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[Pallidal and subthalamic stimulation in Parkinson's disease: lessons from the unsatisfactory results].

BACKGROUND: Deep brain stimulation is being widely used in advanced Parkinson's disease (PD). Outcome determinants are not known.

OBJECTIVE: Some relevant data about outcome may be obtained from the study of patients with unsatisfactory results.

PATIENTS AND METHODS: We have retrospectively analyzed the number and causes of unsatisfactory results (insufficient improvement 6 months after the intervention) in 211 patients.

RESULTS: Forty patients (18.9%) experienced an unsatisfactory result. Inadequate clinical selection by advanced age, abnormal MRI and levodopa unresponsive symptoms was the main cause in 28 cases. In 11 patients a misplacement of the electrode was reported. In 2 cases no cause was identified. Thirty-four out of the 40 patients corresponded to the early experience of the teams involved in the study.

CONCLUSION: We conclude that the main factors responsible for a negative outcome are related to the inadequate clinical selection of the patients and the incorrect placement of the electrode. The experience of the team may also be a key factor.

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