Abstract
BackgroundEffective target regions for deep brain stimulation (DBS) in Parkinson's disease (PD) have been well characterized. We sought to study whether the measured Cartesian coordinates of an implanted DBS lead are predictive of motor outcome(s). We tested the hypothesis that the position and trajectory of the DBS lead relative to the mid-commissural point (MCP) are significant predictors of clinical outcomes. We expected that due to neuroanatomical variation among individuals, a simple measure of the position of the DBS lead relative to MCP (commonly used in clinical practice) may not be a reliable predictor of clinical outcomes when utilized alone.Methods55 PD subjects implanted with subthalamic nucleus (STN) DBS and 41 subjects implanted with globus pallidus internus (GPi) DBS were included. Lead locations in AC-PC space (x, y, z coordinates of the active contact and sagittal and coronal entry angles) measured on high-resolution CT-MRI fused images, and motor outcomes (Unified Parkinson's Disease Rating Scale) were analyzed to confirm or refute a correlation between coordinate-based lead locations and DBS motor outcomes.ResultsCoordinate-based lead locations were not a significant predictor of change in UPDRS III motor scores when comparing pre- versus post-operative values. The only potentially significant individual predictor of change in UPDRS motor scores was the antero-posterior coordinate of the GPi lead (more anterior lead locations resulted in a worse outcome), but this was only a statistical trend (p<.082).ConclusionThe results of the study showed that a simple measure of the position of the DBS lead relative to the MCP is not significantly correlated with PD motor outcomes, presumably because this method fails to account for individual neuroanatomical variability. However, there is broad agreement that motor outcomes depend strongly on lead location. The results suggest the need for more detailed identification of stimulation location relative to anatomical targets.
Highlights
Parkinson’s disease (PD) is a neurodegenerative disorder that impacts multiple motor and non-motor basal ganglia circuits [1,2]
Results from studies have revealed that subthalamic nucleus (STN) deep brain stimulation (DBS) improves many of the cardinal motor symptoms of PD, requires lower energy input when compared to globus pallidus interna (GPi) DBS, and facilitates a greater reduction in levodopa requirements [4,10,11,12,13,14,15,16,17,18,19,20]
Though a 30% improvement in UPDRS score on a dopamine challenge test has been generally accepted as a minimum requirement for undergoing DBS surgery, patients in this series who failed to meet this response threshold were possibly considered for surgery if the interdisciplinary risk-benefit analysis discussion was favorable and they had one of the following exceptional indications for DBS: severe and debilitating on/off-medication symptom fluctuations that were inadequately measured with UPDRS testing or medication-refractory tremor [31]
Summary
Parkinson’s disease (PD) is a neurodegenerative disorder that impacts multiple motor and non-motor basal ganglia circuits [1,2]. Deep brain stimulation (DBS) is a surgical therapy that has been shown to improve tremor, motor fluctuations, and levodoparesponsive symptoms in a subgroup of well-characterized and carefully screened PD patients [4,5,6,7]. Results from studies have revealed that STN DBS improves many of the cardinal motor symptoms of PD (tremor, rigidity, bradykinesia), requires lower energy input when compared to GPi DBS, and facilitates a greater reduction in levodopa requirements [4,10,11,12,13,14,15,16,17,18,19,20]. Effective target regions for deep brain stimulation (DBS) in Parkinson’s disease (PD) have been well characterized. We expected that due to neuroanatomical variation among individuals, a simple measure of the position of the DBS lead relative to MCP (commonly used in clinical practice) may not be a reliable predictor of clinical outcomes when utilized alone
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