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This systematic review examined outcomes when deep brain stimulation (DBS) electrodes are surgically repositioned or modified after initial procedures fail to provide adequate symptom relief. Analysis of 17 case series involving approximately 149 patients found that 81% showed meaningful improvement after revision surgery, with similar success rates whether the lead was repositioned at the same target or moved to a different brain region. In Parkinson disease patients specifically, motor symptom scores improved by an average of 15.6 points following lead revision, with best outcomes occurring when incorrectly placed leads outside the optimal subthalamic nucleus zone were corrected.
Why it matters
These findings suggest that patients who do not adequately respond to initial DBS placement may still benefit from surgical correction rather than abandoning the therapy. However, the research indicates revision should only be pursued after thorough reprogramming attempts and imaging confirmation of suboptimal lead placement, as the procedure carries surgical risks including two reported deaths across the reviewed studies.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background Some patients obtain less benefit than expected from deep brain stimulation (DBS) despite optimized programming. We systematically reviewed the outcomes of surgical revision in this setting. Methods Following PRISMA 2020, we searched PubMed, Embase and Scopus to October 2026 for studies of lead repositioning, replacement, added (rescue) leads or target switching performed for inadequate benefit or stimulation-related adverse effects; revision for infection or hardware failure was excluded. Outcomes were pooled with random-effects models, and certainty was rated with GRADE. Results Seventeen case series (approximately 149 patients) were included. Across 14 studies (95 patients), 81% (95% CI 68 to 91%) improved meaningfully, with similar estimates for same-target revision (82%) and for added or switched leads (79%). In Parkinson disease, the off-medication/on-stimulation motor score fell by 15.6 points after lead revision (95% CI 68 to 91%; four studies). Benefit was greatest when a lead outside the dorsolateral subthalamic nucleus was corrected and levodopa response was preserved. Seven studies reported surgical or hardware complications, and two deaths occurred. Certainty of evidence was very low. Conclusions Most published revised patients improve, but the evidence derives from small uncontrolled series. Revision should follow imaging, hardware checks and exhaustive reprogramming, within multidisciplinary review.