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Subthalamic stimulation for Parkinson disease: determination of electrode location necessary for clinical efficacy.
Neurosurg Focus. 2005 Nov 15; 19(5):E12.NF

Abstract

OBJECT

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) performed using intraoperative microelectrode recording (MER) to adjust electrode placement has become a widely used treatment for patients with advanced Parkinson disease (PD). Few studies have been conducted to examine the location of implanted electrodes relative to the intended target, and even fewer have been undertaken to investigate the degree to which variations in the location of these electrodes impacts their clinical efficacy. This study was performed to examine these issues.

METHODS

The authors located 52 bilaterally implanted DBS electrode tips on postoperative magnetic resonance (MR) images obtained in 26 consecutive patients. Postoperative and preoperative planning MR images were merged to determine the DBS electrode tip coordinates relative to the midcommissural point. Surgical records listed the intended target coordinates for each DBS electrode tip. Clinical outcome assessment included the Unified PD Rating Scale (UPDRS) motor score at 1 year, standardized questionnaires, and routine follow-up visits. The mean difference between electrode tip location and intended target for all 52 electrodes was less than 2 mm in all axes. Only one electrode was farther than 3 mm from the intended target, and this was the only electrode that had to be replaced due to lack of clinical efficacy (lack of tremor suppression); its reimplantation 4 mm more medially provided excellent tremor control. High correlation coefficients indicate that the MR imaging analysis accurately determined the anatomical location of the electrode tips. Blinded videotape reviews of UPDRS motor scores comparing effects of stimulation in patients who were "on" and "off" medication identified subgroups in whom there was minimal and maximal stimulation response. Patients in these subgroups had no differences between the MR imaging-determined actual electrode tip location and its intended location. Similarly, improvements of dyskinesias and severity of symptoms encountered during the wearing-off period for the drug did not correlate with variations of electrode tip location.

CONCLUSIONS

The findings in this study lead the authors to suggest that a DBS electrode placed anywhere within a 6-mm-diameter cylinder centered at the presumed middle of the STN (based on stereotactic atlas coordinates) provides similar clinical efficacy. Future studies may be warranted to evaluate prospectively the degree to which MER modification of the anatomically and/or image-determined target improves clinical efficacy of DBS electrodes.

Authors+Show Affiliations

Department of Neurological Surgery and Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16398462

Citation

McClelland, Shearwood, et al. "Subthalamic Stimulation for Parkinson Disease: Determination of Electrode Location Necessary for Clinical Efficacy." Neurosurgical Focus, vol. 19, no. 5, 2005, pp. E12.
McClelland S, Ford B, Senatus PB, et al. Subthalamic stimulation for Parkinson disease: determination of electrode location necessary for clinical efficacy. Neurosurg Focus. 2005;19(5):E12.
McClelland, S., Ford, B., Senatus, P. B., Winfield, L. M., Du, Y. E., Pullman, S. L., Yu, Q., Frucht, S. J., McKhann, G. M., & Goodman, R. R. (2005). Subthalamic stimulation for Parkinson disease: determination of electrode location necessary for clinical efficacy. Neurosurgical Focus, 19(5), E12.
McClelland S, et al. Subthalamic Stimulation for Parkinson Disease: Determination of Electrode Location Necessary for Clinical Efficacy. Neurosurg Focus. 2005 Nov 15;19(5):E12. PubMed PMID: 16398462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subthalamic stimulation for Parkinson disease: determination of electrode location necessary for clinical efficacy. AU - McClelland,Shearwood,3rd AU - Ford,Blair, AU - Senatus,Patrick B, AU - Winfield,Linda M, AU - Du,Yunling E, AU - Pullman,Seth L, AU - Yu,Qiping, AU - Frucht,Steven J, AU - McKhann,Guy M,2nd AU - Goodman,Robert R, Y1 - 2005/11/15/ PY - 2006/1/10/pubmed PY - 2006/7/13/medline PY - 2006/1/10/entrez SP - E12 EP - E12 JF - Neurosurgical focus JO - Neurosurg Focus VL - 19 IS - 5 N2 - OBJECT: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) performed using intraoperative microelectrode recording (MER) to adjust electrode placement has become a widely used treatment for patients with advanced Parkinson disease (PD). Few studies have been conducted to examine the location of implanted electrodes relative to the intended target, and even fewer have been undertaken to investigate the degree to which variations in the location of these electrodes impacts their clinical efficacy. This study was performed to examine these issues. METHODS: The authors located 52 bilaterally implanted DBS electrode tips on postoperative magnetic resonance (MR) images obtained in 26 consecutive patients. Postoperative and preoperative planning MR images were merged to determine the DBS electrode tip coordinates relative to the midcommissural point. Surgical records listed the intended target coordinates for each DBS electrode tip. Clinical outcome assessment included the Unified PD Rating Scale (UPDRS) motor score at 1 year, standardized questionnaires, and routine follow-up visits. The mean difference between electrode tip location and intended target for all 52 electrodes was less than 2 mm in all axes. Only one electrode was farther than 3 mm from the intended target, and this was the only electrode that had to be replaced due to lack of clinical efficacy (lack of tremor suppression); its reimplantation 4 mm more medially provided excellent tremor control. High correlation coefficients indicate that the MR imaging analysis accurately determined the anatomical location of the electrode tips. Blinded videotape reviews of UPDRS motor scores comparing effects of stimulation in patients who were "on" and "off" medication identified subgroups in whom there was minimal and maximal stimulation response. Patients in these subgroups had no differences between the MR imaging-determined actual electrode tip location and its intended location. Similarly, improvements of dyskinesias and severity of symptoms encountered during the wearing-off period for the drug did not correlate with variations of electrode tip location. CONCLUSIONS: The findings in this study lead the authors to suggest that a DBS electrode placed anywhere within a 6-mm-diameter cylinder centered at the presumed middle of the STN (based on stereotactic atlas coordinates) provides similar clinical efficacy. Future studies may be warranted to evaluate prospectively the degree to which MER modification of the anatomically and/or image-determined target improves clinical efficacy of DBS electrodes. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/16398462/Subthalamic_stimulation_for_Parkinson_disease:_determination_of_electrode_location_necessary_for_clinical_efficacy_ L2 - https://www.diseaseinfosearch.org/result/5603 DB - PRIME DP - Unbound Medicine ER -