Multicenter study report: electrophysiological monitoring procedures for subthalamic deep brain stimulation surgery in Parkinson’s disease (original) (raw)
Related papers
European Neurology, 2008
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) gained general acceptance in the treatment of Parkinson’s disease (PD). Objective: To study the clinical outcome and the predicting factors of efficacy of chronic STN stimulation, while DBS electrodes were implanted under local or general anaesthesia with intra-operative electrophysiological guidance based on multi-unit recordings. Methods: We included a large single-centre cohort of 54 patients with advanced PD (mean age: 59 years; disease duration: 14 years). Clinical evaluation was performed by the Unified Parkinson’s Disease Rating Scale (UPDRS) before and 1 year after surgical placement of DBS electrodes. Results: In the on-stimulation and off-medication condition, the UPDRS part III score was reduced by 56% compared to the off-stimulation condition or pre-operative off-drug score. In the on-stimulation and on-medication condition, this score was reduced by 73%. The severity of motor fluctuations and dysk...
Journal of Neurosurgery, 2008
Object The authors of this preliminary study investigated the outcome and feasibility of intraoperative microelectrode recording (MER) in patients with Parkinson disease (PD) undergoing deep brain stimulation of the subthalamic nucleus (STN) after anesthetic inhalation. Methods The authors conducted a retrospective analysis of 10 patients with PD who received a desflurane anesthetic during bilateral STN electrode implantation. The MERs were obtained as an intraoperative guide for final electrode implantation and the data were analyzed offline. The functional target coordinates of the electrodes were compared preoperatively with estimated target coordinates. Results Outcomes were evaluated using the Unified Parkinson's Disease Rating Scale 6 months after surgery. The mean improvement in total and motor Unified Parkinson's Disease Rating Scale scores was 54.27 ± 17.96% and 48.85 ± 16.97%, respectively. The mean STN neuronal firing rate was 29.7 ± 14.6 Hz. Typical neuronal firi...
2021
Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) has become a routine treatment of advanced Parkinson’s disease (PD). DBS surgery is commonly performed under local anesthesia (LA) to obtain reliable microelectrode recordings. However, procedural sedation and/or analgesia (PSA) is often desirable to improve patient comfort. The impact of PSA in addition to LA on outcome is largely unknown. Therefore, we performed an observational study to assess the effect of PSA compared to LA alone during STN DBS surgery on outcome in PD patients. Methods: Seventy PD patients (22 under LA, 48 under LA + PSA) scheduled for STN DBS implantation were included. Dexmedetomidine, clonidine or remifentanil were used for PSA. The primary outcome was the change in Movement Disorders Society Unified Parkinson’s Disease Rating Score III (MDS-UPDRS III) and levodopa equivalent daily dosage (LEDD) between baseline, one month before surgery, and twelve months postoperatively. Secondary outcome ...
Deep Brain Stimulation and Microelectrode Recording for the Treatment of Parkinson’s Disease
Cureus
Parkinson's disease (PD) is a neurological disorder in which nigrostriatal pathways involving the basal ganglia experience a decrease in neural activity regarding dopaminergic neurons. PD symptoms, such as muscle stiffness and involuntary tremors, have an adverse impact on the daily lives of those affected. Current medical treatments seek to decrease the severity of these symptoms. Deep brain stimulation (DBS) has become the preferred safe, and reliable treatment approach. DBS involves implanting microelectrodes into subcortical areas that produce electrical impulses directly to high populations of dopaminergic neurons. The most common targets are the subthalamic nucleus (STN), and the basal ganglia's globus pallidus pars interna (GPi). Research studies suggest that DBS of the STN may cause a significant reduction in the daily dose of L-DOPA compared to DBS of the GPi. DBS of the STN has suggested that there may be sweet spots within the STN that provide hyper-direct cortical connectivity pathways to the primary motor cortex (M1), supplementary motor area (SMA), and prefrontal cortex (PFC). In addition, the pedunculopontine nucleus (PPN) may be a new target for DBS that helps treat locomotion problems associated with gait and posture. Both microelectrode recording (MER) and magnetic resonance imaging (MRI) are used to ensure electrode placement accuracy. Using MER, stimulation of the STN at high frequencies (140<) decreased oscillatory neuronal firing by 67%. This paper investigates methods of intraoperative neuromonitoring during DBS as a form of PD treatment.
Deep Brain Stimulation in Parkinsonʼs Disease
AJN, American Journal of Nursing, 2009
Purpose of review Deep-brain high-frequency stimulation of the thalamus was introduced in 1987 to treat tremor, and was applied in 1993 to the subthalamic nucleus to treat advanced Parkinson's disease. High-frequency stimulation of the subthalamic nucleus has become the surgical therapy of choice. This review concentrates on recent data on long-term results and side-effects, after 12 years of practice using this technique. Recent findings A literature search produced 260 papers from February 2004 to March 2005. The stable efficacy of high-frequency stimulation of the subthalamic nucleus on Parkinson's disease motor symptoms is confirmed. Evidence for a neuroprotective effect is still lacking. There are transient neuropsychological disturbances, but no cognitive impairment over time. Complications are rare and mild, mortality is extremely low and hardware complications are highly variable. Summary The safety and inocuity of the method legitimizes earlier operations, before impairment of the quality of life. Depression and suicide are related to pre-existing co-morbidities and multifactorial causes that could become contraindications. Neuropsychological effects should be documented, to determine whether they are caused by an alteration of high-frequency stimulation of the subthalamic nucleus, or inappropriate electrode placement. There is an urgent need for the organization of research and reports, and no need to report small series replicating wellestablished conclusions. Clinical reports should concentrate on unobserved effects in relation to causative parameters, based on the precise location of electrodes, and on clinical reports comparable between teams and on methods to optimize and facilitate the tuning of parameters and postoperative evaluations in order to make this treatment easier to provide for the neurologist.
Comparison of Awake vs. Asleep Surgery for Subthalamic Deep Brain Stimulation in Parkinson's Disease
Neuromodulation : journal of the International Neuromodulation Society, 2018
Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are scarce. To investigate the difference between awake and asleep surgery comparing motor and nonmotor outcome after subthalamic nucleus (STN)-DBS in a large single center PD population. Ninety-six patients were retrospectively matched pairwise (48 asleep and 48 awake) and compared regarding improvement of Unified PD Rating Scale Motor Score (UPDRS-III), cognitive function, Levodopa-equivalent-daily-dose (LEDD), stimulation amplitudes, side effects, surgery duration, and complication rates. Routine testing took place at three months and one year postoperatively. Chronic DBS effects (UPDRS-III without medication and with stimulation on [OFF/ON]) significantly improved UPDRS-III only after awake surgery at...
Surgical Neurology, 2006
Background: The contribution of MER to improving bilateral STN-DBS is debatable. To resolve the controversy and elucidate the role of MER in DBS, we compared the outcome of bilateral STN-DBS surgery with and without MER in parkinsonian patients. Methods: From February 2002 to November 2002, the first 7 of 13 consecutive parkinsonian patients received STN-DBS without MER (group A), and the last 6 received STN-DBS with MER (group B). Pre-and postoperative assessments included scoring of UPDRS with video taping, and MR images. Results: The mean Hoehn and Yahr stage was 3.6 in group A and 4.0 in group B. The mean followup was 7.4 months for group A and 5.3 months for group B. The mean coordinates of the tip of the permanent electrode relative to the mid-commissural point were x = 8.1 mm, y = 4.3 mm, and z = 5.9 mm for group A and x = 10.6 mm, y = 4.1 mm, and z = 6.9 mm for group B. When levodopa was withdrawn from group A for 12 hours at follow-up, the postoperative UPDRS total score improved by 27.6% (P = .01) and the motor score by 25.4% (P = .02); their LEDD decreased by 17.5% (P = .03). In group B, the postoperative UPDRS total score improved by 49.3% (P = .00002) and the motor score by 45.2% (P = .0004); LEDD decreased by 48.5% (P = .01). Conclusions: Although STN-DBS is a promising surgical modality for advanced parkinsonian patients, there is an inevitable learning curve associated with adopting this new procedure. Intraoperative MER is an effective way to ensure correct electrode placement in the STN. With the assistance of intraoperative MER, the outcome of STN-DBS can be improved significantly.
Two‐year follow‐up of subthalamic deep brain stimulation in Parkinson's disease
Movement Disorders, 2003
We studied 48 patients after bilateral subthalamic nucleus deep brain stimulation (STN‐DBS) who were evaluated 6 months after the surgical procedure using the Unified Parkinson's Disease Rating Scale (UPDRS) in a standardized levodopa test. Additional follow‐up was available in 32 patients after 12 months and in 20 patients after 24 months. At 6 months follow‐up, STN‐DBS reduced the UPDRS motor score by 50.9% compared to baseline. This improvement remained constant at 12 months with 57.5% and at 24 months with 57.3%. Relevant side effects after STN‐DBS included intraoperative subdural hematoma without neurological sequelae (n = 1), minor intracerebral bleeding with slight transient hemiparesis (n = 1), dislocation of impulse generator (n = 2), transient perioperative confusional symptoms (n = 7), psychotic symptoms (n = 2), depression (n = 5), hypomanic behaviour (n = 2), and transient manic psychosis (n = 1). One patient died because of heart failure during the first postoperat...
Journal of Neurological Research and Therapy, 2019
Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentl...