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Updated: Feb 25, 2026
Controlling Parkinson's Disease With Adaptive Deep Brain Stimulation
Published on: July 16, 2014
Micro lesion effect of the globus pallidus internus with deep brain stimulation in Parkinson's disease patients
Yi Wang1, Peng Li1, FeiLong Gong1
1Department of Neurosurgery, West China Hospital, Sichuan University, Guoxue Alley 37, Chengdu, China.
Background:
The micro-lesion effect (MLE) has been observed in many Parkinson's disease (PD) patients after deep brain stimulation (DBS) surgery. For subthalamic nucleus (STN) stimulation, the MLE has been reported as a predictor of the long-term efficacy of DBS. However, the research on the MLE in the globus pallidus internus (GPi) is insufficient. In this report, we conducted a study of the correlation between the MLE and improvement of GPi DBS.
Methods:
From July 2014 to November 2015, 36 PD patients underwent GPi DBS in our hospital. The patients were evaluated before DBS and postoperatively at 24 h, 1 week, 2 weeks, 3 weeks, 6 months and 1 year. The evaluated items included the following: the UPDRSIII score with and without medication, off time per day and severe dyskinesia time per day. The dose of L-dopa, magnitude and duration of MLE were also recorded.
Results:
There were 32 patients with a postoperative MLE. In these 32 cases, the dose of L-dopa decreased from 960.5 ± 257.8 mg (range, 550-1550) to 910.4 ± 207.5 mg (range, 550-1250). There is a correlation between the magnitude of the MLE in UPDRSIII and the improvement degree of DBS at 6 and 12 months compared with the preoperative findings when off medication. The duration of the MLE is also an indication of the improvement of DBS in the long term when off medication. However, there was no correlation with on medication. Compared with the preoperative state, the UPDRSIII score, off time and severe dyskinesia time had improved postoperatively.
Conclusions:
The MLE of GPi is a predictor of PD patients who would benefit from DBS in the long term. Medication may have some conflicting effects on the MLE. The exact mechanism of the MLE requires further exploration.
Insights
The micro-lesion effect (MLE) after globus pallidus internus deep brain stimulation (GPi DBS) predicts long-term Parkinson's disease improvement. This effect, particularly its magnitude and duration, correlates with better outcomes when patients are off medication.
Area of Science:
- Neurosurgery
- Neurology
- Biomedical Engineering
Background:
- The micro-lesion effect (MLE) is known in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS), particularly for subthalamic nucleus (STN) targets.
- Research on the MLE in globus pallidus internus (GPi) DBS is limited.
- This study investigates the correlation between MLE and GPi DBS efficacy in PD.
Purpose of the Study:
- To determine if the micro-lesion effect (MLE) in globus pallidus internus (GPi) deep brain stimulation (DBS) predicts long-term outcomes in Parkinson's disease (PD) patients.
- To explore the relationship between the magnitude and duration of the MLE and clinical improvements.
- To assess the influence of medication on the MLE and its predictive value.
Main Methods:
- 36 PD patients receiving GPi DBS were evaluated preoperatively and at multiple time points up to 1 year post-surgery.
- Assessments included UPDRS III scores (on/off medication), daily off-medication time, and severe dyskinesia time.
- L-dopa dosage, MLE magnitude, and MLE duration were recorded.
Main Results:
- 32 patients exhibited a postoperative MLE.
- A significant correlation was found between MLE magnitude and UPDRS III improvement at 6 and 12 months (off-medication).
- MLE duration also predicted long-term, off-medication improvement, though no correlation was observed with on-medication status. Postoperative improvements in UPDRS III, off-time, and dyskinesia were noted.
Conclusions:
- The MLE following GPi DBS is a valuable predictor of long-term treatment benefit in Parkinson's disease.
- Medication status may influence the MLE's predictive power, suggesting complex interactions.
- Further research is needed to elucidate the precise mechanisms underlying the MLE in GPi DBS.
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