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Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using intraoperative MRI.
J Neurosurg. 2019 Oct 11 [Online ahead of print]JN

Abstract

OBJECTIVE

Lead placement for deep brain stimulation (DBS) using intraoperative MRI (iMRI) relies solely on real-time intraoperative neuroimaging to guide electrode placement, without microelectrode recording (MER) or electrical stimulation. There is limited information, however, on outcomes after iMRI-guided DBS for dystonia. The authors evaluated clinical outcomes and targeting accuracy in patients with dystonia who underwent lead placement using an iMRI targeting platform.

METHODS

Patients with dystonia undergoing iMRI-guided lead placement in the globus pallidus pars internus (GPi) were identified. Patients with a prior ablative or MER-guided procedure were excluded from clinical outcomes analysis. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed preoperatively and at 6 and 12 months postoperatively. Other measures analyzed include lead accuracy, complications/adverse events, and stimulation parameters.

RESULTS

A total of 60 leads were implanted in 30 patients. Stereotactic lead accuracy in the axial plane was 0.93 ± 0.12 mm from the intended target. Nineteen patients (idiopathic focal, n = 7; idiopathic segmental, n = 5; DYT1, n = 1; tardive, n = 2; other secondary, n = 4) were included in clinical outcomes analysis. The mean improvement in BFMDRS score was 51.9% ± 9.7% at 6 months and 63.4% ± 8.0% at 1 year. TWSTRS scores in patients with predominant cervical dystonia (n = 13) improved by 53.3% ± 10.5% at 6 months and 67.6% ± 9.0% at 1 year. Serious complications occurred in 6 patients (20%), involving 8 of 60 implanted leads (13.3%). The rate of serious complications across all patients undergoing iMRI-guided DBS at the authors' institution was further reviewed, including an additional 53 patients undergoing GPi-DBS for Parkinson disease. In this expanded cohort, serious complications occurred in 11 patients (13.3%) involving 15 leads (10.1%).

CONCLUSIONS

Intraoperative MRI-guided lead placement in patients with dystonia showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided lead placement. The accuracy of lead placement was high, and the procedure was well tolerated in the majority of patients. However, a number of patients experienced serious adverse events that were attributable to the introduction of a novel technique into a busy neurosurgical practice, and which led to the revision of protocols, product inserts, and on-site training.

Authors+Show Affiliations

Departments of1Neurology and. Departments of2Neurology and.3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia. 4Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida; and.3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.6Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia. 5Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.Departments of1Neurology and.Departments of1Neurology and.Departments of1Neurology and.Departments of1Neurology and. 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.Departments of1Neurology and.Departments of1Neurology and.Departments of1Neurology and. 3Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31604331

Citation

Sharma, Vibhash D., et al. "Clinical Outcomes of Pallidal Deep Brain Stimulation for Dystonia Implanted Using Intraoperative MRI." Journal of Neurosurgery, 2019, pp. 1-13.
Sharma VD, Bezchlibnyk YB, Isbaine F, et al. Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using intraoperative MRI. J Neurosurg. 2019.
Sharma, V. D., Bezchlibnyk, Y. B., Isbaine, F., Naik, K. B., Cheng, J., Gale, J. T., Miocinovic, S., Buetefisch, C., Factor, S. A., Willie, J. T., Boulis, N. M., Wichmann, T., DeLong, M. R., & Gross, R. E. (2019). Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using intraoperative MRI. Journal of Neurosurgery, 1-13. https://doi.org/10.3171/2019.6.JNS19548
Sharma VD, et al. Clinical Outcomes of Pallidal Deep Brain Stimulation for Dystonia Implanted Using Intraoperative MRI. J Neurosurg. 2019 Oct 11;1-13. PubMed PMID: 31604331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes of pallidal deep brain stimulation for dystonia implanted using intraoperative MRI. AU - Sharma,Vibhash D, AU - Bezchlibnyk,Yarema B, AU - Isbaine,Faical, AU - Naik,Kushal B, AU - Cheng,Jennifer, AU - Gale,John T, AU - Miocinovic,Svjetlana, AU - Buetefisch,Cathrin, AU - Factor,Stewart A, AU - Willie,Jon T, AU - Boulis,Nicholas M, AU - Wichmann,Thomas, AU - DeLong,Mahlon R, AU - Gross,Robert E, Y1 - 2019/10/11/ PY - 2019/03/02/received PY - 2019/06/27/accepted PY - 2019/10/12/entrez PY - 2019/10/12/pubmed PY - 2019/10/12/medline KW - BFMDRS = Burke-Fahn-Marsden Dystonia Rating Scale KW - CD = cervical dystonia KW - CI = confidence interval KW - CP = cerebral palsy KW - ClearPoint KW - DBS = deep brain stimulation KW - GPi = globus pallidus pars internus KW - ICL = intercommissural line KW - IPG = internal pulse generator KW - MCP = midcommissural point KW - MER = microelectrode recording KW - PD = Parkinson disease KW - QSM = quantitative susceptibility mapping KW - SAE = serious adverse event KW - SEM = standard error of the mean KW - STN = subthalamic nucleus KW - TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale KW - asleep DBS KW - deep brain stimulation KW - dystonia KW - functional neurosurgery KW - globus pallidus KW - iMRI = intraoperative MRI KW - interventional MRI KW - intraoperative MRI SP - 1 EP - 13 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVE: Lead placement for deep brain stimulation (DBS) using intraoperative MRI (iMRI) relies solely on real-time intraoperative neuroimaging to guide electrode placement, without microelectrode recording (MER) or electrical stimulation. There is limited information, however, on outcomes after iMRI-guided DBS for dystonia. The authors evaluated clinical outcomes and targeting accuracy in patients with dystonia who underwent lead placement using an iMRI targeting platform. METHODS: Patients with dystonia undergoing iMRI-guided lead placement in the globus pallidus pars internus (GPi) were identified. Patients with a prior ablative or MER-guided procedure were excluded from clinical outcomes analysis. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed preoperatively and at 6 and 12 months postoperatively. Other measures analyzed include lead accuracy, complications/adverse events, and stimulation parameters. RESULTS: A total of 60 leads were implanted in 30 patients. Stereotactic lead accuracy in the axial plane was 0.93 ± 0.12 mm from the intended target. Nineteen patients (idiopathic focal, n = 7; idiopathic segmental, n = 5; DYT1, n = 1; tardive, n = 2; other secondary, n = 4) were included in clinical outcomes analysis. The mean improvement in BFMDRS score was 51.9% ± 9.7% at 6 months and 63.4% ± 8.0% at 1 year. TWSTRS scores in patients with predominant cervical dystonia (n = 13) improved by 53.3% ± 10.5% at 6 months and 67.6% ± 9.0% at 1 year. Serious complications occurred in 6 patients (20%), involving 8 of 60 implanted leads (13.3%). The rate of serious complications across all patients undergoing iMRI-guided DBS at the authors' institution was further reviewed, including an additional 53 patients undergoing GPi-DBS for Parkinson disease. In this expanded cohort, serious complications occurred in 11 patients (13.3%) involving 15 leads (10.1%). CONCLUSIONS: Intraoperative MRI-guided lead placement in patients with dystonia showed improvement in clinical outcomes comparable to previously reported results using awake MER-guided lead placement. The accuracy of lead placement was high, and the procedure was well tolerated in the majority of patients. However, a number of patients experienced serious adverse events that were attributable to the introduction of a novel technique into a busy neurosurgical practice, and which led to the revision of protocols, product inserts, and on-site training. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/31604331/Clinical_outcomes_of_pallidal_deep_brain_stimulation_for_dystonia_implanted_using_intraoperative_MRI_ L2 - https://thejns.org/doi/10.3171/2019.6.JNS19548 DB - PRIME DP - Unbound Medicine ER -
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