PMC8656942_01
Genetic family diagram of the patient.
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F1
On assessment of the patient's family history, it was found that the patient's two sisters had similar symptoms (Figure 1).
MRI (magnetic resonance imaging) after bSCG-DBS implantation (the red circle is STN, and the blue circle is GPi).
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F2
The implantation point of the GPi was posterior, 28 mm from the implantation point of the STN (Figure 2).
Intraoperative microelectrode monitoring was recorded. (A) GPi on the left: during the monitoring process, GPe electrical activity was recorded from 11.0 mm above the target to 5.5 mm above the target, GPi discharge was recorded from 4.0 mm above the target to 1.5 mm below the target, and the electrode was placed at 1.0 mm below the target. (B) GPi on the right side: during the monitoring process, GPe electrical activity was recorded from 11.0 to 4.5 mm on the target, and GPi discharge was recorded from 3.5 to 1.5 mm below the target; The electrode was placed 1.0 mm below the target. (C) left STN: electrical activity of STN is recorded from 2.5 mm above the target to 3.5 mm below the target during monitoring: electrode is placed at 3.0 mm below the target. (D) Right STN: electrical activity of STN was recorded from 4.0 mm above target to 3.0 mm below target during monitoring; The electrode was placed 2.5 mm below the target.
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F3
Microelectrode monitoring was performed to determine the location of the target (Figure 3).
(A) Trends in UPDRS-III off-period scores. (B) Trends in UPDRS-III on-period scores. (C) Trends in UPDRS-IV scores. (D) Trends in NMSS scores. (E) Trend in PDQ-39 scores. (F) Trends in Levodopa Equivalents (LDE). (G) Comparison of UPDRS-III score in 4 conditions (pre-surgery, GPi stimulation, STN stimulation, and combined GPi and STN stimulation). (H) Comparison of UPDRS-IV score in 4 conditions (pre-surgery, GPi stimulation, STN stimulation, and combined GPi and STN stimulation).
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F4
The dosage has also dropped dramatically (Figures 4A-F). We attempted to switch STN and GPi on and off alternately, subsequently evaluating patients' UPDRS-III and UPDRS-IV scores (Figures 4G,H).