CLINICAL OUTCOME OF THE PATIENTS WITH SUBTHALMIC NUCLEUS DEEP BRAIN STIMULATION – WITH CALCULATED AND VISUAL TARGETS IN PARKINSONISM .

Ajaydeep Singh, Arvinpreet Kour, Dinesh Choudhary

Abstract


Objectives: The purpose of this study was to evaluate the efficacy of Deep Brain Stimulation (DBS) at subthalmic nucleus in patients of  Parkinsonism.

Patients and Methods: Total 30 patients down with idiopathic Parkinson’s disease with excellent motor ‘On’ state after levodopa challenge response with disability were studied. The target(STN) was localised using 3 tesla MRI[Visual target] and calculated target  on the basis of the AC and PC .The final targets achieved were finalized with MER with inomed software. Patients were informed about the study and benefits. Confidentiality of the participants was maintained at all the levels.

Results: Percent improvements in parameters like tremors, rigidity and dyskinesia was carried out preoperatively and post-operatively in both the target groups. The comparison of the effects of the stimulation on the different contacts at calculated group and the visual group showed that , in the visual target group the improvement was 88%, 75% and 58 % respectively in tremors, rigidity and dyskinesia in on state and  in the calculated target group  62%, 46% and 58% improvement respectively in tremors, rigidity and dyskinesia in on state. There was statically significantly more improvement in visual target group in tremors (p=0.040) and rigidity (p = 0.032) than calculated group and insignificant (p = 0.265) improvement of dyskinesia between the 2 groups. The improvement in rigidity, tremor and the dyskinesia due to subthalamic nuclei stimulation correlated well with the improvement of the other sensory and motor parkinsonian symptoms.

Conclusion: Our results clearly suggested that the visual target with MER gave better clinical results than calculated  targets with MER and the outcome of the patients showed significant improvement with least need of the medications.


Keywords


DBS; Parkinsonism; calculated targets, visual target , response of DBS on STN.

Full Text:

PDF

References


Schwartz, A., Rosenberg, G., Spencer, A., Barbeau, A., Mars, H. & Libman, I: The effects of levodopa therapy in patients with Parkinson's disease. I. Clinical response. Can Med Assoc J, (1972) 107, 973-6.

Hassler, R., Riechert, T., Mundinger, F., Umbach, W. & Ganglberger, J.A: Physiological observations in stereotaxic operations in extrapyramidal motor disturbances. Brain, (1960) 83, 337-50.

Bechtereva, N. P. & Hughes, H. K. Implanted electrodes: experimentation on humans: Am J Psychiatry, (1971) 127, 1422-3.

Benabid, A. L., Pollak, P., Louveau, A., Henry, S. & De Rougemont, J: Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol, (1987) 50, 344-6.

Priori A, Egidi M, Pesenti A, Rohr M, Rampini P, Locatelli M: Do intraoperative microrecordings improve subthalamic nucleus targeting in stereotactic neurosurgery for Parkinson's disease? J Neurosurg Sci. 2003 Mar;47(1):56-60.

Pollo C, Meuli R, Maeder P, Vingerhoets F, Ghika J, Villemure JG:Subthalamic nucleus deep brain stimulation for Parkinson's disease: magnetic resonance imaging targeting using visible anatomical landmarks. Stereotact Funct Neurosurg. 2003;80(1-4):76-81.

Hamid NA, Mitchell RD, Mocroft P, Westby GW, Milner J, Pall H:Targeting the subthalamic nucleus for deep brain stimulation: technical approach and fusion of pre- and postoperative MR images to define accuracy of lead placement. J Neurol Neurosurg Psychiatry. 2005 Mar; 76(3):409-14.

Littlechild P, Varma TR, Eldridge PR, Fox S, Forster A, Fletcher N et al,. Variability in position of the subthalamic nucleus targeted by magnetic resonance imaging and microelectrode recordings as compared to atlas co-ordinates. Stereotact Funct Neurosurg. 2003;80(1-4):82-7.

Slavin KV, Thulborn KR, Wess C, Nersesyan H: Direct visualization of the human subthalamic nucleus with 3T MR imaging.AJNR Am J Neuroradiol. 2005 Jan;27(1):80-4.

Patel NK, Khan S, Gill SS:Comparison of atlas- and magnetic-resonance-imaging-based stereotactic targeting of the subthalamic nucleus in the surgical treatment of Parkinson's disease.Stereotact Funct Neurosurg. 2008;86(3):153-61.

Daniluk S, G Davies K, Ellias SA, Novak P, Nazzaro JM: Assessment of the variability in the anatomical position and size of the subthalamic nucleus among patients with advanced Parkinson's disease using magnetic resonance imaging.Acta Neurochir (Wien). 2010 Feb;152(2):201-210

Limousin P, Krack P, Pollak P,et al. Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease.N Engl J Med 1998;339:1105–11

Schaltenbrand G, Wahren W. Atlas for Stereotaxy of the Human Brain. Stuttgart, New York: Thieme; 1977.

Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosley A, Marks WJ Jr: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg. 2002 Aug;97(2):370-87.

Slavin KV, Thulborn KR, Wess C, Nersesyan H: Direct visualization of the human subthalamic nucleus with 3T MR imaging.AJNR Am J Neuroradiol. 2005 Jan;27(1):80-4.

Elyne Kahn, Pierre-Francois, Benoit Dawant, Laura Allen , Koa Chris , Charles P David, Konrad Peter: Deep Brain Stimulation in Early Stage Parkinson’s Disease: Operative Experience from a Prospective, Randomized Clinical Trial:J Neurol Neurosurg Psychiatry. 2012 Feb; 83(2): 164–170.

Hamel W, Fietzek U, Morsnowski A,Schrader B, Herzog J, Weinert D et al,. Deep brain

stimulation of the subthalamic nucleus in Parkinson's disease: evaluation of active electrode contacts. J Neurol Neurosurg Psychiatry. 2003 Aug; 74(8): 1036–1046.

Lanotte M M, Rizzone M, Bergamasco B, Faccani G, Melcarne A, Lopiano L : Deep brain stimulation of the subthalamic nucleus:anatomical, neurophysiological, and outcome correlations with the effects of stimulation. J Neurol Neurosurg Psychiatry 2002;72:53–58

Shin-Yuan Chen,Chao-Chin Lee, Sheng-Huang Lin, Yue-Long Hsin, Tien-Wen Lee, Pao-Sheng Yen, et al: Microelectrode recording can be a good adjunct in magnetic resonance image–directed subthalamic nucleus deep brain stimulation for parkinsonism. Surgical NeurologyVolume 65, Issue 3, March 2006, Pages 253–260

Lanotte M M, Rizzone M, Bergamasco B, Faccani G, Melcarne A, Lopiano L : Deep brain stimulation of the subthalamic nucleus:anatomical, neurophysiological, and outcome correlations with the effects of stimulation. J Neurol Neurosurg Psychiatry 2002;72:53–58

Guridi J , Rodriguez MC, Lozano,Moro, Albanese,Nuttin et al;Targetting the basal ganglia for deep brain stimulation in Parkinson’s disease: Neurology 2000;55(Supll);S21-S28

Hamani C, Richter EO, Andrade-Souza Y, Hutchison W, Saint-Cyr JA, et al:Correspondence of microelectrode mapping with magnetic resonance imaging for subthalamic nucleus procedures. Surg Neurol. 2005 Mar;63(3):249-53; discussion 253.


Refbacks

  • There are currently no refbacks.