ParkinsonFranceV1, Hal, Checkpoint, bibRecord, 000906

Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.

Identifieur interne : 000906 ( Hal/Checkpoint ); précédent : 000905; suivant : 000907

Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.

Auteurs : Mathieu Anheim [France] ; Alina Batir [France] ; Valérie Fraix [France] ; Madjid Silem [France] ; Stéphan Chabardès [France] ; Eric Seigneuret [France] ; Paul Krack [France] ; Alim-Louis Benabid [France] ; Pierre Pollak [France]

Source :

Archives of Neurology -Chigago- [ 0003-9942 ] ; 2008-05.

RBID : Hal:inserm-00382038

Abstract

BACKGROUND: The misplacement of electrodes is a possible explanation for suboptimal response to bilateral subthalamic nucleus (STN) stimulation in patients with Parkinson disease. OBJECTIVE: To evaluate whether reimplantation of electrodes in the STN can produce improvement in patients with poor results from surgery and with suspected electrode misplacement based on imaging findings. DESIGN: Prospective follow-up study. SETTING: Academic research. PATIENTS: A 1-year postoperative study was undertaken in 7 consecutive patients with Parkinson disease who, despite bilateral STN stimulation, experienced persistent motor disability and who were operated on for reimplantation a median of 16.9 months later. MAIN OUTCOME MEASURES: The primary outcome was measured as the change in the Unified Parkinson Disease Rating Scale (UPDRS) motor score 1 year after reimplantation. The secondary outcome was measured as the extent of pharmacologic and electrical treatments required and the threshold at which the first stimulation-induced adverse effect appeared. The distances between the electrode contacts used for chronic stimulation and the STN theoretical effective target, defined as the mean position of the clinically efficient contact from 193 previously implanted electrodes, were compared. RESULTS: Except for a single patient, all patients displayed improvement following reimplantation. Under off-medication (ie, the patient is taking no medication) condition, STN stimulation improved the basal state UPDRS motor score by 26.7% before reimplantation and by 59.4% at 1 year after reimplantation. The median off-medication Schwab and England score improved from 51% to 76%. The median levodopa equivalent daily dose was reduced from 1202 mg to 534 mg. The stimulation varibles changed from a mean of 2.6 V/73.0 micros/163.0 Hz to 2.8 V/60. 0 micros/ 140.0 Hz. The mean threshold of the first stimulation-induced adverse effect increased from 2.6 to 4.4 V. The mean distance between the contacts used for chronic stimulation and the theoretical effective target decreased from 5.4 to 2.0 mm. This distance correlated inversely with the percentage improvement in theUPDRS motor score. CONCLUSION: Patients demonstrating poor response to STN stimulation as a result of electrode misplacement can benefit from reimplantation in the STN closer to the theoretical target.

Url:

http://www.hal.inserm.fr/inserm-00382038

DOI: 10.1001/archneur.65.5.612

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<idno type="DOI">10.1001/archneur.65.5.612</idno>
<series><title level="j">Archives of Neurology -Chigago-</title>
<idno type="ISSN">0003-9942</idno>
<imprint><date type="datePub">2008-05</date>
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<front><div type="abstract" xml:lang="en">BACKGROUND: The misplacement of electrodes is a possible explanation for suboptimal response to bilateral subthalamic nucleus (STN) stimulation in patients with Parkinson disease. OBJECTIVE: To evaluate whether reimplantation of electrodes in the STN can produce improvement in patients with poor results from surgery and with suspected electrode misplacement based on imaging findings. DESIGN: Prospective follow-up study. SETTING: Academic research. PATIENTS: A 1-year postoperative study was undertaken in 7 consecutive patients with Parkinson disease who, despite bilateral STN stimulation, experienced persistent motor disability and who were operated on for reimplantation a median of 16.9 months later. MAIN OUTCOME MEASURES: The primary outcome was measured as the change in the Unified Parkinson Disease Rating Scale (UPDRS) motor score 1 year after reimplantation. The secondary outcome was measured as the extent of pharmacologic and electrical treatments required and the threshold at which the first stimulation-induced adverse effect appeared. The distances between the electrode contacts used for chronic stimulation and the STN theoretical effective target, defined as the mean position of the clinically efficient contact from 193 previously implanted electrodes, were compared. RESULTS: Except for a single patient, all patients displayed improvement following reimplantation. Under off-medication (ie, the patient is taking no medication) condition, STN stimulation improved the basal state UPDRS motor score by 26.7% before reimplantation and by 59.4% at 1 year after reimplantation. The median off-medication Schwab and England score improved from 51% to 76%. The median levodopa equivalent daily dose was reduced from 1202 mg to 534 mg. The stimulation varibles changed from a mean of 2.6 V/73.0 micros/163.0 Hz to 2.8 V/60. 0 micros/ 140.0 Hz. The mean threshold of the first stimulation-induced adverse effect increased from 2.6 to 4.4 V. The mean distance between the contacts used for chronic stimulation and the theoretical effective target decreased from 5.4 to 2.0 mm. This distance correlated inversely with the percentage improvement in theUPDRS motor score. CONCLUSION: Patients demonstrating poor response to STN stimulation as a result of electrode misplacement can benefit from reimplantation in the STN closer to the theoretical target.</div>
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            <author role="crp">              <persName>                <forename type="first">Mathieu</forename>
                <surname>Anheim</surname>
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            <author role="aut">              <persName>                <forename type="first">Alina</forename>
                <surname>Batir</surname>
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                    <surname>Fraix</surname>
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                  <idno type="halauthorid">296411</idno>
                  <affiliation ref="#struct-14242"></affiliation>
                  <affiliation ref="#struct-2812"></affiliation>
                </author>
                <author role="aut">                  <persName>                    <forename type="first">Madjid</forename>
                    <surname>Silem</surname>
                  </persName>
                  <idno type="halauthorid">402663</idno>
                  <affiliation ref="#struct-14242"></affiliation>
                </author>
                <author role="aut">                  <persName>                    <forename type="first">Stéphan</forename>
                    <surname>Chabardès</surname>
                  </persName>
                  <idno type="halauthorid">402664</idno>
                  <affiliation ref="#struct-2812"></affiliation>
                  <affiliation ref="#struct-92131"></affiliation>
                </author>
                <author role="aut">                  <persName>                    <forename type="first">Eric</forename>
                    <surname>Seigneuret</surname>
                  </persName>
                  <idno type="halauthorid">361462</idno>
                  <affiliation ref="#struct-2812"></affiliation>
                  <affiliation ref="#struct-92131"></affiliation>
                </author>
                <author role="aut">                  <persName>                    <forename type="first">Paul</forename>
                    <surname>Krack</surname>
                  </persName>
                  <idno type="halauthorid">296412</idno>
                  <affiliation ref="#struct-14242"></affiliation>
                  <affiliation ref="#struct-2812"></affiliation>
                </author>
                <author role="aut">                  <persName>                    <forename type="first">Alim-Louis</forename>
                    <surname>Benabid</surname>
                  </persName>
                  <idno type="halauthorid">296407</idno>
                  <affiliation ref="#struct-2812"></affiliation>
                  <affiliation ref="#struct-92131"></affiliation>
                </author>
                <author role="aut">                  <persName>                    <forename type="first">Pierre</forename>
                    <surname>Pollak</surname>
                  </persName>
                  <idno type="halauthorid">233619</idno>
                  <affiliation ref="#struct-14242"></affiliation>
                  <affiliation ref="#struct-2812"></affiliation>
                </author>
              </analytic>
              <monogr>                <idno type="halJournalId" status="VALID">10757</idno>
                <idno type="issn">0003-9942</idno>
                <title level="j">Archives of Neurology -Chigago-</title>
                <imprint>                  <publisher>American Medical Association</publisher>
                  <biblScope unit="volume">65</biblScope>
                  <biblScope unit="issue">5</biblScope>
                  <biblScope unit="pp">612-6</biblScope>
                  <date type="datePub">2008-05</date>
                </imprint>
              </monogr>
              <idno type="doi">10.1001/archneur.65.5.612</idno>
              <idno type="pubmed">18474736</idno>
            </biblStruct>
          </sourceDesc>
          <profileDesc>            <langUsage>              <language ident="en">English</language>
            </langUsage>
            <textClass>              <classCode scheme="mesh">Aged</classCode>
              <classCode scheme="mesh">Basal Ganglia</classCode>
              <classCode scheme="mesh">Neural Pathways</classCode>
              <classCode scheme="mesh">Neuronavigation</classCode>
              <classCode scheme="mesh">Parkinson Disease</classCode>
              <classCode scheme="mesh">Postoperative Complications</classCode>
              <classCode scheme="mesh">Prospective Studies</classCode>
              <classCode scheme="mesh">Recovery of Function</classCode>
              <classCode scheme="mesh">Reoperation</classCode>
              <classCode scheme="mesh">Stereotaxic Techniques</classCode>
              <classCode scheme="mesh">Subthalamic Nucleus</classCode>
              <classCode scheme="mesh">Treatment Outcome</classCode>
              <classCode scheme="mesh">Deep Brain Stimulation</classCode>
              <classCode scheme="mesh">Electrodes, Implanted</classCode>
              <classCode scheme="mesh">Female</classCode>
              <classCode scheme="mesh">Follow-Up Studies</classCode>
              <classCode scheme="mesh">Humans</classCode>
              <classCode scheme="mesh">Male</classCode>
              <classCode scheme="mesh">Microelectrodes</classCode>
              <classCode scheme="mesh">Middle Aged</classCode>
              <classCode scheme="halDomain" n="sdv.neu">Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]</classCode>
              <classCode scheme="halTypology" n="ART">Journal articles</classCode>
            </textClass>
            <abstract xml:lang="en">BACKGROUND: The misplacement of electrodes is a possible explanation for suboptimal response to bilateral subthalamic nucleus (STN) stimulation in patients with Parkinson disease. OBJECTIVE: To evaluate whether reimplantation of electrodes in the STN can produce improvement in patients with poor results from surgery and with suspected electrode misplacement based on imaging findings. DESIGN: Prospective follow-up study. SETTING: Academic research. PATIENTS: A 1-year postoperative study was undertaken in 7 consecutive patients with Parkinson disease who, despite bilateral STN stimulation, experienced persistent motor disability and who were operated on for reimplantation a median of 16.9 months later. MAIN OUTCOME MEASURES: The primary outcome was measured as the change in the Unified Parkinson Disease Rating Scale (UPDRS) motor score 1 year after reimplantation. The secondary outcome was measured as the extent of pharmacologic and electrical treatments required and the threshold at which the first stimulation-induced adverse effect appeared. The distances between the electrode contacts used for chronic stimulation and the STN theoretical effective target, defined as the mean position of the clinically efficient contact from 193 previously implanted electrodes, were compared. RESULTS: Except for a single patient, all patients displayed improvement following reimplantation. Under off-medication (ie, the patient is taking no medication) condition, STN stimulation improved the basal state UPDRS motor score by 26.7% before reimplantation and by 59.4% at 1 year after reimplantation. The median off-medication Schwab and England score improved from 51% to 76%. The median levodopa equivalent daily dose was reduced from 1202 mg to 534 mg. The stimulation varibles changed from a mean of 2.6 V/73.0 micros/163.0 Hz to 2.8 V/60. 0 micros/ 140.0 Hz. The mean threshold of the first stimulation-induced adverse effect increased from 2.6 to 4.4 V. The mean distance between the contacts used for chronic stimulation and the theoretical effective target decreased from 5.4 to 2.0 mm. This distance correlated inversely with the percentage improvement in theUPDRS motor score. CONCLUSION: Patients demonstrating poor response to STN stimulation as a result of electrode misplacement can benefit from reimplantation in the STN closer to the theoretical target.</abstract>
            <particDesc>              <org type="consortium">Collaboration</org>
            </particDesc>
          </profileDesc>
        </hal>
</record>

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	La maladie de Parkinson en France (serveur d'exploration)
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La maladie de Parkinson en France (serveur d'exploration)

Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.

Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.

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