Direct Localization of Subthalamic Nucleus Supplemented by Single-Track Electrophysiological Guidance in Deep Brain Stimulation Lead Implantation: Techniques and Clinical Results

Abstract

Background/Aims: In subthalamic nucleus (STN) deep brain stimulation (DBS) lead implantation, it is still controversial whether it is more appropriate to employ indirect or direct methods in magnetic resonance imaging (MRI)-based tentative targeting and to select single- or multiple-track recording in electrophysiological definitive targeting. The efficacy of single-track electrophysiological recording through direct targeting was compared with the conventional indirect targeting methods in light of the identified STN thickness and clinical results. Methods: The identified mean STN thickness, pre- and 6-month postoperative Unified Parkinson’s Disease Rating Scale (UPDRS), dose change of L-dopa and dopaminergic agonists were compared in indirect (midcommissural point-based, 44 procedures) and direct (image-based, 44 procedures) targeting methods. Results: The identified mean STN thickness was significantly greater in the group employing direct methods. For evaluation of the UPDRS, a significant scale improvement was noted in part 2 OFF for both groups. Significant scale improvements occurred in parts 3 and 4 in the group employing the direct method. Both groups revealed significant L-dopa dose reduction with the tendency towards a greater reduction in the group employing the direct method. Conclusion: MRI-based direct targeting supplemented by single-track recording could be justified as a standard for DBS lead implantation to achieve better clinical results.

Implications for programming strategy of the location of the active contact in subthalamic nucleus deep brain stimulation

“…Most of the activated contacts were located in the posterolateral region of STN and at or above the STN center, consistent with our targeting scheme and with previous reports suggesting that the most efficacious target within the STN is the dorsolateral region. 14,15 Contact 0 was rarely the active contact in our patients. This may be due to its proximity to the substantia nigra.…”

Matrix Metalloproteinase Inhibitors as Investigational and Therapeutic Tools in Unrestrained Tissue Remodeling and Pathological Disorders

“…259 MMP-1, MMP-12 and MMP-13 derived from intimal macrophages have been suggested to play a role in both plaque initiation and progression. 260 On the other hand, transgenic mice that specifically express MMP-1 in macrophages show smaller plaques and no evidence of plaque rupture when compared with control littermates. 261 This is likely because these mice have altered MMP-1 from birth, which could reduce collagen accumulation.…”

Matrix Metalloproteinase Inhibitors as Investigative Tools in the Pathogenesis and Management of Vascular Disease

“…On the other hand, MMP-3 and -9 appeared to play protective roles, limiting plaque growth and promoting a stable plaque phenotype (Johnson et al, 2005). MMP-1, -12 and -13 derived from intimal macrophages have been proposed to play a pivotal role in both plaque initiation and progression (Koike et al, 2008). However, mice with MMP-1-producing macrophages show smaller plaques than control mice and no evidence of plaque rupture (Lemaitre et al, 2001).…”