gets for DBS. Although the motor outcomes after STN and GPi DBS are similar, apparently, non-motor factors could affect the target selection. In addition, although both STN and GPi stimulation markedly improve postural instability and gait disorder (PIGD), contradicting studies have revealed that patients experienced more frequent falls and gait disturbance in the first 3 months postoperatively (4). Moreover, some long-term studies reported that the gait function worsened in patients with PD undergoing STN DBS (13,16,17,22,23). For instance, █ INTRODUCTION I n patients with advanced idiopathic Parkinson's disease (PD), deep brain stimulation (DBS) is a well-established treatment option. Previously, randomized studies have revealed that treatment with subthalamic nucleus (STN) DBS is superior to the best medical therapy for improving the motor function and quality of life for patients with advanced PD (8). Both STN and globus pallidus interna (GPi) are accepted tar-AIM: To compare the effects of subthalamic nucleus (STN) and globus pallidus interna (GPi) deep brain stimulation (DBS) on the motor outcome, gait and balance function, fall risk (FR), and non-motor symptoms in patients with advanced Parkinson's disease (PD). MATERIAL and METHODS: We randomized patients with advanced PD with the indication of DBS to undergo either STN or GPi DBS and followed them for 2 years. We collected data at baseline and postoperative 6, 12, and 24 months. We compared changes in the Unified Parkinson's Disease Rating Scale (UPDRS) score, timed gait tests, posturography, non-motor symptom questionnaire (NMSQuest), hospital anxiety and depression (HAD) scale, and levodopa equivalent dose (LED). RESULTS: We enrolled and randomized 12 patients to receive either STN (n = 6) or GPi (n = 6) DBS. Postoperative motor outcomes were significantly improved in both groups (p<0.05). In both groups, timed gait tests exhibited better performance in mobility; however, patients receiving GPi DBS performed better than those receiving STN DBS in the timed gait tests (p<0.05). Furthermore, the posturographic evaluation demonstrated a significant elevation in the FR in the STN group (p<0.05). CONCLUSION: Both STN and GPi DBS are equally effective in alleviating disabling motor complications. However, seemingly, STN DBS could cause more gait and balance problems; hence, a tailored approach seems to be more appropriate in the target selection.

Background: Hardware-related infection after deep brain stimulation (DBS) is one of the most serious complications and may need additional interventions. Objectives: To reuse the internal pulse generator (IPG) after DBS infection and to reduce the economic costs. Methods: A database of 102 patients who underwent DBS surgery was used in the study. The incidence, clinical characteristics and management of infections while reusing the IPG after DBS-related infection were analyzed and reported. Results: The overall infection rate was 5.9% (6 of 102 patients). Management consisted of total hardware removal followed by intravenous antibiotics. The IPG was at first kept in a solution, then rinsed with water and dried following sterilization with ethylene oxide gas at 38°C for 18 h. When the treatment of the infection was finished, we reused the IPG and reimplanted the DBS. No hardware-related infection or other complications were observed after reimplantation. Conclusions: Management of hardware-related infections can be challenging. The medical and economic costs associated with these infections are enormous. The IPG can often be saved in infected patients. Thus, a significant cost burden is eliminated. Properly executed, reuse of IPG should markedly reduce the costs of these devices.

Pituitary abscess is extremely rare and often misdiagnosed as pituitary tumor pre-operatively.We document a case of a 64-year-old lady presented to the outpatient department with complaints of headache and blurring vision of right eye for one month. Based on preliminary investigations, a clinical diagnosis of pituitary adenoma was made and the pituitary gland was surgically excised. Histopathological examination showed Actinomyces infection. This case has been documented due to the extremely rare involvement of the pituitary gland by actinomyces infection. Pituitary abscess is a rare pathology, but it must be considered during evaluating sellar masses, since its prognosis depends on surgical drainage and on the use of specific antibiotics. We report, to our knowledge, the fourth case of Actinomyces israelii infection of the pituitary region.

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