Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson's disease and tremor
Identifieur interne : 003451 ( Main/Exploration ); précédent : 003450; suivant : 003452Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson's disease and tremor
Auteurs : Robert E. Gross [États-Unis] ; Paul Krack [France] ; Maria C. Rodriguez-Oroz [Espagne] ; Ali R. Rezai [États-Unis] ; Alim-Louis Benabid [France]Source :
- Movement Disorders [ 0885-3185 ] ; 2006-06.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Cartographie.
English descriptors
- KwdEn :
- Brain (surgery), Brain Mapping (methods), Cartography, Cerebral disorder, Deep Brain Stimulation (methods), Electrodes, Implanted, Globus Pallidus (anatomy & histology), Globus Pallidus (physiology), Humans, Microelectrodes, Nervous system diseases, Parkinson Disease (complications), Parkinson Disease (surgery), Parkinson Disease (therapy), Parkinson disease, Stimulator, Subthalamic Nucleus (anatomy & histology), Subthalamic Nucleus (physiology), Subthalamic nucleus, Tremor, Tremor (etiology), Tremor (therapy), Ventral Thalamic Nuclei (physiology), globus pallidus, stimulation, subthalamic nucleus, ventral intermedius.
- MESH :
- anatomy & histology : Globus Pallidus, Subthalamic Nucleus.
- complications : Parkinson Disease.
- etiology : Tremor.
- methods : Brain Mapping, Deep Brain Stimulation.
- physiology : Globus Pallidus, Subthalamic Nucleus, Ventral Thalamic Nuclei.
- surgery : Brain, Parkinson Disease.
- therapy : Parkinson Disease, Tremor.
- Electrodes, Implanted, Humans, Microelectrodes.
Abstract
The vast majority of centers use electrophysiological mapping techniques to finalize target selection during the implantation of deep brain stimulation (DBS) leads for the treatment of Parkinson's disease and tremor. This review discusses the techniques used for physiological mapping and addresses the questions of how various mapping strategies modify target selection and outcome following subthalamic nucleus (STN), globus pallidus internus (GPi), and ventralis intermedius (Vim) deep brain stimulation. Mapping strategies vary greatly across centers, but can be broadly categorized into those that use microelectrode or semimicroelectrode techniques to optimize position prior to implantation and macrostimulation through a macroelectrode or the DBS lead, and those that rely solely on macrostimulation and its threshold for clinical effects (benefits and side effects). Microelectrode criteria for implantation into the STN or GPi include length of the nucleus recorded, presence of movement‐responsive neurons, and/or distance from the borders with adjacent structures. However, the threshold for the production of clinical benefits relative to side effects is, in most centers, the final, and sometimes only, determinant of DBS electrode position. Macrostimulation techniques for mapping, the utility of microelectrode mapping is reflected in its modification of electrode position in 17% to 87% of patients undergoing STN DBS, with average target adjustments of 1 to 4 mm. Nevertheless, with the absence of class I data, and in consideration of the large number of variables that impact clinical outcome, it is not possible to conclude that one technique is superior to the other in so far as motor Unified Parkinson's Disease Rating Scale outcome is concerned. Moreover, mapping technique is only one out of many variables that determine the outcome. The increase in surgical risk of intracranial hemorrhage correlated to the number of microelectrode trajectories must be considered against the risk of suboptimal benefits related to omission of this technique. © 2006 Movement Disorder Society
Url:
- https://api.istex.fr/document/B1528809FC653EA8BF1A04C37FDAC339B94062FB/fulltext/pdf
- http://www.hal.inserm.fr/inserm-00390675
DOI: 10.1002/mds.20960
Affiliations:
- Espagne, France, États-Unis
- Auvergne-Rhône-Alpes, Géorgie (États-Unis), Ohio, Rhône-Alpes
- Grenoble
- Centre hospitalier universitaire Grenoble Alpes
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Le document en format XML
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<term>Deep Brain Stimulation (methods)</term>
<term>Electrodes, Implanted</term>
<term>Globus Pallidus (anatomy & histology)</term>
<term>Globus Pallidus (physiology)</term>
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<term>Microelectrodes</term>
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<term>stimulation</term>
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<front><div type="abstract" xml:lang="en">The vast majority of centers use electrophysiological mapping techniques to finalize target selection during the implantation of deep brain stimulation (DBS) leads for the treatment of Parkinson's disease and tremor. This review discusses the techniques used for physiological mapping and addresses the questions of how various mapping strategies modify target selection and outcome following subthalamic nucleus (STN), globus pallidus internus (GPi), and ventralis intermedius (Vim) deep brain stimulation. Mapping strategies vary greatly across centers, but can be broadly categorized into those that use microelectrode or semimicroelectrode techniques to optimize position prior to implantation and macrostimulation through a macroelectrode or the DBS lead, and those that rely solely on macrostimulation and its threshold for clinical effects (benefits and side effects). Microelectrode criteria for implantation into the STN or GPi include length of the nucleus recorded, presence of movement‐responsive neurons, and/or distance from the borders with adjacent structures. However, the threshold for the production of clinical benefits relative to side effects is, in most centers, the final, and sometimes only, determinant of DBS electrode position. Macrostimulation techniques for mapping, the utility of microelectrode mapping is reflected in its modification of electrode position in 17% to 87% of patients undergoing STN DBS, with average target adjustments of 1 to 4 mm. Nevertheless, with the absence of class I data, and in consideration of the large number of variables that impact clinical outcome, it is not possible to conclude that one technique is superior to the other in so far as motor Unified Parkinson's Disease Rating Scale outcome is concerned. Moreover, mapping technique is only one out of many variables that determine the outcome. The increase in surgical risk of intracranial hemorrhage correlated to the number of microelectrode trajectories must be considered against the risk of suboptimal benefits related to omission of this technique. © 2006 Movement Disorder Society</div>
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