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Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease.
J Neurosurg. 2016 Apr; 124(4):908-16.JN

Abstract

OBJECTIVE

The ClearPoint real-time interventional MRI-guided methodology for deep brain stimulation (DBS) lead placement may offer advantages to frame-based approaches and allow accurate implantation under general anesthesia. In this study, the authors assessed the safety and efficacy of DBS in Parkinson's disease (PD) using this surgical method.

METHODS

This was a prospective single-center study of bilateral DBS therapy in patients with advanced PD and motor fluctuations. Symptom severity was evaluated at baseline and 12 months postimplantation using the change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III "off" medication score as the primary outcome variable.

RESULTS

Twenty-six PD patients (15 men and 11 women) were enrolled from 2010 to 2013. Twenty patients were followed for 12 months (16 with a subthalamic nucleus target and 4 with an internal globus pallidus target). The mean UPDRS Part III "off" medication score improved from 40.75 ± 10.9 to 24.35 ± 8.8 (p = 0.001). "On" medication time without troublesome dyskinesia increased 5.2 ± 2.6 hours per day (p = 0.0002). UPDRS Parts II and IV, total UPDRS score, and dyskinesia rating scale "on" medication scores also significantly improved (p < 0.01). The mean levodopa equivalent daily dose decreased from 1072.5 ± 392 mg to 828.25 ± 492 mg (p = 0.046). No significant cognitive or mood declines were observed. A single brain penetration was used for placement of all leads, and the mean targeting error was 0.6 ± 0.3 mm. There were 3 serious adverse events (1 DBS hardware-related infection, 1 lead fracture, and 1 unrelated death).

CONCLUSIONS

DBS leads placed using the ClearPoint interventional real-time MRI-guided method resulted in highly accurate lead placement and outcomes comparable to those seen with frame-based approaches.

Authors+Show Affiliations

Surgical Movement Disorders Center, Department of Neurology; andSurgical Movement Disorders Center, Department of Neurology; andSurgical Movement Disorders Center, Department of Neurology; andDepartments of 2 Neurological Surgery and.Surgical Movement Disorders Center, Department of Neurology; andSurgical Movement Disorders Center, Department of Neurology; andDepartments of 2 Neurological Surgery and.Radiology, University of California, San Francisco, California.Surgical Movement Disorders Center, Department of Neurology; andDepartments of 2 Neurological Surgery and.

Pub Type(s)

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

Language

eng

PubMed ID

26495947

Citation

Ostrem, Jill L., et al. "Clinical Outcomes Using ClearPoint Interventional MRI for Deep Brain Stimulation Lead Placement in Parkinson's Disease." Journal of Neurosurgery, vol. 124, no. 4, 2016, pp. 908-16.
Ostrem JL, Ziman N, Galifianakis NB, et al. Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease. J Neurosurg. 2016;124(4):908-16.
Ostrem, J. L., Ziman, N., Galifianakis, N. B., Starr, P. A., Luciano, M. S., Katz, M., Racine, C. A., Martin, A. J., Markun, L. C., & Larson, P. S. (2016). Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease. Journal of Neurosurgery, 124(4), 908-16. https://doi.org/10.3171/2015.4.JNS15173
Ostrem JL, et al. Clinical Outcomes Using ClearPoint Interventional MRI for Deep Brain Stimulation Lead Placement in Parkinson's Disease. J Neurosurg. 2016;124(4):908-16. PubMed PMID: 26495947.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes using ClearPoint interventional MRI for deep brain stimulation lead placement in Parkinson's disease. AU - Ostrem,Jill L, AU - Ziman,Nathan, AU - Galifianakis,Nicholas B, AU - Starr,Philip A, AU - Luciano,Marta San, AU - Katz,Maya, AU - Racine,Caroline A, AU - Martin,Alastair J, AU - Markun,Leslie C, AU - Larson,Paul S, Y1 - 2015/10/23/ PY - 2015/10/27/entrez PY - 2015/10/27/pubmed PY - 2016/8/16/medline KW - AP = anteroposterior KW - CGI = Clinical Global Impression KW - ClearPoint KW - DBS = deep brain stimulation KW - GPi = internal globus pallidus KW - IPG = implantable pulse generator KW - LEDD = levodopa equivalent daily dose KW - MER = microelectrode recording KW - PD = Parkinson’s disease KW - PDQ-39 = Parkinson’s Disease Questionnaire-39 KW - Parkinson’s disease KW - SF-36 = 36-Item Short Form Health Survey KW - STN = subthalamic nucleus KW - UPDRS = Unified Parkinson’s Disease Rating Scale KW - deep brain stimulation KW - functional neurosurgery KW - iMRI = interventional MRI KW - interventional MRI KW - outcomes SP - 908 EP - 16 JF - Journal of neurosurgery JO - J Neurosurg VL - 124 IS - 4 N2 - OBJECTIVE: The ClearPoint real-time interventional MRI-guided methodology for deep brain stimulation (DBS) lead placement may offer advantages to frame-based approaches and allow accurate implantation under general anesthesia. In this study, the authors assessed the safety and efficacy of DBS in Parkinson's disease (PD) using this surgical method. METHODS: This was a prospective single-center study of bilateral DBS therapy in patients with advanced PD and motor fluctuations. Symptom severity was evaluated at baseline and 12 months postimplantation using the change in Unified Parkinson's Disease Rating Scale (UPDRS) Part III "off" medication score as the primary outcome variable. RESULTS: Twenty-six PD patients (15 men and 11 women) were enrolled from 2010 to 2013. Twenty patients were followed for 12 months (16 with a subthalamic nucleus target and 4 with an internal globus pallidus target). The mean UPDRS Part III "off" medication score improved from 40.75 ± 10.9 to 24.35 ± 8.8 (p = 0.001). "On" medication time without troublesome dyskinesia increased 5.2 ± 2.6 hours per day (p = 0.0002). UPDRS Parts II and IV, total UPDRS score, and dyskinesia rating scale "on" medication scores also significantly improved (p < 0.01). The mean levodopa equivalent daily dose decreased from 1072.5 ± 392 mg to 828.25 ± 492 mg (p = 0.046). No significant cognitive or mood declines were observed. A single brain penetration was used for placement of all leads, and the mean targeting error was 0.6 ± 0.3 mm. There were 3 serious adverse events (1 DBS hardware-related infection, 1 lead fracture, and 1 unrelated death). CONCLUSIONS: DBS leads placed using the ClearPoint interventional real-time MRI-guided method resulted in highly accurate lead placement and outcomes comparable to those seen with frame-based approaches. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/26495947/Clinical_outcomes_using_ClearPoint_interventional_MRI_for_deep_brain_stimulation_lead_placement_in_Parkinson's_disease_ L2 - https://thejns.org/doi/10.3171/2015.4.JNS15173 DB - PRIME DP - Unbound Medicine ER -