Subthalamic nucleus stimulation in Parkinson’s disease

Godinho, Fábio; Thobois, Stéphane; Magnin, M.; Guénot, Marc; Polo, Gustavo; Bénatru, Isabelle; Xie, Jing; Salvetti, A.; Garcia-Larrea, Luis; Broussolle, Emmanuel; Mertens, Patrick

doi:10.1007/s00415-006-0222-z

Cited by 92 publications

(21 citation statements)

References 78 publications

(106 reference statements)

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“…Furthermore, we could confirm previous reports [22,24,25] that there is a correlation between the center of the electrophysiological and anatomical signal of the STN with a mean deviation of only 0.8 mm (SD 1.7) (p = 0.55). The standard deviation of the anatomical center of 0.9 mm was slightly lower than in a previous study [24].…”

Section: Discussionsupporting

confidence: 79%

“…Considering the anatomical and electrophysiological borders, 14 and 50% of active contacts are found dorsal to the dorsolateral STN border, respectively. These findings are compared with former studies evaluating the localization of the most effective contacts [9,10,22] in table 2. They are consistent with our study showing that the majority of active contacts are found within or dorsal to the dorsolateral STN.…”

Section: Discussionmentioning

confidence: 76%

“…Interestingly, Godinho et al [22] found a good concordance between an immunohistological-based atlas [26] and the electrophysiological borders. This finding underlines the hypothesis that the STN signal on T2-weighted images exaggerates the actual size of the STN.…”

Section: Discussionmentioning

confidence: 99%

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Correlation of Active Contact Positions with the Electrophysiological and Anatomical Subdivisions of the Subthalamic Nucleus in Deep Brain Stimulation

Weise¹,

Seifried

Eibach³

et al. 2013

Stereotact Funct Neurosurg

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Background: The most effective contacts in subthalamic nucleus (STN) deep brain stimulation are reported to be dorsolateral, and suppression of synchronized oscillatory activity might be a mechanism of action. Objectives: To analyze the optimal contact position in regard to the anatomical and electrophysiological position and to determine whether oscillatory and bursty activity is more frequent around the active contact. Methods: In 21 patients, the clinically most effective contacts were analyzed according to their relative position to the anatomical and electrophysiological STN center, which was assessed by T2-weighted MRI and microrecording. In 12 out of 21 consecutive patients, autocorrelograms of the action potentials within the vicinity of the active contact were compared to the most ventromedial reference contact. Results: The isocenter of the anatomical and electrophysiological STN had a mean deviation of 0.8 mm (SD 1.45). Thirty-two out of 42 active contacts were found dorsal to the anatomical isocenter of the STN. None of the active contacts were ventral to the STN. Synchronized oscillatory or bursty activity was found in 67% of the patients within the vicinity of the active contact. In 64% of the patients, the ventromedial reference contact showed irregular activity. Conclusions: Synchronized activity in the autocorrelogram correlates with the most effective contact. The optimal localization of the finally stimulated contact is dorsal to the STN isocenter.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 76%

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Correlation of Active Contact Positions with the Electrophysiological and Anatomical Subdivisions of the Subthalamic Nucleus in Deep Brain Stimulation

Weise¹,

Seifried

Eibach³

et al. 2013

Stereotact Funct Neurosurg

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“…This is consistent with clinical studies that have shown correlations between the location of the active contact within the target nuclei and the outcome of STN-DBS. Retrospective studies using magnetic resonance imaging have indicated that the dorsal areas of the STN, the dorsal border of the STN, and structures dorsal to the STN (e.g., zona incerta) are effective sites for STN DBS in PD (Voges et al 2002; Hamel et al 2003; Yelnik et al 2003; Zonenshayn et al 2004; Godinho et al 2006; Yokoyama et al 2006; Pollo et al 2007; Johnsen et al 2010). Computational studies that combined quantitative clinical outcome measures with brain atlas models have also indentified areas dorsal to the STN as optimal target regions for treating rigidity and bradykinesia (Butson et al 2010).…”

Section: Discussionmentioning

confidence: 99%

Relative contributions of local cell and passing fiber activation and silencing to changes in thalamic fidelity during deep brain stimulation and lesioning: a computational modeling study

2011

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Deep brain stimulation (DBS) and lesioning are two surgical techniques used in the treatment of advanced Parkinson’s disease (PD) in patients whose symptoms are not well controlled by drugs, or who experience dyskinesias as a side effect of medications. Although these treatments have been widely practiced, the mechanisms behind DBS and lesioning are still not well understood. The subthalamic nucleus (STN) and globus pallidus pars interna (GPi) are two common targets for both DBS and lesioning. Previous studies have indicated that DBS not only affects local cells within the target, but also passing axons within neighboring regions. Using a computational model of the basal ganglia-thalamic network, we studied the relative contributions of activation and silencing of local cells (LCs) and fibers of passage (FOPs) to changes in the accuracy of information transmission through the thalamus (thalamic fidelity), which is correlated with the effectiveness of DBS. Activation of both LCs and FOPs during STN and GPi-DBS were beneficial to the outcome of stimulation. During STN and GPi lesioning, effects of silencing LCs and FOPs were different between the two types of lesioning. For STN lesioning, silencing GPi FOPs mainly contributed to its effectiveness, while silencing only STN LCs did not improve thalamic fidelity. In contrast, silencing both GPi LCs and GPe FOPs during GPi lesioning contributed to improvements in thalamic fidelity. Thus, two distinct mechanisms produced comparable improvements in thalamic function: driving the output of the basal ganglia to produce tonic inhibition and silencing the output of the basal ganglia to produce tonic disinhibition. These results show the importance of considering effects of activating or silencing fibers passing close to the nucleus when deciding upon a target location for DBS or lesioning.

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“…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]. …”

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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Subthalamic nucleus stimulation in Parkinson’s disease

Abstract: In our series, most of the active electrodes were situated near the STN-DB. This suggests that HFS-STN could influence not only STN but also the dorsal adjacent structures (zona incerta and/or Fields of Forel).

Cited by 92 publications

References 78 publications

Correlation of Active Contact Positions with the Electrophysiological and Anatomical Subdivisions of the Subthalamic Nucleus in Deep Brain Stimulation

Correlation of Active Contact Positions with the Electrophysiological and Anatomical Subdivisions of the Subthalamic Nucleus in Deep Brain Stimulation

Relative contributions of local cell and passing fiber activation and silencing to changes in thalamic fidelity during deep brain stimulation and lesioning: a computational modeling study

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

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