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Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.
Arch Neurol. 2008 May; 65(5):612-6.AN

Abstract

BACKGROUND

The misplacement of electrodes is a possible explanation for suboptimal response to bilateral subthalamic nucleus (STN) stimulation in patients with Parkinson disease.

OBJECTIVE

To evaluate whether reimplantation of electrodes in the STN can produce improvement in patients with poor results from surgery and with suspected electrode misplacement based on imaging findings.

DESIGN

Prospective follow-up study.

SETTING

Academic research.

PATIENTS

A 1-year postoperative study was undertaken in 7 consecutive patients with Parkinson disease who, despite bilateral STN stimulation, experienced persistent motor disability and who were operated on for reimplantation a median of 16.9 months later.

MAIN OUTCOME MEASURES

The primary outcome was measured as the change in the Unified Parkinson Disease Rating Scale (UPDRS) motor score 1 year after reimplantation. The secondary outcome was measured as the extent of pharmacologic and electrical treatments required and the threshold at which the first stimulation-induced adverse effect appeared. The distances between the electrode contacts used for chronic stimulation and the STN theoretical effective target, defined as the mean position of the clinically efficient contact from 193 previously implanted electrodes, were compared.

RESULTS

Except for a single patient, all patients displayed improvement following reimplantation. Under off-medication (ie, the patient is taking no medication) condition, STN stimulation improved the basal state UPDRS motor score by 26.7% before reimplantation and by 59.4% at 1 year after reimplantation. The median off-medication Schwab and England score improved from 51% to 76%. The median levodopa equivalent daily dose was reduced from 1202 mg to 534 mg. The stimulation varibles changed from a mean of 2.6 V/73.0 micros/163.0 Hz to 2.8 V/60. 0 micros/ 140.0 Hz. The mean threshold of the first stimulation-induced adverse effect increased from 2.6 to 4.4 V. The mean distance between the contacts used for chronic stimulation and the theoretical effective target decreased from 5.4 to 2.0 mm. This distance correlated inversely with the percentage improvement in theUPDRS motor score.

CONCLUSION

Patients demonstrating poor response to STN stimulation as a result of electrode misplacement can benefit from reimplantation in the STN closer to the theoretical target.

Authors+Show Affiliations

Department of Neurology, University Hospital A. Michallon, Grenoble, France. anheim@titus.u-strasbg.frNo 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)

Journal Article

Language

eng

PubMed ID

18474736

Citation

Anheim, Mathieu, et al. "Improvement in Parkinson Disease By Subthalamic Nucleus Stimulation Based On Electrode Placement: Effects of Reimplantation." Archives of Neurology, vol. 65, no. 5, 2008, pp. 612-6.
Anheim M, Batir A, Fraix V, et al. Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. Arch Neurol. 2008;65(5):612-6.
Anheim, M., Batir, A., Fraix, V., Silem, M., Chabardès, S., Seigneuret, E., Krack, P., Benabid, A. L., & Pollak, P. (2008). Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. Archives of Neurology, 65(5), 612-6. https://doi.org/10.1001/archneur.65.5.612
Anheim M, et al. Improvement in Parkinson Disease By Subthalamic Nucleus Stimulation Based On Electrode Placement: Effects of Reimplantation. Arch Neurol. 2008;65(5):612-6. PubMed PMID: 18474736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. AU - Anheim,Mathieu, AU - Batir,Alina, AU - Fraix,Valérie, AU - Silem,Madjid, AU - Chabardès,Stéphan, AU - Seigneuret,Eric, AU - Krack,Paul, AU - Benabid,Alim-Louis, AU - Pollak,Pierre, PY - 2008/5/14/pubmed PY - 2008/7/17/medline PY - 2008/5/14/entrez SP - 612 EP - 6 JF - Archives of neurology JO - Arch Neurol VL - 65 IS - 5 N2 - BACKGROUND: The misplacement of electrodes is a possible explanation for suboptimal response to bilateral subthalamic nucleus (STN) stimulation in patients with Parkinson disease. OBJECTIVE: To evaluate whether reimplantation of electrodes in the STN can produce improvement in patients with poor results from surgery and with suspected electrode misplacement based on imaging findings. DESIGN: Prospective follow-up study. SETTING: Academic research. PATIENTS: A 1-year postoperative study was undertaken in 7 consecutive patients with Parkinson disease who, despite bilateral STN stimulation, experienced persistent motor disability and who were operated on for reimplantation a median of 16.9 months later. MAIN OUTCOME MEASURES: The primary outcome was measured as the change in the Unified Parkinson Disease Rating Scale (UPDRS) motor score 1 year after reimplantation. The secondary outcome was measured as the extent of pharmacologic and electrical treatments required and the threshold at which the first stimulation-induced adverse effect appeared. The distances between the electrode contacts used for chronic stimulation and the STN theoretical effective target, defined as the mean position of the clinically efficient contact from 193 previously implanted electrodes, were compared. RESULTS: Except for a single patient, all patients displayed improvement following reimplantation. Under off-medication (ie, the patient is taking no medication) condition, STN stimulation improved the basal state UPDRS motor score by 26.7% before reimplantation and by 59.4% at 1 year after reimplantation. The median off-medication Schwab and England score improved from 51% to 76%. The median levodopa equivalent daily dose was reduced from 1202 mg to 534 mg. The stimulation varibles changed from a mean of 2.6 V/73.0 micros/163.0 Hz to 2.8 V/60. 0 micros/ 140.0 Hz. The mean threshold of the first stimulation-induced adverse effect increased from 2.6 to 4.4 V. The mean distance between the contacts used for chronic stimulation and the theoretical effective target decreased from 5.4 to 2.0 mm. This distance correlated inversely with the percentage improvement in theUPDRS motor score. CONCLUSION: Patients demonstrating poor response to STN stimulation as a result of electrode misplacement can benefit from reimplantation in the STN closer to the theoretical target. SN - 1538-3687 UR - https://www.unboundmedicine.com/medline/citation/18474736/Improvement_in_Parkinson_disease_by_subthalamic_nucleus_stimulation_based_on_electrode_placement:_effects_of_reimplantation_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/archneur.65.5.612 DB - PRIME DP - Unbound Medicine ER -