Stimulation site within the MRI-defined STN predicts postoperative motor outcome.
Identifieur interne : 000C08 ( Main/Exploration ); précédent : 000C07; suivant : 000C09Stimulation site within the MRI-defined STN predicts postoperative motor outcome.
Auteurs : Fritz Wodarg [Allemagne] ; Jan Herzog ; René Reese ; Daniela Falk ; Markus O. Pinsker ; Frank Steigerwald ; Olav Jansen ; Günther Deuschl ; H Maximillian Mehdorn ; Jens VolkmannSource :
- Movement disorders : official journal of the Movement Disorder Society [ 1531-8257 ] ; 2012.
English descriptors
- KwdEn :
- Aged, Deep Brain Stimulation (methods), Female, Functional Laterality, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Movement (physiology), Parkinson Disease (physiopathology), Parkinson Disease (therapy), Predictive Value of Tests, Retrospective Studies, Subthalamic Nucleus (physiology), Time Factors, Treatment Outcome.
- MESH :
- methods : Deep Brain Stimulation.
- physiology : Movement, Subthalamic Nucleus.
- physiopathology : Parkinson Disease.
- therapy : Parkinson Disease.
- Aged, Female, Functional Laterality, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Time Factors, Treatment Outcome.
Abstract
High-frequency stimulation of the subthalamic nucleus (STN-HFS) is highly effective in treating motor symptoms in Parkinson's disease (PD) and medication side effects as well as in improving quality of life. Despite preoperative screening for patients as eligible candidates for this treatment, electrode position may furthermore influence treatment quality. Here, we investigated the relationship between the anatomical site of stimulation within the MRI-defined STN and the outcome of PD patients after STN-HFS. In 30 PD patients with bilateral STN stimulation, we retrospectively defined the boundaries of the STN within the axial target plane of the stereotactic T2-weighted MRI and determined the position of the active electrode contact in relation to the border of the STN. The position of the active contact within the STN was the only variable to predict the outcome of STN stimulation. In contrast, covariates such as age, disease duration, symptom severity, and response to levodopa had no effect. The lateral position of the stimulation contact within the STN led to significantly better clinical improvement, lower stimulation parameters, and less need for postoperative dopaminergic medication. The outcome of patients with stimulation contacts within the medial region of the STN was significantly worse. Precise targeting of the lateral region of the STN is essential for achieving sufficient stimulation efficacy. Preoperative T2-weighted MRI might be a useful component of the targeting procedure to improve the outcome of PD patients.
DOI: 10.1002/mds.25006
PubMed: 22517070
Affiliations:
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Pinsker</name></author><author><name sortKey="Steigerwald, Frank" sort="Steigerwald, Frank" uniqKey="Steigerwald F" first="Frank" last="Steigerwald">Frank Steigerwald</name></author><author><name sortKey="Jansen, Olav" sort="Jansen, Olav" uniqKey="Jansen O" first="Olav" last="Jansen">Olav Jansen</name></author><author><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name></author><author><name sortKey="Mehdorn, H Maximillian" sort="Mehdorn, H Maximillian" uniqKey="Mehdorn H" first="H Maximillian" last="Mehdorn">H Maximillian Mehdorn</name></author><author><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2012">2012</date><idno type="doi">10.1002/mds.25006</idno><idno type="RBID">pubmed:22517070</idno><idno type="pmid">22517070</idno><idno type="wicri:Area/PubMed/Corpus">000D92</idno><idno type="wicri:Area/PubMed/Curation">000D92</idno><idno type="wicri:Area/PubMed/Checkpoint">000C21</idno><idno type="wicri:Area/Ncbi/Merge">003638</idno><idno type="wicri:Area/Ncbi/Curation">003638</idno><idno type="wicri:Area/Ncbi/Checkpoint">003638</idno><idno type="wicri:Area/Main/Merge">000C14</idno><idno type="wicri:Area/Main/Curation">000C08</idno><idno type="wicri:Area/Main/Exploration">000C08</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Stimulation site within the MRI-defined STN predicts postoperative motor outcome.</title><author><name sortKey="Wodarg, Fritz" sort="Wodarg, Fritz" uniqKey="Wodarg F" first="Fritz" last="Wodarg">Fritz Wodarg</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, Christian- Albrechts-University Kiel, Kiel, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Neurology, Christian- Albrechts-University Kiel, Kiel</wicri:regionArea><placeName><region type="land" nuts="2">Schleswig-Holstein</region><settlement type="city">Kiel</settlement></placeName></affiliation></author><author><name sortKey="Herzog, Jan" sort="Herzog, Jan" uniqKey="Herzog J" first="Jan" last="Herzog">Jan Herzog</name></author><author><name sortKey="Reese, Rene" sort="Reese, Rene" uniqKey="Reese R" first="René" last="Reese">René Reese</name></author><author><name sortKey="Falk, Daniela" sort="Falk, Daniela" uniqKey="Falk D" first="Daniela" last="Falk">Daniela Falk</name></author><author><name sortKey="Pinsker, Markus O" sort="Pinsker, Markus O" uniqKey="Pinsker M" first="Markus O" last="Pinsker">Markus O. Pinsker</name></author><author><name sortKey="Steigerwald, Frank" sort="Steigerwald, Frank" uniqKey="Steigerwald F" first="Frank" last="Steigerwald">Frank Steigerwald</name></author><author><name sortKey="Jansen, Olav" sort="Jansen, Olav" uniqKey="Jansen O" first="Olav" last="Jansen">Olav Jansen</name></author><author><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name></author><author><name sortKey="Mehdorn, H Maximillian" sort="Mehdorn, H Maximillian" uniqKey="Mehdorn H" first="H Maximillian" last="Mehdorn">H Maximillian Mehdorn</name></author><author><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="eISSN">1531-8257</idno><imprint><date when="2012" type="published">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Deep Brain Stimulation (methods)</term><term>Female</term><term>Functional Laterality</term><term>Humans</term><term>Longitudinal Studies</term><term>Magnetic Resonance Imaging</term><term>Male</term><term>Middle Aged</term><term>Movement (physiology)</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (therapy)</term><term>Predictive Value of Tests</term><term>Retrospective Studies</term><term>Subthalamic Nucleus (physiology)</term><term>Time Factors</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Movement</term><term>Subthalamic Nucleus</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Female</term><term>Functional Laterality</term><term>Humans</term><term>Longitudinal Studies</term><term>Magnetic Resonance Imaging</term><term>Male</term><term>Middle Aged</term><term>Predictive Value of Tests</term><term>Retrospective Studies</term><term>Time Factors</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">High-frequency stimulation of the subthalamic nucleus (STN-HFS) is highly effective in treating motor symptoms in Parkinson's disease (PD) and medication side effects as well as in improving quality of life. Despite preoperative screening for patients as eligible candidates for this treatment, electrode position may furthermore influence treatment quality. Here, we investigated the relationship between the anatomical site of stimulation within the MRI-defined STN and the outcome of PD patients after STN-HFS. In 30 PD patients with bilateral STN stimulation, we retrospectively defined the boundaries of the STN within the axial target plane of the stereotactic T2-weighted MRI and determined the position of the active electrode contact in relation to the border of the STN. The position of the active contact within the STN was the only variable to predict the outcome of STN stimulation. In contrast, covariates such as age, disease duration, symptom severity, and response to levodopa had no effect. The lateral position of the stimulation contact within the STN led to significantly better clinical improvement, lower stimulation parameters, and less need for postoperative dopaminergic medication. The outcome of patients with stimulation contacts within the medial region of the STN was significantly worse. Precise targeting of the lateral region of the STN is essential for achieving sufficient stimulation efficacy. Preoperative T2-weighted MRI might be a useful component of the targeting procedure to improve the outcome of PD patients.</div></front></TEI><affiliations><list><country><li>Allemagne</li></country><region><li>Schleswig-Holstein</li></region><settlement><li>Kiel</li></settlement></list><tree><noCountry><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name><name sortKey="Falk, Daniela" sort="Falk, Daniela" uniqKey="Falk D" first="Daniela" last="Falk">Daniela Falk</name><name sortKey="Herzog, Jan" sort="Herzog, Jan" uniqKey="Herzog J" first="Jan" last="Herzog">Jan Herzog</name><name sortKey="Jansen, Olav" sort="Jansen, Olav" uniqKey="Jansen O" first="Olav" last="Jansen">Olav Jansen</name><name sortKey="Mehdorn, H Maximillian" sort="Mehdorn, H Maximillian" uniqKey="Mehdorn H" first="H Maximillian" last="Mehdorn">H Maximillian Mehdorn</name><name sortKey="Pinsker, Markus O" sort="Pinsker, Markus O" uniqKey="Pinsker M" first="Markus O" last="Pinsker">Markus O. Pinsker</name><name sortKey="Reese, Rene" sort="Reese, Rene" uniqKey="Reese R" first="René" last="Reese">René Reese</name><name sortKey="Steigerwald, Frank" sort="Steigerwald, Frank" uniqKey="Steigerwald F" first="Frank" last="Steigerwald">Frank Steigerwald</name><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name></noCountry><country name="Allemagne"><region name="Schleswig-Holstein"><name sortKey="Wodarg, Fritz" sort="Wodarg, Fritz" uniqKey="Wodarg F" first="Fritz" last="Wodarg">Fritz Wodarg</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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