Motor and non motor effects during intraoperative subthalamic stimulation for Parkinson?s disease

Abstract

Spatial distribution of the clinical effects induced by deep brain stimulation during the intraoperative investigation of the subthalamic nucleus (STN) for Parkinson's disease (PD) was analysed in 17 patients under local anesthesia. The stimulation parameters were 130 hertz, 100 micros, and voltage ranged from 0.05 to 5 volts. Optimal motor response was assessed as the total and lasting disappearance of wrist rigidity on the side opposite to stimulation. Among the adverse effects induced by stimulation, special attention was given to frequently observed autonomic effects (AE). Full motor response was achieved in 49.2% of the 301 points evaluated,with a mean voltage (MV) of 0.94 volts; paresthesiae occurred in 6.6% (MV: 2 volts), dystonia in 10.6% (MV: 3.4 volts), autonomic effects in 19.6% (MV: 3.1 volts) and oculomotor effects in 31.6% (MV: 3 volts). The motor target was located in the posterodorsal part of the nucleus and the optimal point for motor response was close to the superior limit of the nucleus. Whereas other adverse effects occurred relatively far from the motor target, AE occurred with statistic significance near this point. Their neural substrates, such as limbic system and their relationship with postoperative behavioral disorders, are discussed.

Outcome of Bilateral Subthalamic Nucleus Stimulation in the Treatment of Parkinson’s Disease: Correlation with Intra-Operative Multi-Unit Recordings but Not with the Type of Anaesthesia

“…Furthermore, this technique can characterize the dorsolateral sensorimotor part of the STN by revealing the presence of kinaesthetic cells responsive to active or passive contralateral joint movements [22,44,45,46]. This is of value, because the dorsolateral portion of the STN with its adjacent structures (zona incerta, fields of Forel) was found to be the optimal target for chronic stimulation [22, 39, 43,47,48,49,50,51,52,53,54,55,56]. …”

“…This technique helps to determine the location of the best contact, i.e. the site where the threshold is the lowest to produce clinical benefits and the highest to produce adverse effects [54, 60, 65]. However, this procedure significantly prolongs already long operations [35, 64], and some parkinsonian symptoms, e.g.…”

Does subthalamic nucleus stimulation induce apathy in Parkinson’s disease?

“…The overall methodology was similar to that previously described by Benabid et al [3]. The localisation of the unipolar chronic electrodes contacts at M3 and M6 was determined using the technique we have previously reported [38]. The focus of each stimulation contact was located in relation to the middle of the bicommissural line (AC-PC) by superimposing the electrode positioning picture with that of the corresponding ventriculography.…”

SPECT and PET analysis of subthalamic stimulation in Parkinson’s disease: analysis using a manual segmentation

“…During surgery, the quadripolar DBS electrodes (Medtronic, Minneapolis, MN, USA) were adjusted to achieve a maximum improvement in motor symptoms. The location of each stimulation contact was determined 3 months after surgery, by superimposing the electrode positioning picture on that of the corresponding ventriculography [40]. Distances were measured on a sheet of transparent graph paper then readjusted using a computerized spreadsheet.…”