Motor outcome and electrode location in deep brain stimulation in Parkinson's disease

Abstract

ObjectivesTo evaluate the efficacy and adverse effects of subthalamic deep brain stimulation (STN‐DBS) in patients with advanced Parkinson's disease (PD) and the possible correlation between electrode location and clinical outcome.MethodsWe retrospectively reviewed 87 PD‐related STN‐DBS operations at Helsinki University Hospital (HUH) from 2007 to 2014. The changes of Unified Parkinson's Disease Rating Scale (UPDRS) part III score, Hoehn & Yahr stage, antiparkinson medication, and adverse effects were studied. We estimated the active electrode location in three different coordinate systems: direct visual analysis of MRI correlated to brain atlas, location in relation to the nucleus borders and location in relation to the midcommisural point.ResultsAt 6 months after operation, both levodopa equivalent doses (LEDs; 35%, Wilcoxon signed‐rank test = 0.000) and UPDRS part III scores significantly decreased (38%, Wilcoxon signed‐rank test = 0.000). Four patients (5%) suffered from moderate DBS‐related dysarthria. The generator and electrodes had to be removed in one patient due to infection (1%). Electrode coordinates in the three coordinate systems correlated well with each other. On the left side, more ventral location of the active contact was associated with greater LED decrease.ConclusionsSTN‐DBS improves motor function and enables the reduction in antiparkinson medication with an acceptable adverse effect profile. More ventral location of the active contact may allow stronger LED reduction. Further research on the correlation between contact location, clinical outcome, and LED reduction is warranted.

Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis

“…The main descriptive characteristics of the eligible studies are summarized in Table 1. All studies were of cohort design yielding a total sample size of 12,258 participants (10,42–106). The follow‐up period ranged from 0.5 to 22 years (median: 3.35 years).…”

A comparison of indirect and direct targeted STN DBS in the treatment of Parkinson’s disease—surgical method and clinical outcome over 15-year timespan

“…Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been a surgical treatment option for advanced Parkinson disease (PD) for over two decades in situations where antiparkinsonian medication (APM) is insufficient or poorly tolerated [12,14]. Its ability to reduce motor symptoms and levodopa-induced dyskinesias has been well-documented [13,18,23].…”

Rat subthalamic stimulation: Evaluating stimulation-induced dyskinesias, choosing stimulation currents and evaluating the anti-akinetic effect in the cylinder test

“…Furthermore, a therapeutic anti-akinetic effect was found not only with electrodes implanted in the STN but also with electrodes implanted in the larger subthalamic area, including the zona incerta dorsal to the STN, as has been reported in clinical DBS [23,32]. It is also necessary to note that because the electrode configuration used in this study had a thinner active electrode in the tip and 1 mm proximal and superior to it a larger electrode (current sink), the electric field practically always spans over the zona incerta and fibers traversing to and from the STN [33].…”