Multiple Microelectrode Recordings in STN‐DBS Surgery for Parkinson's Disease: A Randomized Study

Bjerknes, Silje; Toft, Mathias; Konglund, Ane; Pham, Uyen; Waage, Trine Rygvold; Pedersen, Lena; Skjelland, Mona; Haraldsen, Ira; Andersson, Stein; Dietrichs, Espen; Skogseid, Inger Marie

doi:10.1002/mdc3.12621

Cited by 27 publications

(28 citation statements)

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“…Three patients had surgical site infections with subsequent hardware explantation and discontinuation of neurostimulation (before the 3-month follow-up), and two patients were lost to 1-year follow-up. Significant improvements were found for MDS-UPDRS I-IV, Parkinson's Disease Questionnaire-39 (PDQ-39), and levodopa equivalent daily dosage (LEDD) 30 at both the 3-and 12-month evaluations, as presented in our previous publication 29 ( Table 2).…”

Section: Resultssupporting

confidence: 53%

“…The primary endpoints of the parent trial were the differences in motor outcome (scores of MDS-UPDRS III medication-off) and quality of life (PDQ-39), from baseline to 1 year of STN-DBS. The multiple simultaneous MER group had a significantly greater improvement both in MDS-UPDRS III off score and in two PDQ-39 domains (activities of daily living and bodily discomfort) 29 .…”

Section: Methodsmentioning

confidence: 89%

“…In this study, 60 patients were included, operated, and examined preoperatively, with planned follow-up after 3 and 12 months of continuous STN-DBS 29 . There were no significant differences in Parkinson's Disease Sleep Scale (PDSS) or Scopa-Aut (scales for outcomes in PD-autonomic) between the two randomization groups of the parent study (see "Methods" section), neither regarding improvement from baseline to the 12-month follow-up nor in the scores at the different time points.…”

Section: Resultsmentioning

confidence: 99%

“…We compared two methods of using up to five trajectories of preoperative microelectrode recordings (MER): single sequential versus multiple simultaneous introduction of MER to guide the placement of the permanent electrode. The detailed description of the study design (including surgical procedure) and the main results of this study on motor and quality of life outcomes have been published previously 29 . The primary endpoints of the parent trial were the differences in motor outcome (scores of MDS-UPDRS III medication-off) and quality of life (PDQ-39), from baseline to 1 year of STN-DBS.…”

Section: Methodsmentioning

confidence: 99%

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Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Bjerknes

Skogseid

Hauge

et al. 2020

npj Parkinsons Dis.

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Parkinson’s disease (PD) is a complex multisystem disorder with motor and non-motor symptoms (NMS). NMS may have an even greater impact on quality of life than motor symptoms. Subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to improve motor fluctuations and quality of life, whereas the effects on different NMS have been less examined. Sleep disturbances and autonomic dysfunction are among the most prevalent NMS. We here report the efficacy of STN-DBS on sleep disturbances and autonomic dysfunction. In the parent trial, 60 patients were included in a single-center randomized prospective study, with MDS-UPDRS III and PDQ-39 as primary endpoints at 12 months of STN-DBS. Preplanned assessments at baseline and postoperatively at 3 and 12 months also included Parkinson’s Disease Sleep Scale (PDSS); Scopa-Aut; and MDS-UPDRS I, II, and IV. We found that STN-DBS had a significant and lasting positive effect on overall sleep quality, nocturnal motor symptoms and restlessness, and daytime dozing. Several aspects of autonomic dysfunction were also improved at 3 months postoperatively, although at 12 months only thermoregulation (sudomotor symptoms) remained significantly improved. We could not identify preoperative factors that predicted improvement in PDSS or Scopa-Aut. There was a close relationship between improved autonomic symptoms and improved quality of life after 1 year. NMS and especially sleep and autonomic dysfunction deserve more focus to improve patient outcomes further.

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Section: Resultssupporting

confidence: 53%

Section: Methodsmentioning

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Bjerknes

Skogseid

Hauge

et al. 2020

npj Parkinsons Dis.

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“…When small targets are used in DBS surgery, also surgical precision may be an issue. Our operating neurosurgeons have long experience from DBS implantation, and they have obtained very good results from stimulation on other targets . Still, our results show that the final electrode position along different axes often were more than 1‐2 mm away from the planned target.…”

Section: Discussionmentioning

confidence: 72%

Direct visual targeting versus preset coordinates for ANT‐DBS in epilepsy

Nome

Herrman

Kai³

et al. 2020

Acta Neurol Scand

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Deep brain stimulation (DBS) of the anterior nucleus of thalamus (ANT) is an evolving treatment option in refractory focal epilepsy. 1,2 The SANTE study 3 was for a long time the only randomized double-blinded trial with bilateral implantation of DBS electrodes to the ANT. They found that bilateral ANT stimulation reduced seizures with a sustained effect for 2 years. An open follow-up continuation of the study showed reduction in the median seizure frequency by 69% from baseline after 5 years of stimulation. 4 Funding informationThis project has been made possible by Dam Foundation.Objectives: Deep brain stimulation (DBS) of the anterior thalamic nucleus (ANT) may be used against refractory focal epilepsy, but only two randomized double-blinded trials have been performed. The Oslo study was discontinued prematurely since reduction in seizure frequency was less than expected. The aim of the present study was to review the targeting used in the Oslo study and to identify the actual positions of the contacts used for stimulation. Material and methods:BrainLab MRI data were available from 12 Oslo study patients. Based on MRI the coordinates of the center of the ANT were identified. The coordinates were considered as the visually identified preferred target and were compared with the target originally used for ANT electrode implantation and with the actual electrode positions estimated from post-operative CT scans. Results:We found considerable differences between the visually identified preferred target, the originally planned target, and the actual electrode position. The total distance between the active electrode position and the visually identified preferred target was on average 3.3 mm on the right and 2.9 mm on the left side. Conclusion:Indirect targeting based on preset coordinates may contribute to explain the modest effect of ANT-DBS on seizure frequency seen in the Oslo study.Observed differences between the center of the ANT and the actual electrode position may at least in part be explained by variations in position and size of the ANT. Direct identification of the target using better MRI imaging protocols is recommended for future ANT-DBS surgery. K E Y W O R D Santerior nucleus of thalamus, deep brain stimulation, epilepsy 24 | NOME Et al.

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Deep Brain Stimulation for Arm Tremor: A Randomized Trial Comparing Two Targets

Kvernmo

Konglund

Reich

et al. 2022

Annals of Neurology

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Objective Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) effectively suppresses arm tremor. Uncontrolled studies suggest the posterior subthalamic area (PSA) may be superior. We compared the intra‐individual efficacy of VIM‐ versus PSA‐DBS on tremor suppression and arm function. Methods We performed a randomized, double‐blind, crossover trial at Oslo University Hospital in patients (18–80 years) with isolated or combined action tremor affecting at least one arm. Four‐contact DBS leads were implanted (bi‐ or unilaterally) with a trajectory to cover the VIM (upper two contacts) and PSA (lower two contacts). Patients were randomized (1:1 ratio) post‐surgery to: Group 1, VIM‐stimulation months 0–3 (period 1), then PSA‐stimulation months 4–6 (period 2); Group 2, PSA‐stimulation first, then VIM‐stimulation. Primary endpoint was the difference in improvement from baseline to the end of the VIM‐ versus PSA‐period in the sum of the dominant arm tremor scores of the Fahn‐Tolosa‐Marin Tremor Rating Scale (FTMTRS), items 5/6 + 10−14. Results Forty‐five patients were randomized to Group 1 (n = 23) or 2 (n = 22). In the primary endpoint per‐protocol analysis (mixed model, n = 40), mean difference in the sum FTMTRS score improvement for the dominant arm was −2.65 points (95% CI −4.33 to −0.97; p = 0.002). The difference in favour of PSA stimulation was highly significant in period 2, but not period 1. Interpretation Our randomized trial demonstrated that PSA stimulation provided superior tremor suppression compared with VIM stimulation. A period effect reducing tremor for up to three months in both groups was most likely attributed to a post‐surgery stun effect. ANN NEUROL 2022;91:585–601

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Multiple Microelectrode Recordings in STN‐DBS Surgery for Parkinson's Disease: A Randomized Study

Cited by 27 publications

References 43 publications

Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Direct visual targeting versus preset coordinates for ANT‐DBS in epilepsy

Deep Brain Stimulation for Arm Tremor: A Randomized Trial Comparing Two Targets

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