Article
Role of macrostimulation on clinical outcome (UDPRS-III) in subthalamic deep brain stimulation procedure for Parkinson's disease
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Authors
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Anabel Pinter
- Heidelberg, Deutschland
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Kajetan von Eckardstein
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen, UMG, Göttingen, Deutschland
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Friederike Sixel-Döring
- Göttingen, Deutschland
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Timo Behm
- Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
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Claudia Trenkwalder
- Göttingen, Deutschland
| Published: | June 9, 2017 |
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Outline
Text
Objective: Subthalamic (STN) lead placement for Parkinson’s disease typically involves MR-based target planning, microelectrode recording (MER), and macrostimulation. Macrostimulation in the awake patient is used to test for clinical responses as well as stimulation induced side effects and is thought to optimize lead position. Little is known of the impact of intraoperative macrostimulation on clinical long-term results.
Methods: We performed a review of prospectively collected data of clinical outcome scores of patients undergoing bilateral placement of non-segmented leads in the STN and compared patients in respect to consistency of results of MER and macrostimulation. Group A consisted of patients where trajectory selection for final lead placement followed consistent MER and macrostimulation results; group B included patients where trajectory selection for final lead placement followed macrostimulation results that were different from MER unilaterally; group C included patients in which there was a mismatch between MER and intraoperative macrostimulation bilaterally and lead placement hence followed macrostimulation results. We hypothesized that UPDRS-III scores at one year do not differ in those patient groups.
Results: We included 47 patients with 94 leads (42.6% female; mean age 60 +/- 7.2 years). In 21 patients with consistent MER and macrostimulation results bilaterally (group A), UPDRS-III score at one year was 11.6 +/- 8.5 stim ON and 39.0 +/- 11.6 stim OFF. In 14 patients with unilaterally inconsistent MER and macrostimulation (group B), the score reading was 14.6 +/- 11.0 stim ON and 40.0 +/- 11.1 stim OFF. In group C (bilaterally inconsistent MER and macrostimulation results, 12 patients), patients showed a UPDRS-III score at one year of 15.6 +/- 6.5 stim ON and 45.8 +/- 12.9 stim OFF. The UPDRS-III score between groups is of no significant difference (ANOVA test).
Conclusion: Macrostimulation may alter trajectory preselection based on MER. As motor outcomes do not differ in those cases where macrostimulation overrules MER tract selection we assume that with non-segmented electrodes macrostimulation provides important information for optimal tract selection.
