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Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease.
Neurosurgery. 2007 Sep; 61(3 Suppl):119-27; discussion 127-9.N

Abstract

OBJECTIVE

The aim of this study is to establish the safety and efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients with disabling motor fluctuations performed with an expedient procedure with limited intraoperative mapping.

METHODS

Bilateral STN DBS systems were implanted in 110 PD patients. Targeting of STN was achieved with T2-weighted magnetic resonance imaging guidance and a stereotactic navigation system confirmed by limited electrophysiological mapping. The safety of the procedure was analyzed in all 110 patients. The efficacy of the procedure was assessed in the practically-defined off medication state in the 72 patients who underwent evaluations 3 to 12 months after electrode implantation.

RESULTS

Adverse effects were infrequent and transient with no incidence of death, hemiparesis, or seizure. In the 72 patients, STN DBS reduced total Unified Parkinson's Disease Rating Scale motor scores at the time of the follow-up evaluation by 47% from 43.4 +/- 16.1 with stimulators off to 22.8 +/- 11.6 with stimulators on (P < 0.001). The changes in Unified Parkinson's Disease Rating Scale motor subscores improved as follows: rest tremor, 74% (P < 0.001); rigidity, 58% (P < 0.001); bradykinesia, 37% (P < 0.001); pull test, 35% (P < 0.001); gait, 44% (P < 0.001); axial signs, 42% (P < 0.001); and speech, 13% (P = 0.002). The prescribed total daily levodopa-equivalent dose decreased 45 +/- 32%. We averaged 1.3 +/- 0.9 electrodes passes per lead implantation. The mean operating time from the mounting of the stereotactic frame to its removal was 5 hours 42 minutes (median, 5 h 25 min; standard deviation, 1 h 12 min).

CONCLUSION

This STN DBS surgical technique for PD is expedient with effective outcomes and low complication rates.

Authors+Show Affiliations

Department of Neurology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. tabbals@neuro.wustl.eduNo 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)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17876242

Citation

Tabbal, Samer D., et al. "Safety and Efficacy of Subthalamic Nucleus Deep Brain Stimulation Performed With Limited Intraoperative Mapping for Treatment of Parkinson's Disease." Neurosurgery, vol. 61, no. 3 Suppl, 2007, pp. 119-27; discussion 127-9.
Tabbal SD, Revilla FJ, Mink JW, et al. Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery. 2007;61(3 Suppl):119-27; discussion 127-9.
Tabbal, S. D., Revilla, F. J., Mink, J. W., Schneider-Gibson, P., Wernle, A. R., de Erausquin, G. A., Perlmutter, J. S., Rich, K. M., & Dowling, J. L. (2007). Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. Neurosurgery, 61(3 Suppl), 119-27; discussion 127-9.
Tabbal SD, et al. Safety and Efficacy of Subthalamic Nucleus Deep Brain Stimulation Performed With Limited Intraoperative Mapping for Treatment of Parkinson's Disease. Neurosurgery. 2007;61(3 Suppl):119-27; discussion 127-9. PubMed PMID: 17876242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease. AU - Tabbal,Samer D, AU - Revilla,Fredy J, AU - Mink,Jonathan W, AU - Schneider-Gibson,Patricia, AU - Wernle,Angela R, AU - de Erausquin,Gabriel A, AU - Perlmutter,Joel S, AU - Rich,Keith M, AU - Dowling,Joshua L, PY - 2007/10/3/pubmed PY - 2007/10/30/medline PY - 2007/10/3/entrez SP - 119-27; discussion 127-9 JF - Neurosurgery JO - Neurosurgery VL - 61 IS - 3 Suppl N2 - OBJECTIVE: The aim of this study is to establish the safety and efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients with disabling motor fluctuations performed with an expedient procedure with limited intraoperative mapping. METHODS: Bilateral STN DBS systems were implanted in 110 PD patients. Targeting of STN was achieved with T2-weighted magnetic resonance imaging guidance and a stereotactic navigation system confirmed by limited electrophysiological mapping. The safety of the procedure was analyzed in all 110 patients. The efficacy of the procedure was assessed in the practically-defined off medication state in the 72 patients who underwent evaluations 3 to 12 months after electrode implantation. RESULTS: Adverse effects were infrequent and transient with no incidence of death, hemiparesis, or seizure. In the 72 patients, STN DBS reduced total Unified Parkinson's Disease Rating Scale motor scores at the time of the follow-up evaluation by 47% from 43.4 +/- 16.1 with stimulators off to 22.8 +/- 11.6 with stimulators on (P < 0.001). The changes in Unified Parkinson's Disease Rating Scale motor subscores improved as follows: rest tremor, 74% (P < 0.001); rigidity, 58% (P < 0.001); bradykinesia, 37% (P < 0.001); pull test, 35% (P < 0.001); gait, 44% (P < 0.001); axial signs, 42% (P < 0.001); and speech, 13% (P = 0.002). The prescribed total daily levodopa-equivalent dose decreased 45 +/- 32%. We averaged 1.3 +/- 0.9 electrodes passes per lead implantation. The mean operating time from the mounting of the stereotactic frame to its removal was 5 hours 42 minutes (median, 5 h 25 min; standard deviation, 1 h 12 min). CONCLUSION: This STN DBS surgical technique for PD is expedient with effective outcomes and low complication rates. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/17876242/Safety_and_efficacy_of_subthalamic_nucleus_deep_brain_stimulation_performed_with_limited_intraoperative_mapping_for_treatment_of_Parkinson's_disease_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/01.neu.0000289725.97211.51 DB - PRIME DP - Unbound Medicine ER -