Subthalamic Stimulation in Parkinson Disease

Houeto, Jean‐Luc; Welter, Marie‐Laure; Bejjani, Paul-Boulos; Montcel, Sophie Tezenas du; Bonnet, Anne‐Marie; Mesnage, Valérie; Navarro, Soledad; Pidoux, B.; Dormont, Didier; Cornu, Philippe; Agid, Yves

doi:10.1001/archneur.60.5.690

Cited by 91 publications

(66 citation statements)

References 19 publications

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“…Houeto et al [10] did not find any correlation between the postoperative clinical outcome and the extent of STN neuronal activity along the best trajectory in single-unit microrecordings. In contrast, we found that the clinical outcome correlated with the length of neuronal hyperactivity in multi-unit recordings.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, pre-operative predictive factors for STN-DBS outcome include young age and high baseline values or levodopa responsiveness of UPDRS III scores, in particular regarding the axial subscore [8,9,10,11,12,13,14]. Herein, patients have been selected to the bilateral STN stimulation procedure according to a specific set of clinical characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, STN cells could be present when signal amplitude was higher than 1 mV but lower than twofold the basal noise, and, therefore, this was not taken into account in the present study. In addition, in the former study [10], not only intra-operative recordings, but also the effectiveness of intra-operative stimulation was considered to define the final target.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the passage into the STN resulted in a frank increase in signal amplitude, likely due to the density of hyperactive cells. The tracks were repeated until we obtained a signal amplitude higher than 1 mV for more than 4 mm, since the average length of STN-like activity ranged from 4.2 to 4.9 mm along the best track in previous reports using microelectrode recordings [10,22,23,24,25]. When the initial track was inaccurate, the subsequent tracks were done 2 mm anterior, posterior, lateral or medial, after radiological verification of the semi-microelectrode tip location at the end of the track.…”

Section: Methodsmentioning

confidence: 99%

“…Various predictive factors for STN-DBS efficacy have been reported, including higher motor score at baseline, pre-operative levodopa responsiveness, age and disease duration [8,9,10,11,12,13,14]. The objective of the present study was to reappraise these factors in a large single-centre cohort of 54 patients.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Bilateral Subthalamic Nucleus Stimulation in the Treatment of Parkinson’s Disease: Correlation with Intra-Operative Multi-Unit Recordings but Not with the Type of Anaesthesia

Lefaucheur

Gurruchaga²,

Pollin³

et al. 2008

Eur Neurol

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Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) gained general acceptance in the treatment of Parkinson’s disease (PD). Objective: To study the clinical outcome and the predicting factors of efficacy of chronic STN stimulation, while DBS electrodes were implanted under local or general anaesthesia with intra-operative electrophysiological guidance based on multi-unit recordings. Methods: We included a large single-centre cohort of 54 patients with advanced PD (mean age: 59 years; disease duration: 14 years). Clinical evaluation was performed by the Unified Parkinson’s Disease Rating Scale (UPDRS) before and 1 year after surgical placement of DBS electrodes. Results: In the on-stimulation and off-medication condition, the UPDRS part III score was reduced by 56% compared to the off-stimulation condition or pre-operative off-drug score. In the on-stimulation and on-medication condition, this score was reduced by 73%. The severity of motor fluctuations and dyskinesia (UPDRS part IV) and the activities of daily living (UPDRS part II) were reduced by 65 and 80%, respectively, in the on-stimulation/on-medication condition compared to the pre-operative baseline. The daily dose of antiparkinsonian treatment was diminished by 72%. Among the various pre- and intra-operative data, the most important predictive factor for clinical efficacy of STN stimulation was the length of hyperactivity along the best track observed in intra-operative multi-unit recordings. Other predictive factors included age, disease duration and pre-operative levodopa responsiveness or baseline off-drug values of the Hoehn and Yahr and UPDRS part III scores. In contrast, the type of anaesthesia (local vs. general) did not significantly influence the clinical outcome. Conclusion: The present results are in the average of previously published results, but they have been obtained from a large single-centre cohort of patients with important reductions in the daily dose of antiparkinsonian drugs. This study confirmed the efficacy of the STN-DBS technique and emphasized the value of an original intra-operative electrophysiological approach based on multi-unit and not single-unit quantified recordings. This method allows DBS electrode implantation to be safely performed under general anaesthesia without lessening the rate of efficacy of the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Outcome of Bilateral Subthalamic Nucleus Stimulation in the Treatment of Parkinson’s Disease: Correlation with Intra-Operative Multi-Unit Recordings but Not with the Type of Anaesthesia

Lefaucheur

Gurruchaga²,

Pollin³

et al. 2008

Eur Neurol

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