Abstract
Deep brain stimulation (DBS) has emerged as a viable therapy for Parkinson’s disease
(PD). The impact of subthalamic nucleus (STN) lead placement (lateral versus medial) on motor outcome, however, has not been systematically evaluated. Forty-eight
patients with PD underwent STN-DBS surgery and were evaluated postoperatively for
48 weeks for motor improvement as measured by the Unified Parkinson’s Disease Rating
Scale (UPDRS) part III (standardized motor examination) and levodopa equivalent daily
dose (LEDD). Postoperative MRI was used to identify the location of the active stimulating
contact and motor outcome was analyzed. STN-DBS was associated with significant improvement
in motor outcome as determined by a reduction in the UPDRS part III subscore from
34.44 ± 1.29 at baseline to 18.76 ± 1.06 at end visit (p < 0.0001) and a reduction in LEDD from 1721 ± 152 mg/day at baseline to 1134 ± 119 mg/day at end visit (p = 0.0024). Patients with stimulating contacts in the medial STN compared to the lateral
STN did not demonstrate any significant differences in motor outcome (UPDRS, p = 0.5811; LEDD, p = 0.7341). No significant differences were found in motor outcome between patients with
STN stimulation compared to stimulation of surrounding fiber tracts (p = 0.80). No significant difference in stimulation voltage was noted with respect to
lead location. Our study did not find a significant effect for the location of active
contact and motor outcome neither within the subregions of the STN nor between the
STN and surrounding fibers. Further research is needed to better understand the neurophysiological
basis for these results.
Keywords
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References
- Clinical practice. Diagnosis and initial management of Parkinson’s disease.N Engl J Med. 2005; 353: 1021-1027
- Determinants of disability and quality of life in mild to moderate Parkinson disease.Neurology. 2008; 70: 2241-2247
- New considerations in the medical management of early Parkinson’s disease: impact of recent clinical trials on treatment strategy.Parkinsonism Relat Disord. 2009; 15: S17-S21
- Milestones in Parkinson’s disease therapeutics.Mov Disord. 2011; 26: 1072-1082
- Available and emerging treatments for Parkinson’s disease: a review.Drug Des Devel Ther. 2011; 5: 241-254
- Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson’s disease.Lancet Neurol. 2009; 8: 67-81
- Deep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson’s disease: which target?.Parkinsonism Relat Disord. 2012; 18: S165-S167
- Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease.Appl Neurophysiol. 1987; 50: 344-346
- Leksell’s posteroventral pallidotomy in the treatment of Parkinson’s disease.J Neurosurg. 1992; 76: 53-61
- Treatment results: Parkinson’s disease.Mov Disord. 2002; 17: S75-S83
- Acute and long-term effects of subthalamic nucleus stimulation in Parkinson’s disease.Stereotact Funct Neurosurg. 1994; 62: 76-84
- Effects of the stimulation of the subthalamic nucleus in Parkinson disease.Rev Neurol (Paris). 1993; 149: 175-176
- A randomized trial of deep-brain stimulation for Parkinson’s disease.N Engl J Med. 2006; 355: 896-908
- Long-term outcome of 50 consecutive Parkinson’s disease patients treated with subthalamic deep brain stimulation.Parkinsonism Relat Disord. 2008; 14: 114-119
- Bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease: five year follow-up.J Neurol. 2009; 256: 225-233
- Levodopa withdrawal after bilateral subthalamic nucleus stimulation in advanced Parkinson disease.Arch Neurol. 2000; 57: 983-988
- Long-term follow up of bilateral deep brain stimulation of the subthalamic nucleus in patients with advanced Parkinson disease.J Neurosurg. 2003; 99: 489-495
- Chronic inhibition of the subthalamic nucleus in Parkinson’s disease.J Neurol Sci. 2004; 219: 119-124
- Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease.N Engl J Med. 2003; 349: 1925-1934
- Treatment of motor and non-motor features of Parkinson’s disease with deep brain stimulation.Lancet Neurol. 2012; 11: 429-442
- Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease.N Engl J Med. 1998; 339: 1105-1111
- Double-blind evaluation of subthalamic nucleus deep brain stimulation in advanced Parkinson’s disease.Neurology. 1998; 51: 850-855
- A randomized trial of deep-brain stimulation for Parkinson’s disease.N Engl J Med. 2006; 355: 896-908
- Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial.JAMA. 2009; 301: 63-73
- Safety and efficacy of pallidal or subthalamic nucleus stimulation in advanced PD.Neurology. 2001; 56: 548-551
- Effect of subthalamic nucleus stimulation on levodopa-induced dyskinesia in Parkinson’s disease.Neurology. 2000; 55: 1921-1923
- Subthalamic DBS replaces levodopa in Parkinson’s disease: two-year follow-up.Neurology. 2002; 58: 396-401
- Bilateral subthalamic nucleus stimulation improves health-related quality of life in PD.Neurology. 2002; 59: 1976-1978
- Improvement in quality of life in patients with advanced Parkinson’s disease following bilateral deep-brain stimulation in subthalamic nucleus.Eur J Neurol. 2004; 11: 451-454
- Long-term benefits in quality of life provided by bilateral subthalamic stimulation in patients with Parkinson disease.J Neurosurg. 2005; 103: 252-255
- Subthalamic nucleus and its connections: anatomic substrate for the network effects of deep brain stimulation.Neurology. 2008; 70: 1991-1995
- Resurgence of functional neurosurgery for Parkinson’s disease: a historical perspective.Mov Disord. 1998; 13: 582-588
- Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlas-magnetic resonance imaging coregistration method.J Neurosurg. 2003; 99: 89-99
- Relationship of stimulation site location within the subthalamic nucleus region to clinical effects on Parkinsonian symptoms.Stereotact Funct Neurosurg. 2006; 84: 170-175
- Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation.Mov Disord. 2008; 23: 2377-2383
- Bilateral high-frequency stimulation in the subthalamic nucleus for the treatment of Parkinson disease: correlation of therapeutic effect with anatomical electrode position.J Neurosurg. 2002; 96: 269-279
- Subthalamic stimulation for Parkinson disease: determination of electrode location necessary for clinical efficacy.Neurosurg Focus. 2005; 19: E12
- Electrode position determined by fused images of preoperative and postoperative magnetic resonance imaging and surgical outcome after subthalamic nucleus deep brain stimulation.Neurosurgery. 2008; 63: 925-936
- Computed three-dimensional atlas of subthalamic nucleus and its adjacent structures for deep brain stimulation in Parkinson’s disease.ISRN Neurol. 2012; 2012: 592678
- Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral Parkinsonism.Brain. 2006; 129: 1732-1747
- Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson’s disease and tremor.Mov Disord. 2006; 21: S259-S283
- Atlas for stereotaxy of the human brain.Georg Thieme Publishers, New York1977
- Recent developments in Parkinson’s disease.Macmillan Health Care Information, Florham Park, NJ1987 ([pp 153–163])
- Effect of GPi pallidotomy on motor function in Parkinson’s disease.Lancet. 1995; 346: 1383-1387
- How does deep brain stimulation work? Present understanding and future questions.J Clin Neurophysiol. 2004; 21: 40-50
- Neurophysiological effects of stimulation through electrodes in the human subthalamic nucleus.Brain. 1999; 122: 1919-1931
- Which elements are excited in electrical stimulation of mammalian central nervous system: a review.Brain Res. 1975; 98: 417-440
- Multiarchitectonic and stereotactic atlas of the human thalamus.J Comp Neurol. 1997; 387: 588-630
- Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging.J Neurosurg. 2002; 97: 1152-1166
- Physiologic study of the subthalamic volume.Neurol Sci. 2001; 22: 111-112
- Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both.Clin Neurophysiol. 2004; 115: 1239-1248
- Mechanisms of deep brain stimulation: excitation or inhibition.Mov Disord. 2002; 17: S69-S72
- Ablative surgery and deep brain stimulation for Parkinson’s disease.Neurosurgery. 1998; 43: 989-1013
Article info
Publication history
Accepted:
February 9,
2013
Received:
January 28,
2013
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
