Stimulation Site Within the MRI-Defined STN Predicts Postoperative Motor Outcome
Identifieur interne : 000F78 ( Main/Exploration ); précédent : 000F77; suivant : 000F79Stimulation Site Within the MRI-Defined STN Predicts Postoperative Motor Outcome
Auteurs : Fritz Wodarg [Allemagne] ; Jan Herzog [Allemagne] ; Rene Reese [Allemagne] ; Daniela Falk [Allemagne] ; Markus O. Pinsker [Allemagne] ; Frank Steigerwald [Allemagne] ; Olav Jansen [Allemagne] ; Gunther Deuschl [Allemagne] ; H. Maximillian Mehdorn [Allemagne] ; Jens Volkmann [Allemagne]Source :
- Movement disorders [ 0885-3185 ] ; 2012.
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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.
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Pinsker</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Christian- Albrechts-University Kiel</s1><s2>Kiel</s2><s3>DEU</s3><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="2">Schleswig-Holstein</region><settlement type="city">Kiel</settlement></placeName></affiliation></author><author><name sortKey="Steigerwald, Frank" sort="Steigerwald, Frank" uniqKey="Steigerwald F" first="Frank" last="Steigerwald">Frank Steigerwald</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian- Albrechts-University Kiel</s1><s2>Kiel</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="2">Schleswig-Holstein</region><settlement type="city">Kiel</settlement></placeName></affiliation></author><author><name sortKey="Jansen, Olav" sort="Jansen, Olav" uniqKey="Jansen O" first="Olav" last="Jansen">Olav Jansen</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Neuroradiology, Christian- Albrechts-University Kiel</s1><s2>Kiel</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="2">Schleswig-Holstein</region><settlement type="city">Kiel</settlement></placeName></affiliation></author><author><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Gunther" last="Deuschl">Gunther Deuschl</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian- Albrechts-University Kiel</s1><s2>Kiel</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="2">Schleswig-Holstein</region><settlement type="city">Kiel</settlement></placeName></affiliation></author><author><name sortKey="Maximillian Mehdorn, H" sort="Maximillian Mehdorn, H" uniqKey="Maximillian Mehdorn H" first="H." last="Maximillian Mehdorn">H. Maximillian Mehdorn</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Christian- Albrechts-University Kiel</s1><s2>Kiel</s2><s3>DEU</s3><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="2">Schleswig-Holstein</region><settlement type="city">Kiel</settlement></placeName></affiliation></author><author><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian- Albrechts-University Kiel</s1><s2>Kiel</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>3 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="2">Schleswig-Holstein</region><settlement type="city">Kiel</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Atlas</term><term>Nervous system diseases</term><term>Nuclear magnetic resonance imaging</term><term>Parkinson disease</term><term>Postoperative</term><term>Prognosis</term><term>Stereotaxia</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Imagerie RMN</term><term>Postopératoire</term><term>Pronostic</term><term>Stéréotaxie</term><term>Atlas</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Atlas</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><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><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Gunther" last="Deuschl">Gunther 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="Maximillian Mehdorn, H" sort="Maximillian Mehdorn, H" uniqKey="Maximillian Mehdorn H" first="H." last="Maximillian 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="Rene" last="Reese">Rene 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><name sortKey="Wodarg, Fritz" sort="Wodarg, Fritz" uniqKey="Wodarg F" first="Fritz" last="Wodarg">Fritz Wodarg</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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