Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance

Abstract

At evaluation 6 months after surgery, continuous STN stimulation was shown to have improved parkinsonian motor disability by 64% and 78% in the "off' and "on" medication states, respectively. Antiparkinsonian drug treatment was reduced by 70% in 10 patients and withdrawn in two patients. The severity of levodopa-induced dyskinesias was reduced by 83% and motor fluctuations by 88%. Continuous high-frequency stimulation of the STN applied through electrodes implanted with the aid of 3D MR imaging and electrophysiological guidance is a safe and effective therapy for patients suffering from severe, advanced levodopa-responsive PD.

Co-registration of Histological, Optical and MR Data of the Human Brain

“…The relationship between the measured signal and the real anatomy is not always completely understood. For example, for Parkinson's disease, the STN is targeted on pre-operative MR acquisitions (T1 and T2-weighted) [1]. On the T1 image (acquired in stereotactic conditions), this nucleus is undistinguishable, and on the T2 image (not in stereotactic conditions, due to geometric distortions), an hyposignal at the STN level is observed, but a clearly defined relationship between this signal and the STN is still debated.…”

“…for Parkinson's disease a small, deeply located, nucleus called the subthalamic nucleus (STN) [6]. The nucleus is targeted on pre-operative stereotactic MR acquisitions [1]. In these procedures, the surgical success depends primarily on the accurate localisation of the target.…”

STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

“…Bejjani et al reported that MRI alone was not sufficient in their experience of 12 cases in which T2-weighted coronal images were used for targeting 1) . Zonenshayn and colleagues found that MRI targeting was the least accurate method with an average error of 2.6 mm 38) .…”

Stimulation sites in the subthalamic nucleus projected onto a mean 3-D atlas of the thalamus and basal ganglia

“…The variability in the 40 brain hemispheres is accounted for at three levels. First, in the most important step ("direct targeting" [2]) we set the target into the hypointense zone in MR, which roughly corresponds to the STN [12]. This target coordinate was then adjusted on the basis of, second, micro-electrode recording and, third, neurological testing.…”

“…(1) Preoperatively, MR images are scanned for a hypointense zone, which is caused by a susceptibility artefact due to iron enrichment in the subthalamic area [21]. This zone is used to identify the STN ("direct targeting" [2]). However, this zone does not necessarily correspond to the anatomical boundaries of the STN [12,19].…”