UMMS Affiliation

Department of Neurology

Publication Date


Document Type



Nervous System Diseases | Neurology


Objective: The aim of this study is to evaluate the evolution of GPi DBS targeting.

Methods: This retrospective, single-center study included patients implanted with GPi DBS leads for dystonia or PD during the years 2004 to 2018 at the University of Florida Fixel Institute for Neurological Diseases. Each patient underwent a high-resolution targeting study on the day prior to the surgery, which was fused with a high resolution CT scan that was acquired on the day of the procedure. Intraoperative target location was selected using a digitized 3D Schaltenbrand-Bailey atlas. All patients underwent a high-resolution head CT scan without contrast approximately one month after lead implantation and accurate measurement of neuroanatomical lead position was acquired after fusion of pre-operative and post-operative image studies.

Results: We analyzed 253 PD patients with 352 leads and 80 dystonia patients with 141 leads. During 15 years of follow-up, lead locations in the PD group migrated more laterally (beta = 0.09, p < 0.0001), posteriorly [slope (beta) = 0.04, p < 0.05], and dorsally (beta = 0.07, p < 0.001), whereas leads in the dystonia group did not significantly change position aside from a trend in the dorsal direction (beta = 0.06, p = 0.053).

Conclusion: The evolving target likely results from multiple factors including improvements in targeting techniques and clinical feedback intraoperatively and post-operatively. Our demonstrates the potential importance of a systematic post-operative DBS lead measurement protocol to ensure quality control and to inform and optimize DBS programming.


Parkinson's disease, deep brain stimulation, dystonia, globus pallidus, targeting

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Copyright © 2021 Holanda, Eisinger, Almeida, Tsuboi, Wang, Okun, Deeb, Patterson, Wagle Shukla, Lobo Lopes and Foote. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

DOI of Published Version



Holanda VM, Eisinger RS, Almeida L, Tsuboi T, Wang H, Okun MS, Deeb W, Patterson A, Wagle Shukla A, Lobo Lopes J, Foote KD. Evolution of Globus Pallidus Targeting for Parkinson's and Dystonia Deep Brain Stimulation: A 15-Year Experience. Front Neurol. 2021 Aug 12;12:679918. doi: 10.3389/fneur.2021.679918. PMID: 34456844; PMCID: PMC8387620. Link to article on publisher's site

Journal/Book/Conference Title

Frontiers in neurology

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.