ParkinsonFranceV1, Main, Curation, bibRecord, 002521

Improvement in Parkinson Disease by Subthalamic Nucleus Stimulation Based on Electrode Placement : Effects of Reimplantation

Identifieur interne : 002521 ( Main/Curation ); précédent : 002520; suivant : 002522

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 Chabardes [France] ; Eric Seigneuret [France] ; Paul Krack [France] ; Alim-Louis Benabid [France] ; Pierre Pollak [France]

Source :

Archives of neurology : (Chicago) [ 0003-9942 ] ; 2008.

RBID : Pascal:08-0248405

Descripteurs français

Pascal (Inist)
- Maladie de Parkinson, Pathologie du système nerveux, Amélioration, Noyau sousthalamique, Electrode.

English descriptors

KwdEn :
- Aged, Basal Ganglia (physiopathology), Deep Brain Stimulation (instrumentation), Deep Brain Stimulation (methods), Electrodes, Electrodes, Implanted, Female, Follow-Up Studies, Humans, Improvement, Male, Microelectrodes (standards), Middle Aged, Nervous system diseases, Neural Pathways (physiopathology), Neuronavigation (methods), Neuronavigation (standards), Parkinson Disease (therapy), Parkinson disease, Postoperative Complications (etiology), Postoperative Complications (physiopathology), Postoperative Complications (prevention & control), Prospective Studies, Recovery of Function (physiology), Reoperation, Stereotaxic Techniques (instrumentation), Stereotaxic Techniques (standards), Subthalamic Nucleus (physiology), Subthalamic Nucleus (surgery), Subthalamic nucleus, Treatment Outcome.
MESH :
- etiology : Postoperative Complications.
- instrumentation : Deep Brain Stimulation, Stereotaxic Techniques.
- methods : Deep Brain Stimulation, Neuronavigation.
- physiology : Recovery of Function, Subthalamic Nucleus.
- physiopathology : Basal Ganglia, Neural Pathways, Postoperative Complications.
- prevention & control : Postoperative Complications.
- standards : Microelectrodes, Neuronavigation, Stereotaxic Techniques.
- surgery : Subthalamic Nucleus.
- therapy : Parkinson Disease.
- Aged, Electrodes, Implanted, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Reoperation, Treatment Outcome.

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 μs/163.0 Hz to 2.8 V/60. 0 μs/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 the UPDRS 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

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Le document en format XML

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<author><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurology, University Hospital A. Michallon</s1>
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<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<series><title level="j" type="main">Archives of neurology : (Chicago)</title>
<title level="j" type="abbreviated">Arch. neurol. : (Chic.)</title>
<idno type="ISSN">0003-9942</idno>
<imprint><date when="2008">2008</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Archives of neurology : (Chicago)</title>
<title level="j" type="abbreviated">Arch. neurol. : (Chic.)</title>
<idno type="ISSN">0003-9942</idno>
</seriesStmt>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Basal Ganglia (physiopathology)</term>
<term>Deep Brain Stimulation (instrumentation)</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Electrodes</term>
<term>Electrodes, Implanted</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Improvement</term>
<term>Male</term>
<term>Microelectrodes (standards)</term>
<term>Middle Aged</term>
<term>Nervous system diseases</term>
<term>Neural Pathways (physiopathology)</term>
<term>Neuronavigation (methods)</term>
<term>Neuronavigation (standards)</term>
<term>Parkinson Disease (therapy)</term>
<term>Parkinson disease</term>
<term>Postoperative Complications (etiology)</term>
<term>Postoperative Complications (physiopathology)</term>
<term>Postoperative Complications (prevention & control)</term>
<term>Prospective Studies</term>
<term>Recovery of Function (physiology)</term>
<term>Reoperation</term>
<term>Stereotaxic Techniques (instrumentation)</term>
<term>Stereotaxic Techniques (standards)</term>
<term>Subthalamic Nucleus (physiology)</term>
<term>Subthalamic Nucleus (surgery)</term>
<term>Subthalamic nucleus</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Deep Brain Stimulation</term>
<term>Stereotaxic Techniques</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term>
<term>Neuronavigation</term>
</keywords>
<keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Recovery of Function</term>
<term>Subthalamic Nucleus</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Basal Ganglia</term>
<term>Neural Pathways</term>
<term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Microelectrodes</term>
<term>Neuronavigation</term>
<term>Stereotaxic Techniques</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Subthalamic Nucleus</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>Electrodes, Implanted</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Prospective Studies</term>
<term>Reoperation</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term>
<term>Pathologie du   système nerveux</term>
<term>Amélioration</term>
<term>Noyau sousthalamique</term>
<term>Electrode</term>
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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 μs/163.0 Hz to 2.8 V/60. 0 μs/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 the UPDRS 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>
</front>
</TEI>
<double idat="0003-9942:2008:Anheim M:improvement:in:parkinson"><INIST><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Improvement in Parkinson Disease by Subthalamic Nucleus Stimulation Based on Electrode Placement : Effects of Reimplantation</title>
<author><name sortKey="Anheim, Mathieu" sort="Anheim, Mathieu" uniqKey="Anheim M" first="Mathieu" last="Anheim">Mathieu Anheim</name>
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</inist:fA14>
<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Neurology, University Hospital</s1>
<s2>Strasbourg</s2>
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<sZ>1 aut.</sZ>
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<country>France</country>
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<author><name sortKey="Batir, Alina" sort="Batir, Alina" uniqKey="Batir A" first="Alina" last="Batir">Alina Batir</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurology, University Hospital A. Michallon</s1>
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<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valérie" last="Fraix">Valérie Fraix</name>
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<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<author><name sortKey="Silem, Madjid" sort="Silem, Madjid" uniqKey="Silem M" first="Madjid" last="Silem">Madjid Silem</name>
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</affiliation>
</author>
<author><name sortKey="Chabardes, Stephan" sort="Chabardes, Stephan" uniqKey="Chabardes S" first="Stéphan" last="Chabardes">Stéphan Chabardes</name>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<country>France</country>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
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<wicri:noRegion>Department of Neurosurgery, University Hospital A. Michallon</wicri:noRegion>
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</author>
<author><name sortKey="Seigneuret, Eric" sort="Seigneuret, Eric" uniqKey="Seigneuret E" first="Eric" last="Seigneuret">Eric Seigneuret</name>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
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</affiliation>
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</inist:fA14>
<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<country>France</country>
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<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
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</affiliation>
</author>
<author><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<country>France</country>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Neurosurgery, University Hospital A. Michallon</s1>
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<sZ>5 aut.</sZ>
<sZ>6 aut.</sZ>
<sZ>8 aut.</sZ>
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<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurosurgery, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurology, University Hospital A. Michallon</s1>
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<sZ>1 aut.</sZ>
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<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
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</inist:fA14>
<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
<s2>Grenoble</s2>
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<sZ>6 aut.</sZ>
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<country>France</country>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
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</titleStmt>
<publicationStmt><idno type="wicri:source">INIST</idno>
<idno type="inist">08-0248405</idno>
<date when="2008">2008</date>
<idno type="stanalyst">PASCAL 08-0248405 INIST</idno>
<idno type="RBID">Pascal:08-0248405</idno>
<idno type="wicri:Area/PascalFrancis/Corpus">000896</idno>
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</affiliation>
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</placeName>
</affiliation>
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<author><name sortKey="Batir, Alina" sort="Batir, Alina" uniqKey="Batir A" first="Alina" last="Batir">Alina Batir</name>
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</affiliation>
</author>
<author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valérie" last="Fraix">Valérie Fraix</name>
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<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
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<region type="old region">Rhône-Alpes</region>
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<author><name sortKey="Silem, Madjid" sort="Silem, Madjid" uniqKey="Silem M" first="Madjid" last="Silem">Madjid Silem</name>
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<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Chabardes, Stephan" sort="Chabardes, Stephan" uniqKey="Chabardes S" first="Stéphan" last="Chabardes">Stéphan Chabardes</name>
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<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
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<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Neurosurgery, University Hospital A. Michallon</s1>
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<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurosurgery, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Seigneuret, Eric" sort="Seigneuret, Eric" uniqKey="Seigneuret E" first="Eric" last="Seigneuret">Eric Seigneuret</name>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
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<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Neurosurgery, University Hospital A. Michallon</s1>
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<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurosurgery, University Hospital A. Michallon</wicri:noRegion>
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<author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name>
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<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
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<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
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<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
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<author><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name>
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<s2>Grenoble</s2>
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<country>France</country>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
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<affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Neurosurgery, University Hospital A. Michallon</s1>
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<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurosurgery, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Neurology, University Hospital A. Michallon</s1>
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<country>France</country>
<wicri:noRegion>University Hospital A. Michallon</wicri:noRegion>
<wicri:noRegion>Department of Neurology, University Hospital A. Michallon</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Clinical and Biologic Neurosciences, Joseph Fourier University, and Institut National de la Santé et de la Récherche Médicale Unité 318</s1>
<s2>Grenoble</s2>
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<settlement type="city">Grenoble</settlement>
</placeName>
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<series><title level="j" type="main">Archives of neurology : (Chicago)</title>
<title level="j" type="abbreviated">Arch. neurol. : (Chic.)</title>
<idno type="ISSN">0003-9942</idno>
<imprint><date when="2008">2008</date>
</imprint>
</series>
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<seriesStmt><title level="j" type="main">Archives of neurology : (Chicago)</title>
<title level="j" type="abbreviated">Arch. neurol. : (Chic.)</title>
<idno type="ISSN">0003-9942</idno>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Electrodes</term>
<term>Improvement</term>
<term>Nervous system diseases</term>
<term>Parkinson disease</term>
<term>Subthalamic nucleus</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Maladie de Parkinson</term>
<term>Pathologie du   système nerveux</term>
<term>Amélioration</term>
<term>Noyau sousthalamique</term>
<term>Electrode</term>
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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 μs/163.0 Hz to 2.8 V/60. 0 μs/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 the UPDRS 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>
</front>
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<PubMed><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation.</title>
<author><name sortKey="Anheim, Mathieu" sort="Anheim, Mathieu" uniqKey="Anheim M" first="Mathieu" last="Anheim">Mathieu Anheim</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, University Hospital A. Michallon, Grenoble, France. anheim@titus.u-strasbg.fr</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology, University Hospital A. Michallon, Grenoble</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Batir, Alina" sort="Batir, Alina" uniqKey="Batir A" first="Alina" last="Batir">Alina Batir</name>
</author>
<author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valérie" last="Fraix">Valérie Fraix</name>
</author>
<author><name sortKey="Silem, Madjid" sort="Silem, Madjid" uniqKey="Silem M" first="Madjid" last="Silem">Madjid Silem</name>
</author>
<author><name sortKey="Chabardes, Stephan" sort="Chabardes, Stephan" uniqKey="Chabardes S" first="Stéphan" last="Chabardès">Stéphan Chabardès</name>
</author>
<author><name sortKey="Seigneuret, Eric" sort="Seigneuret, Eric" uniqKey="Seigneuret E" first="Eric" last="Seigneuret">Eric Seigneuret</name>
</author>
<author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name>
</author>
<author><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name>
</author>
<author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name>
</author>
</titleStmt>
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<date when="2008">2008</date>
<idno type="RBID">pubmed:18474736</idno>
<idno type="pmid">18474736</idno>
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<idno type="wicri:Area/Ncbi/Checkpoint">000859</idno>
<idno type="wicri:source">HAL</idno>
<idno type="RBID">Hal:inserm-00382038</idno>
<idno type="url">http://www.hal.inserm.fr/inserm-00382038</idno>
<idno type="wicri:Area/Hal/Corpus">000555</idno>
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<author><name sortKey="Anheim, Mathieu" sort="Anheim, Mathieu" uniqKey="Anheim M" first="Mathieu" last="Anheim">Mathieu Anheim</name>
<affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, University Hospital A. Michallon, Grenoble, France. anheim@titus.u-strasbg.fr</nlm:affiliation>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Neurology, University Hospital A. Michallon, Grenoble</wicri:regionArea>
<placeName><region type="region">Auvergne-Rhône-Alpes</region>
<region type="old region">Rhône-Alpes</region>
<settlement type="city">Grenoble</settlement>
</placeName>
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</author>
<author><name sortKey="Batir, Alina" sort="Batir, Alina" uniqKey="Batir A" first="Alina" last="Batir">Alina Batir</name>
</author>
<author><name sortKey="Fraix, Valerie" sort="Fraix, Valerie" uniqKey="Fraix V" first="Valérie" last="Fraix">Valérie Fraix</name>
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<author><name sortKey="Silem, Madjid" sort="Silem, Madjid" uniqKey="Silem M" first="Madjid" last="Silem">Madjid Silem</name>
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<author><name sortKey="Chabardes, Stephan" sort="Chabardes, Stephan" uniqKey="Chabardes S" first="Stéphan" last="Chabardès">Stéphan Chabardès</name>
</author>
<author><name sortKey="Seigneuret, Eric" sort="Seigneuret, Eric" uniqKey="Seigneuret E" first="Eric" last="Seigneuret">Eric Seigneuret</name>
</author>
<author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name>
</author>
<author><name sortKey="Benabid, Alim Louis" sort="Benabid, Alim Louis" uniqKey="Benabid A" first="Alim-Louis" last="Benabid">Alim-Louis Benabid</name>
</author>
<author><name sortKey="Pollak, Pierre" sort="Pollak, Pierre" uniqKey="Pollak P" first="Pierre" last="Pollak">Pierre Pollak</name>
</author>
</analytic>
<series><title level="j">Archives of neurology</title>
<idno type="eISSN">1538-3687</idno>
<imprint><date when="2008" type="published">2008</date>
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<term>Basal Ganglia (physiopathology)</term>
<term>Deep Brain Stimulation (instrumentation)</term>
<term>Deep Brain Stimulation (methods)</term>
<term>Electrodes, Implanted</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Male</term>
<term>Microelectrodes (standards)</term>
<term>Middle Aged</term>
<term>Neural Pathways (physiopathology)</term>
<term>Neuronavigation (methods)</term>
<term>Neuronavigation (standards)</term>
<term>Parkinson Disease (therapy)</term>
<term>Postoperative Complications (etiology)</term>
<term>Postoperative Complications (physiopathology)</term>
<term>Postoperative Complications (prevention & control)</term>
<term>Prospective Studies</term>
<term>Recovery of Function (physiology)</term>
<term>Reoperation</term>
<term>Stereotaxic Techniques (instrumentation)</term>
<term>Stereotaxic Techniques (standards)</term>
<term>Subthalamic Nucleus (physiology)</term>
<term>Subthalamic Nucleus (surgery)</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Deep Brain Stimulation</term>
<term>Stereotaxic Techniques</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Deep Brain Stimulation</term>
<term>Neuronavigation</term>
</keywords>
<keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Recovery of Function</term>
<term>Subthalamic Nucleus</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Basal Ganglia</term>
<term>Neural Pathways</term>
<term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Postoperative Complications</term>
</keywords>
<keywords scheme="MESH" qualifier="standards" xml:lang="en"><term>Microelectrodes</term>
<term>Neuronavigation</term>
<term>Stereotaxic Techniques</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Subthalamic Nucleus</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>Electrodes, Implanted</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Prospective Studies</term>
<term>Reoperation</term>
<term>Treatment Outcome</term>
</keywords>
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<front><div type="abstract" xml:lang="en">The misplacement of electrodes is a possible explanation for suboptimal response to bilateral subthalamic nucleus (STN) stimulation in patients with Parkinson disease.</div>
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   |wiki=    Wicri/Sante
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   |texte=   Improvement in Parkinson Disease by Subthalamic Nucleus Stimulation Based on Electrode Placement : Effects of Reimplantation
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This area was generated with Dilib version V0.6.29.
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	La maladie de Parkinson en France (serveur d'exploration)
	Attention, ce site est en cours de développement ! Attention, site généré par des moyens informatiques à partir de corpus bruts. Les informations ne sont donc pas validées.

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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