A systematic review of studies on anatomical position of electrode contacts used for chronic subthalamic stimulation in Parkinson’s disease

Caire, François; Ranoux, Daniéle; Guehl, Dominique; Burbaud, Pierre; Cuny, Emmanuel

doi:10.1007/s00701-013-1782-1

Cited by 88 publications

(100 citation statements)

References 34 publications

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“…We found that the optimal active contact position as determined by the average position of the high improvement-to-voltage group is dorsal relative to the STN midpoint. This finding agrees with several previous studies [8, 15, 18, 21, 33-36]. In addition, active contacts associated with the high improvement-to-voltage ratio were significantly ( p < 0.005) more anterior than those associated with the low improvement-to-voltage ratio.…”

Section: Discussionsupporting

confidence: 83%

“…Several other studies have found that the optimal DBS contact location lies slightly dorsal to the STN in the caudal zona incerta (ZI) [8, 18-20, 23, 25]. It remains unknown why the region dorsal to the STN would necessarily be associated with improved PD symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal locus of stimulation in the STN region is not well defined, either theoretically or empirically [6-8]. Models for the therapeutic mechanism of DBS, which might inform such a definition, differ from one another.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Atlas-Independent, Electrophysiological Mapping of the Optimal Locus of Subthalamic Deep Brain Stimulation for the Motor Symptoms of Parkinson Disease

Conrad

Mossner

Chou

et al. 2018

Stereotact Funct Neurosurg

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Background/Aims: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms of Parkinson disease (PD). However, motor outcomes can be variable, perhaps due to inconsistent positioning of the active contact relative to an unknown optimal locus of stimulation. Here, we determine the optimal locus of STN stimulation in a geometrically unconstrained, mathematically precise, and atlas-independent manner, using Unified Parkinson Disease Rating Scale (UPDRS) motor outcomes and an electrophysiological neuronal stimulation model. Methods: In 20 patients with PD, we mapped motor improvement to active electrode location, relative to the individual, directly MRI-visualized STN. Our analysis included a novel, unconstrained and computational electrical-field model of neuronal activation to estimate the optimal locus of DBS. Results: We mapped the optimal locus to a tightly defined ovoid region 0.49 mm lateral, 0.88 mm posterior, and 2.63 mm dorsal to the anatomical midpoint of the STN. On average, this locus is 11.75 lateral, 1.84 mm posterior, and 1.08 mm ventral to the mid-commissural point. Conclusion: Our novel, atlas-independent method reveals a single, ovoid optimal locus of stimulation in STN DBS for PD. The methodology, here applied to UPDRS and PD, is generalizable to atlas-independent mapping of other motor and non-motor effects of DBS.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Atlas-Independent, Electrophysiological Mapping of the Optimal Locus of Subthalamic Deep Brain Stimulation for the Motor Symptoms of Parkinson Disease

Conrad

Mossner

Chou

et al. 2018

Stereotact Funct Neurosurg

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“…1 = proximity to internal capsule, 2 = proximity to medial lemniscus and 5 = proximity to ventral STN and substantia nigra. The numbers correspond to those used in TABLE 2 Improving outcomes of subthalamic nucleus deep brain stimulation in Parkinson's disease Review informahealthcare.com STN, the ZI and white matter pathways, such as the lenticular fasciculus, may also contribute to the clinical efficacy of STN DBS [36,60]. The decision whether to place the active contact in the anterodorsal STN or in the cZI/PSA/white matter may depend on patient-specific symptomatology.…”

Section: Target Selectionmentioning

confidence: 98%

Improving outcomes of subthalamic nucleus deep brain stimulation in Parkinson’s disease

Bari

Fasano

Munhoz

et al. 2015

Expert Review of Neurotherapeutics

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The subthalamic nucleus (STN) has been a major target of deep brain stimulation (DBS) for Parkinson's disease (PD) over the past 20 years. The benefits of DBS of the STN include: decreased motor fluctuations and bradykinesia, tremor reduction and a reduction in dopaminergic drug requirements and dyskinesias. Despite these overall positive effects, the outcomes of STN DBS can be variable, contributing to the debate over the best DBS target for PD. Here, the authors review the current practice of STN DBS and also review both the existing and emerging technologies that are likely to improve the accuracy and effectiveness of STN DBS for PD. The authors emphasize patient selection, accuracy of electrode placement within the brain and the selection of appropriate stimulation parameters to optimize clinical benefits.

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“…While STN length may guarantee that the trajectory is within the STN, the precise intranuclear position can vary. In our experience, and consistent with many other centers, the most successful active contacts for global symptom reduction are located in the vicinity of the dorsolateral border of the STN [7,29,35,36], and perhaps in the caudal zona incerta, as depicted by the asterisk (*) in Figure 4. However, an anterior trajectory yielding a satisfactory STN length would miss the optimal target.…”

Section: Discussionmentioning

confidence: 52%

The Relationship of Electrophysiologic Subthalamic Nucleus Length as a Predictor of Outcomes in Deep Brain Stimulation for Parkinson Disease

Shenai

Patel²,

Romeo³

et al. 2017

Stereotact Funct Neurosurg

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Background: Intraoperative measurement of subthalamic nucleus (STN) width through microelectrode recording (MER) is a common proxy for optimal electrode location during deep brain stimulation (DBS) surgery for Parkinson disease. We assessed whether the MER-determined STN width is a predictor of postoperative Unified Parkinson Disease Rating Scale (UPDRS) improvement. Methods: Records were reviewed for patients who underwent single-sided STN DBS placement for Parkinson disease between 2005 and 2010 at the UAB Medical Center. Reviews of preoperative and 3-month postoperative UPDRS part III, intraoperative MER records, and postoperative MRI scans were conducted. Results: The final cohort consisted of 73 patients (mean age 59 ± 9.7 years, length of disease 13 ± 9.7 years). STN widths were defined as depths associated with increased background activity and motor-driven, spiking action potentials on MER. The mean contralateral UPDRS improvement was 58% (± 24). The mean STN width was 5.1 mm (± 1.6, min = 0.0, max = 8.7). No significant relationship between STN width and UPDRS improvement was found, with and without AC-PC normalization (R² < 0.05). Conclusion: This analysis raises questions about seeking the maximal electrophysiological width of STN as a proxy for optimal outcome in DBS for PD. We suggest this strategy for DBS placement in Parkinson disease be subject to more robust prospective investigation.

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A systematic review of studies on anatomical position of electrode contacts used for chronic subthalamic stimulation in Parkinson’s disease

Cited by 88 publications

References 34 publications

Atlas-Independent, Electrophysiological Mapping of the Optimal Locus of Subthalamic Deep Brain Stimulation for the Motor Symptoms of Parkinson Disease

Atlas-Independent, Electrophysiological Mapping of the Optimal Locus of Subthalamic Deep Brain Stimulation for the Motor Symptoms of Parkinson Disease

Improving outcomes of subthalamic nucleus deep brain stimulation in Parkinson’s disease

The Relationship of Electrophysiologic Subthalamic Nucleus Length as a Predictor of Outcomes in Deep Brain Stimulation for Parkinson Disease

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