Neurophysiological Refinement of Subthalamic Nucleus Targeting

Sterio, Djordje; Zonenshayn, Martin; Mogilner, Alon Y.; Rezai, Ali R.; Kiprovski, Kiril; Kelly, Patrick J.; Berić, Aleksandar

doi:10.1097/00006123-200201000-00012

Cited by 96 publications

(105 citation statements)

References 34 publications

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“…2 and 3). These conclusions are in favor of microelectrode recording utility in STN surgery, as suggested by other studies [38,72,79]. When these coordinates were placed on the Morel et al atlas (Fig.…”

Section: Discussionmentioning

confidence: 51%

“…Possible anteroposterior displacement was responsible for a mean euclidean error of 0.9 mm, a value which is lower than the accuracy of the stereotactic apparatus (mean euclidean error of 1 mm) [10]. Regarding the precise determination of the STN borders, microelectrode recording techniques are best suited [28,41,59,72,79]. For these reasons, we compared the stereotactic coordinates of the active contact centers obtained by teleradiological means, with the coordinates of the electrophysiologically-defined DB of the STN in each studied patient.…”

Section: Discussionmentioning

confidence: 99%

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Subthalamic nucleus stimulation in Parkinson’s disease

et al. 2006

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Subthalamic nucleus stimulation in Parkinson’s disease

et al. 2006

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“…Considering the size of the definitive implanted electrode (each contact measuring 1.5 × 1.27 mm) and the fact that the DBS electrode generates an electrical field that impinges on a relatively large volume, a ‘single-cell precision’ of targeting is probably superfluous. In fact, the peak of the firing rate in the STN did not correlate with post-operative improvement of the UPDRS score [63] or with the location of the most effective contact for chronic stimulation [40]. Multi-unit recordings appear to be convenient to ensure reliable DBS electrode placement according to STN boundaries, allowing chronic stimulation to be performed at the dorsal border of the nucleus or even in a more mediocaudal region [64].…”

Section: Discussionmentioning

confidence: 99%

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

Lefaucheur

Gurruchaga²,

Pollin³

et al. 2008

Eur Neurol

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Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) gained general acceptance in the treatment of Parkinson’s disease (PD). Objective: To study the clinical outcome and the predicting factors of efficacy of chronic STN stimulation, while DBS electrodes were implanted under local or general anaesthesia with intra-operative electrophysiological guidance based on multi-unit recordings. Methods: We included a large single-centre cohort of 54 patients with advanced PD (mean age: 59 years; disease duration: 14 years). Clinical evaluation was performed by the Unified Parkinson’s Disease Rating Scale (UPDRS) before and 1 year after surgical placement of DBS electrodes. Results: In the on-stimulation and off-medication condition, the UPDRS part III score was reduced by 56% compared to the off-stimulation condition or pre-operative off-drug score. In the on-stimulation and on-medication condition, this score was reduced by 73%. The severity of motor fluctuations and dyskinesia (UPDRS part IV) and the activities of daily living (UPDRS part II) were reduced by 65 and 80%, respectively, in the on-stimulation/on-medication condition compared to the pre-operative baseline. The daily dose of antiparkinsonian treatment was diminished by 72%. Among the various pre- and intra-operative data, the most important predictive factor for clinical efficacy of STN stimulation was the length of hyperactivity along the best track observed in intra-operative multi-unit recordings. Other predictive factors included age, disease duration and pre-operative levodopa responsiveness or baseline off-drug values of the Hoehn and Yahr and UPDRS part III scores. In contrast, the type of anaesthesia (local vs. general) did not significantly influence the clinical outcome. Conclusion: The present results are in the average of previously published results, but they have been obtained from a large single-centre cohort of patients with important reductions in the daily dose of antiparkinsonian drugs. This study confirmed the efficacy of the STN-DBS technique and emphasized the value of an original intra-operative electrophysiological approach based on multi-unit and not single-unit quantified recordings. This method allows DBS electrode implantation to be safely performed under general anaesthesia without lessening the rate of efficacy of the procedure.

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“…Localization to the sensorimotor STN is confirmed by movement-related activity during active and passive examination during surgery [11]. The length of the sensorimotor STN is used by many centers (including ours) as one criterion for the final DBS electrode placement [12,13] - in conjunction with microstimulation and macrostimulation techniques. …”

Section: Introductionmentioning

confidence: 99%

“…In these publications, the length of the STN is implied as a criterion for DBS implantation. Defining the borders and the extent of the STN is encouraged by a number of other authors [7,8,10,13,25,26,27,28,29]. However, to our knowledge, the relationship between the electrophysiologic STN length and clinical outcomes has not been examined.…”

Section: Introductionmentioning

confidence: 99%

The Relationship of Electrophysiologic Subthalamic Nucleus Length as a Predictor of Outcomes in Deep Brain Stimulation for Parkinson Disease

Shenai

Patel²,

Romeo³

et al. 2017

Stereotact Funct Neurosurg

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Background: Intraoperative measurement of subthalamic nucleus (STN) width through microelectrode recording (MER) is a common proxy for optimal electrode location during deep brain stimulation (DBS) surgery for Parkinson disease. We assessed whether the MER-determined STN width is a predictor of postoperative Unified Parkinson Disease Rating Scale (UPDRS) improvement. Methods: Records were reviewed for patients who underwent single-sided STN DBS placement for Parkinson disease between 2005 and 2010 at the UAB Medical Center. Reviews of preoperative and 3-month postoperative UPDRS part III, intraoperative MER records, and postoperative MRI scans were conducted. Results: The final cohort consisted of 73 patients (mean age 59 ± 9.7 years, length of disease 13 ± 9.7 years). STN widths were defined as depths associated with increased background activity and motor-driven, spiking action potentials on MER. The mean contralateral UPDRS improvement was 58% (± 24). The mean STN width was 5.1 mm (± 1.6, min = 0.0, max = 8.7). No significant relationship between STN width and UPDRS improvement was found, with and without AC-PC normalization (R² < 0.05). Conclusion: This analysis raises questions about seeking the maximal electrophysiological width of STN as a proxy for optimal outcome in DBS for PD. We suggest this strategy for DBS placement in Parkinson disease be subject to more robust prospective investigation.

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Neurophysiological Refinement of Subthalamic Nucleus Targeting

Cited by 96 publications

References 34 publications

Subthalamic nucleus stimulation in Parkinson’s disease

Subthalamic nucleus stimulation in Parkinson’s disease

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

The Relationship of Electrophysiologic Subthalamic Nucleus Length as a Predictor of Outcomes in Deep Brain Stimulation for Parkinson Disease

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