Estimation of Electrode Position with Fused Images of Preoperative MRI and Postoperative CT Using the Mutual Information Technique After STN DBS in Patients with Advanced Parkinson's Disease

OBJECTIVE: A prospective cohort study to evaluate the efficacy of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on freezing of gait (FOG) in patients with advanced Parkinson's disease. METHODS: Patients ( n = 10) with advanced Parkinson's disease were surgically implanted with microelectrodes to facilitate STN-DBS. Evaluations of FOG, motor function, activities of daily living and neuropsychological function were carried out in on-medication and off-medication states (with and without levodopa treatment), before surgery and at 6 and 12 months postoperatively. RESULTS: STN-DBS was associated with significant improvement in FOG score and neuropsychological function at both 6 and 12 months postoperatively, compared with preoperatively. Significant postoperative improvements were also observed in motor function and activities of daily living. Daily levodopa dosage was significantly lower at both 6 and 12 months postoperatively. CONCLUSIONS: STN-DBS improved FOG in patients with advanced Parkinson's disease. The significant reduction in levodopa dosage and improvement in neuropsychological function may be the reason for the therapeutic effect seen with STN-DBS.

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Single Electrode and Multiple Electrode Guided Electrical Stimulation of the Subthalamic Nucleus in Advanced Parkinson's Disease

Operative Neurosurgery ◽

10.1227/01.neu.0000303993.82149.98 ◽

2007 ◽

Vol 61 (suppl_5) ◽

pp. ONS346-ONS357 ◽

Cited By ~ 24

Author(s):

Yasin Temel ◽

Poldi Wilbrink ◽

Annelien Duits ◽

Peter Boon ◽

Selma Tromp ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Subthalamic Nucleus ◽

Advanced Parkinson’S Disease ◽

Implanted Electrodes ◽

Risk Of Bleeding ◽

Electrophysiological Recordings ◽

Multiple Electrodes ◽

Neuropsychological Functions ◽

Stn Dbs

Abstract Objective: It is still debated to what extent intraoperative electrophysiological techniques contribute to the outcome of subthalamic nucleus (STN) deep brain stimulation (DBS). Intraoperative electrophysiological recordings for identification of the STN can be made with one electrode or with multiple, simultaneously implanted electrodes. The latter provide more detailed information about the electrophysiological boundaries of the STN; however, implantation of several electrodes at one time might increase the risk of bleeding. Here we report the results of a study of patients with advanced Parkinson's disease, in which one group of patients underwent bilateral STN DBS with electrophysiological recordings from a single electrode, and the other group received STN DBS with multiple (five or fewer) simultaneously implanted electrodes. Patients and Methods: Fifty-five patients suffering from advanced Parkinson's disease who underwent bilateral STN stimulation were included in this study. Thirty-two patients underwent STN DBS guided by a single semi-microelectrode, and 23 patients underwent STN DBS guided with simultaneously implanted multiple microelectrodes. All patients were examined preoperatively and 3 and 12 months postoperatively with regard to activities of daily living, motor functions, and neuropsychological functions. Results: We found that the simultaneous implantation of multiple electrodes does not increase the risk of bleeding or any other major intracranial complication. The use of multiple electrodes resulted in better motor results when compared with patients who underwent STN DBS guided with a single recording electrode. There were significantly more improvements in patients’ tremor and rigidity, and as a consequence, a better total Unified Parkinson Disease Rating Scale, Part III score was identified during the medication-off phase. Despite better motor effects, patients treated with multiple electrodes showed subtle deterioration in neuropsychological functions, particularly in memory function. Conclusion: STN DBS performed with multiple electrophysiological recording electrodes resulted in better motor outcome but induced specific mild declines in neuropsychological functions.

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ELECTRODE POSITION DETERMINED BY FUSED IMAGES OF PREOPERATIVE AND POSTOPERATIVE MAGNETIC RESONANCE IMAGING AND SURGICAL OUTCOME AFTER SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION

Neurosurgery ◽

10.1227/01.neu.0000334045.43940.fb ◽

2008 ◽

Vol 63 (5) ◽

pp. 925-937 ◽

Cited By ~ 42

Author(s):

Sun Ha Paek ◽

Jung Ho Han ◽

Jee-Young Lee ◽

Cheolyoung Kim ◽

Beom Seok Jeon ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Magnetic Resonance ◽

Surgical Outcome ◽

Rating Scale ◽

Electrode Position ◽

Resonance Imaging ◽

Disease Rating ◽

Stn Dbs

Abstract OBJECTIVE The electrode position is important to the surgical outcome after subthalamic nucleus (STN) deep brain stimulation (DBS). The aim of this study was to compare the surgical outcome of bilateral STN DBS with the electrode position estimated using fused magnetic resonance imaging. METHODS Bilateral STN DBS was performed in 60 patients with advanced Parkinson's disease. Patients were evaluated with the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging, Schwab and England Activities of Daily Living, L-dopa equivalent dose, and Short Form-36 Health Survey before and at 3 and 6 months after surgery. Brain magnetic resonance imaging (1.5-T) was performed in 53 patients at 6 months after STN DBS. The electrode position was estimated in the fused pre- and postoperative magnetic resonance images and correlated with the surgical results. RESULTS As a group, the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging, Schwab and England Activities of Daily Living, and Short Form-36 Health Survey scores improved at 3 and 6 months after STN DBS. The L-dopa equivalent dose decreased by 60% at 3 and 6 months after STN DBS. The electrode position was divided into 6 types according to its relationship to the STN and the red nucleus. Most off-medication Unified Parkinson's Disease Rating Scale motor subscale scores improved regardless of the type of electrode position. The off-medication speech subscale score improved only in the patients whose electrodes were correctly positioned in the STN bilaterally. CONCLUSION The electrodes accurately positioned in the STN led to improved speech after bilateral STN DBS. An effort should be made in each patient to document the electrode position to monitor surgical performance and to improve the surgical outcome after STN DBS.

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IMPLANTATION OF ELECTRODES FORDEEP BRAIN STIMULATION OF THE SUBTHALAMIC NUCLEUS IN ADVANCED PARKINSON'S DISEASE WITH THE AID OF INTRAOPERATIVE MICRORECORDING UNDERGENERAL ANESTHESIA

Neurosurgery ◽

10.1227/01.neu.0000245603.77075.55 ◽

2006 ◽

Vol 59 (5) ◽

pp. E1138-E1138 ◽

Cited By ~ 70

Author(s):

Frank Hertel ◽

Mark Züchner ◽

Inge Weimar ◽

Peter Gemmar ◽

Bernhard Noll ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Subthalamic Nucleus ◽

Current Literature ◽

Brain Stimulation ◽

Rating Scale ◽

Pulse Generator ◽

Advanced Parkinson’S Disease ◽

Randomized Controlled Studies ◽

Stn Dbs

Abstract OBJECTIVE Deep brain stimulation (DBS) is widely accepted in the treatment of advanced Parkinson's disease (PD) and other movement disorders. The standard implantation procedure is performed under local anesthesia (LA). Certain groups of patients may not be eligible for surgery under LA because of clinical reasons, such as massive fear, reduced cooperativity, or coughing attacks. Microrecording (MER) has been shown to be helpful in DBS surgery. The purpose of this study was to evaluate the feasibility of MERfor DBS surgery under general anesthesia (GA) and to compare the data of intraoperative MERas well as the clinical data with that of the current literature of patients undergoing operation under LA. CLINICAL PRESENTATION The data of nine patients with advanced PD (mean Hoehn and Yahr status, 4.2) who were operated with subthalamic nucleus (STN) DBS under GA, owing to certain clinical circumstances ruling out DBS under LA, were retrospectively analyzed. All operations were performed under analgosedation with propofol or remifentanil and intraoperative MER. For MER, remifentanil was ceased completely and propofol was lowered as far as possible. INTERVENTION The STN could be identified intraoperatively in all patients with MER. The typical bursting pattern was identified, whereas a widening of the baseline noise could not be as adequately detected as in patients under LA. The daily off phases of the patients were reduced from 50 to 17%, whereas the Unified Parkinson's Disease Rating Scale III score was reduced from 43 (preoperative, medication off) to 19 (stimulation on, medication off) and 12 (stimulation on, medication on). Two patients showed a transient neuropsychological deterioration after surgery, but both also had preexisting episodes of disorientation. One implantable pulse generator infection was noticed. No further significant clinical complications were observed. CONCLUSION STN surgery for advanced PD with MERguidance is possible with good clinical results under GA. Intraoperative MERof the STN region can be performed under GA with a special anesthesiological protocol. In this setting, the typical STN bursting pattern can be identified, whereas the typical widening of the background noise baseline while entering the STN region is obviously absent. This technique may enlarge the group of patients eligible for STN surgery. Although the clinical improvements and parameter settings in this study were within the range of the current literature, further randomized controlled studies are necessary to compare the results of STN DBS under GA and LA, respectively.

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STN-DBS does not change emotion recognition in advanced Parkinson's disease

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2013.10.010 ◽

2014 ◽

Vol 20 (2) ◽

pp. 166-169 ◽

Cited By ~ 14

Author(s):

Luisa Albuquerque ◽

Miguel Coelho ◽

Maurício Martins ◽

Leonor Correia Guedes ◽

Mário M. Rosa ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Emotion Recognition ◽

Advanced Parkinson’S Disease ◽

Stn Dbs

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Relationship between electrode position of deep brain stimulation and motor symptoms of Parkinson’s disease

BMC Neurology ◽

10.1186/s12883-021-02148-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feng Zhang ◽

Feng Wang ◽

Weiguo Li ◽

Ning Wang ◽

Chunlei Han ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Electrode Position ◽

Motor Symptoms ◽

Improvement Rate ◽

Significant Difference ◽

Quality Of Life Scale ◽

Stn Dbs

Abstract Background To investigate the relationship between the position of bilateral STN-DBS location of active contacts and the clinical efficacy of STN-DBS on motor symptoms in Parkinson’s disease (PD) patients. Methods Retrospectively analyze the clinical data of 57 patients with PD who underwent bilateral STN-DBS from March 2018 to December 2018. Unified Parkinson’s Disease Rating Scale-Part III (UPDRS-III) score, levodopa equivalent day dose (LEDD), Parkinson’s Disease Quality of Life Scale (PDQ-39) before operation and within 6 months after operation, determine the location of activated contacts and volume of tissue activated (VTA) in the Montreal Neurological Institute (MNI) space, and analyze their correlation with the improvement rate of motor symptoms (UPDRS-III score improvement rate). Results After 6 months of follow up, the UPDRS-III scores of 57 patients (Med-off) were improved by 55.4 ± 18.9% (P<0.001) compared with that before operation. The improvement rate of PDQ-39 scores [(47.4 ± 23.2)%, (P < 0.001)] and the reduction rate of LEDD [(40.1 ± 24.3)%, (P < 0.01)] at 6 months postoperation were positively correlated with the improvement rate of motor symptoms (Med-off)(PDQ-39:r = 0.461, P<0.001; LEDD: r = 0.354, P = 0.007), the improvement rate of UPDRS-III (Med-off) and the Z-axis coordinate of the active contact in the MNI space were positively correlated (left side: r = 0.349,P = 0.008;right side: r = 0.369,P = 0.005). In the MNI space, there was no correlation between the UPDRS-III scores improvement rate (Med-off) at 6 months after operation and bilateral VTA in the STN motor subregion, STN associative subregion and STN limbic subregion of the active electrode contacts of 57 patients (all P > 0.05). At 6 months after surgery, the difference between the Z-axis coordinate in the different improvement rate subgroups(<25, 25 to 50%, and>50%) in the MNI space was statistically significant (left side: P = 0.030; right side: P = 0.024). In the MNI space, there was no statistically significant difference between the groups in the VTA of the electrode active contacts (all P > 0.05). Conclusion STN-DBS can improve the motor symptoms of PD patients and improve the quality of life. The closer the stimulation is to the STN dorsolateral sensorimotor area, the higher the DBS is to improve the motor symptoms of PD patients.

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