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Parkinson's disease outcomes after intraoperative CT-guided "asleep" deep brain stimulation in the globus pallidus internus.
J Neurosurg. 2016 Apr; 124(4):902-7.JN

Abstract

OBJECTIVE

Recent studies show that deep brain stimulation can be performed safely and accurately without microelectrode recording ortest stimulation but with the patient under general anesthesia. The procedure couples techniques for direct anatomical targeting on MRI with intraoperative imaging to verify stereotactic accuracy. However, few authors have examined the clinical outcomes of Parkinson's disease (PD) patients after this procedure. The purpose of this study was to evaluate PD outcomes following "asleep" deep brain stimulation in the globus pallidus internus (GPi).

METHODS

The authors prospectively examined all consecutive patients with advanced PD who underwent bilateral GPi electrode placement while under general anesthesia. Intraoperative CT was used to assess lead placement accuracy. The primary outcome measure was the change in the off-medication Unified Parkinson's Disease Rating Scale motor score 6 months after surgery. Secondary outcomes included effects on the 39-Item Parkinson's Disease Questionnaire (PDQ-39) scores, on-medication motor scores, and levodopa equivalent daily dose. Lead locations, active contact sites, stimulation parameters, and adverse events were documented.

RESULTS

Thirty-five patients (24 males, 11 females) had a mean age of 61 years at lead implantation. The mean radial error off plan was 0.8 mm. Mean coordinates for the active contact were 21.4 mm lateral, 4.7 mm anterior, and 0.4 mm superior to the midcommissural point. The mean off-medication motor score improved from 48.4 at baseline to 28.9 (40.3% improvement) at 6 months (p < 0.001). The PDQ-39 scores improved (50.3 vs 42.0; p = 0.03), and the levodopa equivalent daily dose was reduced (1207 vs 1035 mg; p = 0.004). There were no significant adverse events.

CONCLUSIONS

Globus pallidus internus leads placed with the patient under general anesthesia by using direct anatomical targeting resulted in significantly improved outcomes as measured by the improvement in the off-medication motor score at 6 months after surgery.

Authors+Show Affiliations

Divisions of 1 Neurological Surgery.Divisions of 1 Neurological Surgery.Divisions of 1 Neurological Surgery.Movement Disorders Center of Arizona, Scottsdale; and.Banner Good Samaritan Medical Center, Phoenix, Arizona.Banner Good Samaritan Medical Center, Phoenix, Arizona.Banner Good Samaritan Medical Center, Phoenix, Arizona.Neurology, and.Neurology, and.Neurology, and.Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix;Neurology, and.Divisions of 1 Neurological Surgery.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26452116

Citation

Mirzadeh, Zaman, et al. "Parkinson's Disease Outcomes After Intraoperative CT-guided "asleep" Deep Brain Stimulation in the Globus Pallidus Internus." Journal of Neurosurgery, vol. 124, no. 4, 2016, pp. 902-7.
Mirzadeh Z, Chapple K, Lambert M, et al. Parkinson's disease outcomes after intraoperative CT-guided "asleep" deep brain stimulation in the globus pallidus internus. J Neurosurg. 2016;124(4):902-7.
Mirzadeh, Z., Chapple, K., Lambert, M., Evidente, V. G., Mahant, P., Ospina, M. C., Samanta, J., Moguel-Cobos, G., Salins, N., Lieberman, A., Tröster, A. I., Dhall, R., & Ponce, F. A. (2016). Parkinson's disease outcomes after intraoperative CT-guided "asleep" deep brain stimulation in the globus pallidus internus. Journal of Neurosurgery, 124(4), 902-7. https://doi.org/10.3171/2015.4.JNS1550
Mirzadeh Z, et al. Parkinson's Disease Outcomes After Intraoperative CT-guided "asleep" Deep Brain Stimulation in the Globus Pallidus Internus. J Neurosurg. 2016;124(4):902-7. PubMed PMID: 26452116.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Parkinson's disease outcomes after intraoperative CT-guided "asleep" deep brain stimulation in the globus pallidus internus. AU - Mirzadeh,Zaman, AU - Chapple,Kristina, AU - Lambert,Margaret, AU - Evidente,Virgilio G, AU - Mahant,Padma, AU - Ospina,Maria C, AU - Samanta,Johan, AU - Moguel-Cobos,Guillermo, AU - Salins,Naomi, AU - Lieberman,Abraham, AU - Tröster,Alexander I, AU - Dhall,Rohit, AU - Ponce,Francisco A, Y1 - 2015/10/09/ PY - 2015/10/10/entrez PY - 2015/10/10/pubmed PY - 2016/8/16/medline KW - ADL = activity of daily living KW - DBS = deep brain stimulation KW - FGATIR = fast gray matter acquisition T1 inversion recovery KW - GPi = globus pallidus internus KW - MDS = International Parkinson and Movement Disorder Society KW - MER = microelectrode recording KW - PD = Parkinson’s disease KW - PDQ-39 = 39-Item Parkinson’s Disease Questionnaire KW - Parkinson’s disease KW - STN = subthalamic nucleus KW - UPDRS-III = Unified Parkinson’s Disease Rating Scale Part III KW - deep brain stimulation KW - functional neurosurgery KW - intraoperative imaging KW - stereotactic accuracy SP - 902 EP - 7 JF - Journal of neurosurgery JO - J Neurosurg VL - 124 IS - 4 N2 - OBJECTIVE: Recent studies show that deep brain stimulation can be performed safely and accurately without microelectrode recording ortest stimulation but with the patient under general anesthesia. The procedure couples techniques for direct anatomical targeting on MRI with intraoperative imaging to verify stereotactic accuracy. However, few authors have examined the clinical outcomes of Parkinson's disease (PD) patients after this procedure. The purpose of this study was to evaluate PD outcomes following "asleep" deep brain stimulation in the globus pallidus internus (GPi). METHODS: The authors prospectively examined all consecutive patients with advanced PD who underwent bilateral GPi electrode placement while under general anesthesia. Intraoperative CT was used to assess lead placement accuracy. The primary outcome measure was the change in the off-medication Unified Parkinson's Disease Rating Scale motor score 6 months after surgery. Secondary outcomes included effects on the 39-Item Parkinson's Disease Questionnaire (PDQ-39) scores, on-medication motor scores, and levodopa equivalent daily dose. Lead locations, active contact sites, stimulation parameters, and adverse events were documented. RESULTS: Thirty-five patients (24 males, 11 females) had a mean age of 61 years at lead implantation. The mean radial error off plan was 0.8 mm. Mean coordinates for the active contact were 21.4 mm lateral, 4.7 mm anterior, and 0.4 mm superior to the midcommissural point. The mean off-medication motor score improved from 48.4 at baseline to 28.9 (40.3% improvement) at 6 months (p < 0.001). The PDQ-39 scores improved (50.3 vs 42.0; p = 0.03), and the levodopa equivalent daily dose was reduced (1207 vs 1035 mg; p = 0.004). There were no significant adverse events. CONCLUSIONS: Globus pallidus internus leads placed with the patient under general anesthesia by using direct anatomical targeting resulted in significantly improved outcomes as measured by the improvement in the off-medication motor score at 6 months after surgery. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/26452116/Parkinson's_disease_outcomes_after_intraoperative_CT_guided_"asleep"_deep_brain_stimulation_in_the_globus_pallidus_internus_ L2 - https://thejns.org/doi/10.3171/2015.4.JNS1550 DB - PRIME DP - Unbound Medicine ER -