Article
Improvements of cardinal motor symptoms in Parkinson's disease depending on the stimulation site relative to a standardized, reconstructed, 3-dimensional MRI-defined subthalamic nucleus
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Published: | June 4, 2012 |
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Objective: To our knowledge this is the first study, which evaluates the improvements of cardinal motor symptoms depending on the stimulation site relative to a standardized, reconstructed, 3-dimensional, MRI-defined Subthalamic Nucleus (STN).
Methods: This retrospective, clinical study includes 22 patients with idiopathic Parkinson's disease, who consecutively underwent bilateral subthalamic nucleus stimulation. Microelectrode recording and clinical testing was performed intraoperatively. The localisation of the best stimulation site found during operation and the position of the active electrode contacts were related to a standardized, reconstructed 3-dimensional MRI-defined STN. Statistical tests for the evaluation of correlations between the stimulation site and the percentile improvements of rigidity, tremor and akinesia included Student-t-tests, Kruskal-Wallis One Way Analysis of Variance on Ranks and ANOVA on ranks.
Results: The more lateral and superior the intraoperative stimulation site was located in the MRI-STN, the more pronounced was the improvement of the contralateral akinesia. Postoperative active electrode contacts located superior to or in the dorsal part of the MRI-STN reduced the tremor of the contralateral hand significantly (p <0.05). No other significant correlations were found between the site of the active contact along the x, y and z-axis and the percentile reduction of rigidity, tremor and akinesia.
Conclusions: We found a positive correlation of certain UPDRS subscores with the anatomical stimulation site related to a standardized, MRI-defined STN. However, there was no equal improvement of all cardinal motor symptoms using one distinct stimulation site.