Disorders: Initial Case Series

BACKGROUND AND OBJECTIVES: Mixed and complex movement disorders represent significant challenges for surgical treatment. These disease states are likely the result of combined or complex network pathologies affecting multiple pathways. Until recently, attempts to treat complex movement disorders with deep brain stimulation (DBS) have primarily focused on stimulating a single deep target to address patients' most severe symptoms. However, a multinodal targeting approach for DBS by simultaneously stimulating more than 1 pair of homologous nuclei could be a more effective treatment strategy. In this study, we present the initial case series of using multinodal stimulation for mixed and complex movement disorders. METHODS: A cohort of 14 patients with mixed and complex movement disorder presenting to Stanford Healthcare underwent a multinodal stimulation approach. In these patients, the multiple (ie, >2) simultaneous deep targets were implanted through only 2 burr holes and connected to a single 32-channel pulse generator. Six patients had previous single target DBS which had proved ineffective, whereas 9 received de novo multinodal therapy. RESULTS: There were no intraoperative or postoperative complications. With the addition of multinodal stimulation, patients with complex Parkinson disease demonstrated a significant reduction in Unified Parkinson Disease Rating Scale ( P = .0078) and complex tremor patients demonstrated a significant reduction in Clinical Rating Scale for Tremor ( P = .0312). CONCLUSION: We present the largest initial case series demonstrating the safety, feasibility, and added efficacy of single system multinodal DBS for treating mixed and complex movement disorders. This approach is safe, provides additional benefit, and warrants further investigation for treating mixed and complex movement disorders.