Clinical outcomes of globus pallidus deep brain stimulation for Parkinson disease: a comparison of intraoperative MRI– and MER-guided lead placement

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Deep brain stimulation (DBS) lead placement is increasingly performed with the patient under general anesthesia by surgeons using intraoperative MRI (iMRI) guidance without microelectrode recording (MER) or macrostimulation. The authors assessed the accuracy of lead placement, safety, and motor outcomes in patients with Parkinson disease (PD) undergoing DBS lead placement into the globus pallidus internus (GPi) using iMRI or MER guidance.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors identified all patients with PD who underwent either MER- or iMRI-guided GPi-DBS lead placement at Emory University between July 2007 and August 2016. Lead placement accuracy and adverse events were determined for all patients. Clinical outcomes were assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS) part III motor scores for patients completing 12 months of follow-up. The authors also assessed the levodopa-equivalent daily dose (LEDD) and stimulation parameters.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Seventy-seven patients were identified (MER, n = 28; iMRI, n = 49), in whom 131 leads were placed. The stereotactic accuracy of the surgical procedure with respect to the planned lead location was 1.94 ± 0.21 mm (mean ± SEM) (95% CI 1.54–2.34) with frame-based MER and 0.84 ± 0.007 mm (95% CI 0.69–0.98) with iMRI. The rate of serious complications was similar, at 6.9% for MER-guided DBS lead placement and 9.4% for iMRI-guided DBS lead placement (RR 0.71 [95% CI 0.13%–3.9%]; p = 0.695). Fifty-seven patients were included in clinical outcome analyses (MER, n = 16; iMRI, n = 41). Both groups had similar characteristics at baseline, although patients undergoing MER-guided DBS had a lower response on their baseline levodopa challenge (44.8% ± 5.4% [95% CI 33.2%–56.4%] vs 61.6% ± 2.1% [95% CI 57.4%–65.8%]; t = 3.558, p = 0.001). Greater improvement was seen following iMRI-guided lead placement (43.2% ± 3.5% [95% CI 36.2%–50.3%]) versus MER-guided lead placement (25.5% ± 6.7% [95% CI 11.1%–39.8%]; F = 5.835, p = 0.019). When UPDRS III motor scores were assessed only in the contralateral hemibody (per-lead analyses), the improvements remained significantly different (37.1% ± 7.2% [95% CI 22.2%–51.9%] and 50.0% ± 3.5% [95% CI 43.1%–56.9%] for MER- and iMRI-guided DBS lead placement, respectively). Both groups exhibited similar reductions in LEDDs (21.2% and 20.9%, respectively; F = 0.221, p = 0.640). The locations of all active contacts and the 2D radial distance from these to consensus coordinates for GPi-DBS lead placement (x, ±20; y, +2; and z, −4) did not differ statistically by type of surgery.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>iMRI-guided GPi-DBS lead placement in PD patients was associated with significant improvement in clinical outcomes, comparable to those observed following MER-guided DBS lead placement. Furthermore, iMRI-guided DBS implantation produced a similar safety profile to that of the MER-guided procedure. As such, iMRI guidance is an alternative to MER guidance for patients undergoing GPi-DBS implantation for PD.</jats:p></jats:sec>

The Effects of Different Anesthesia Methods on the Treatment of Parkinson’s Disease by Bilateral Deep Brain Stimulation of the Subthalamic Nucleus

“…The main reason for this result is that every patient in the GA group received microelectrode recording during microelectrode insertion. Most typical STN discharge waveforms can be recorded by selecting the ideal anesthesia protocol and monitoring the anesthesia depth (60 ± 5) through BIS ( Jain et al, 2007 ; Kinfe and Vesper, 2013 ; Zeiler et al, 2013 ; Chakrabarti et al, 2014 ; Bezchlibnyk et al, 2020 ). However, during local anesthesia surgery, some patients suffer excessive nervousness, coughing, or severe tremors, which would interfere with electrophysiological signals.…”

Single-Stage Deep Brain Stimulator Placement for Movement Disorders: A Case Series

“…A clearly superior technique has not been established [ 7 ]. Studies have shown similar outcomes when comparing intraoperative CT (iCT)-guided sub-thalamic nucleus (STN)- or Globus Pallidus (Gpi)-DBS lead implantation to MER-guided DBS [ 8 ], as well as when comparing iMRI-guided GPi-DBS to MER-guided DBS [ 9 ], with some motor outcomes slightly favoring asleep DBS. Mirzadeh, et al suggested stereotactic accuracy was better under general anesthesia without MER, compared to the group receiving MER intraoperatively [ 10 , 11 ].…”

Photobiomodulation for Parkinson’s Disease in Animal Models: A Systematic Review

“…It should be noted that the regions of the brain where optical fibers are implanted are different from the regions where electrodes are implanted in the DBS procedure. In DBS, electrodes are usually implanted into the globus pallidus internus to improve the motor function [54] or into the subthalamic nucleus [55] or the caudal zona incerta to improve tremor [56]. The optical fibers in PD animal models have been implanted into the mid-brain, with the goal of delivering the light as close as possible to the SNc, to preserve the dopamine producing neurons.…”