Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance
Identifieur interne : 003C07 ( Main/Exploration ); précédent : 003C06; suivant : 003C08Bilateral subthalamic stimulation for Parkinson's disease by using three-dimensional stereotactic magnetic resonance imaging and electrophysiological guidance
Auteurs : B.-P. Bejjani [France, Liban] ; D. Dormont ; B. Pidoux ; J. Yelnik ; P. Damier ; I. Arnulf ; A.-M. Bonnet ; C. Marsault ; Yves Agid [France] ; J. Philippon ; P. CornuSource :
- Journal of neurosurgery [ 0022-3085 ] ; 2000.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Aged, Antiparkinson Agents (administration & dosage), Antiparkinson Agents (adverse effects), Antiparkinson Agents (therapeutic use), Bilateral, Dyskinesia, Drug-Induced (prevention & control), Electric Stimulation Therapy (instrumentation), Electric Stimulation Therapy (methods), Electrodes, Implanted, Electroencephalography, Female, Follow-Up Studies, Human, Humans, Instrumental stimulation, Levodopa (adverse effects), Magnetic Resonance Imaging, Male, Mesencephalon (pathology), Middle Aged, Monitoring, Intraoperative, Movement, Nuclear magnetic resonance imaging, Parkinson Disease (drug therapy), Parkinson Disease (therapy), Parkinson disease, Patient Care Planning, Radiology, Interventional, Red Nucleus (pathology), Safety, Stereotaxic Techniques, Stereotaxic surgery, Subthalamic Nucleus (pathology), Subthalamic nucleus, Technique, Treatment, Tremor (physiopathology), Tremor (therapy).
- MESH :
- chemical , administration & dosage : Antiparkinson Agents.
- chemical , adverse effects : Antiparkinson Agents, Levodopa.
- chemical , therapeutic use : Antiparkinson Agents.
- drug therapy : Parkinson Disease.
- instrumentation : Electric Stimulation Therapy.
- methods : Electric Stimulation Therapy.
- pathology : Mesencephalon, Red Nucleus, Subthalamic Nucleus.
- physiopathology : Tremor.
- prevention & control : Dyskinesia, Drug-Induced.
- therapy : Parkinson Disease, Tremor.
- Aged, Electrodes, Implanted, Electroencephalography, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Monitoring, Intraoperative, Movement, Patient Care Planning, Radiology, Interventional, Safety, Stereotaxic Techniques.
Abstract
Object. Several methods are used for stereotactically guided implantation of electrodes into the subthalamic nucleus (STN) for continuous high-frequency stimulation in the treatment of Parkinson's disease (PD). The authors present a stereotactic magnetic resonance (MR) method relying on three-dimensional (3D) T1-weighted images for surgical planning and multiplanar T2-weighted images for direct visualization of the STN, coupled with electrophysiological recording and stimulation guidance. Methods. Twelve patients with advanced PD were enrolled in this study of bilateral STN implantation. Both STNs were visible as 3D ovoid biconvex hypointense structures located in the upper mesencephalon. The coordinates of the centers of the STNs were determined with reference to the patient's anterior commissure-posterior commissure line by using a new landmark, the anterior border of the red nucleus. Electrophysiological monitoring through five parallel tracks was performed simultaneously to define the functional target accurately. Microelectrode recording identified high-frequency, spontaneous, movement-related activity and tremor-related cells within the STNs. Acute STN macrostimulation improved contralateral rigidity and akinesia, suppressed tremor when present, and could induce dyskinesias, The central track, which was directed at the predetermined target by using MR imaging, was selected for implantation of 19 of 24 electrodes. No surgical complications were noted. Conclusions. At evaluation 6 months after surgery, continuous STN stimulation was shown to have improved parkinsonian motor disability by 64% and 78% in the "off" and "on" medication states, respectively. Antiparkinsonian drug treatment was reduced by 70% in 10 patients and withdrawn in two patients. The severity of levodopainduced dyskinesias was reduced by 83% and motor fluctuations by 88%. Continuous high-frequency stimulation of the STN applied through electrodes implanted with the aid of 3D MR imaging and electrophysiological guidance is a safe and effective therapy for patients suffering from severe, advanced levodopa-responsive PD.
Affiliations:
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Le document en format XML
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<affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Centre d'Investigation Clinique, Fédération de Neurologie, INSERM U 289, Services de Neuroradiologie, Physiologie, et Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière</s1>
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<author><name sortKey="Damier, P" sort="Damier, P" uniqKey="Damier P" first="P." last="Damier">P. Damier</name>
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<author><name sortKey="Arnulf, I" sort="Arnulf, I" uniqKey="Arnulf I" first="I." last="Arnulf">I. Arnulf</name>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term>
<term>Antiparkinson Agents (administration & dosage)</term>
<term>Antiparkinson Agents (adverse effects)</term>
<term>Antiparkinson Agents (therapeutic use)</term>
<term>Bilateral</term>
<term>Dyskinesia, Drug-Induced (prevention & control)</term>
<term>Electric Stimulation Therapy (instrumentation)</term>
<term>Electric Stimulation Therapy (methods)</term>
<term>Electrodes, Implanted</term>
<term>Electroencephalography</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Human</term>
<term>Humans</term>
<term>Instrumental stimulation</term>
<term>Levodopa (adverse effects)</term>
<term>Magnetic Resonance Imaging</term>
<term>Male</term>
<term>Mesencephalon (pathology)</term>
<term>Middle Aged</term>
<term>Monitoring, Intraoperative</term>
<term>Movement</term>
<term>Nuclear magnetic resonance imaging</term>
<term>Parkinson Disease (drug therapy)</term>
<term>Parkinson Disease (therapy)</term>
<term>Parkinson disease</term>
<term>Patient Care Planning</term>
<term>Radiology, Interventional</term>
<term>Red Nucleus (pathology)</term>
<term>Safety</term>
<term>Stereotaxic Techniques</term>
<term>Stereotaxic surgery</term>
<term>Subthalamic Nucleus (pathology)</term>
<term>Subthalamic nucleus</term>
<term>Technique</term>
<term>Treatment</term>
<term>Tremor (physiopathology)</term>
<term>Tremor (therapy)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Antiparkinson Agents</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiparkinson Agents</term>
<term>Levodopa</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiparkinson Agents</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="instrumentation" xml:lang="en"><term>Electric Stimulation Therapy</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Electric Stimulation Therapy</term>
</keywords>
<keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Mesencephalon</term>
<term>Red Nucleus</term>
<term>Subthalamic Nucleus</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Tremor</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Dyskinesia, Drug-Induced</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term>
<term>Tremor</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Aged</term>
<term>Electrodes, Implanted</term>
<term>Electroencephalography</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Humans</term>
<term>Magnetic Resonance Imaging</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Monitoring, Intraoperative</term>
<term>Movement</term>
<term>Patient Care Planning</term>
<term>Radiology, Interventional</term>
<term>Safety</term>
<term>Stereotaxic Techniques</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term>
<term>Stimulation instrumentale</term>
<term>Noyau sousthalamique</term>
<term>Chirurgie stéréotaxique</term>
<term>Imagerie RMN</term>
<term>Bilatéral</term>
<term>Technique</term>
<term>Traitement</term>
<term>Homme</term>
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<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
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<front><div type="abstract" xml:lang="en">Object. Several methods are used for stereotactically guided implantation of electrodes into the subthalamic nucleus (STN) for continuous high-frequency stimulation in the treatment of Parkinson's disease (PD). The authors present a stereotactic magnetic resonance (MR) method relying on three-dimensional (3D) T<sub>1</sub>
-weighted images for surgical planning and multiplanar T<sub>2</sub>
-weighted images for direct visualization of the STN, coupled with electrophysiological recording and stimulation guidance. Methods. Twelve patients with advanced PD were enrolled in this study of bilateral STN implantation. Both STNs were visible as 3D ovoid biconvex hypointense structures located in the upper mesencephalon. The coordinates of the centers of the STNs were determined with reference to the patient's anterior commissure-posterior commissure line by using a new landmark, the anterior border of the red nucleus. Electrophysiological monitoring through five parallel tracks was performed simultaneously to define the functional target accurately. Microelectrode recording identified high-frequency, spontaneous, movement-related activity and tremor-related cells within the STNs. Acute STN macrostimulation improved contralateral rigidity and akinesia, suppressed tremor when present, and could induce dyskinesias, The central track, which was directed at the predetermined target by using MR imaging, was selected for implantation of 19 of 24 electrodes. No surgical complications were noted. Conclusions. At evaluation 6 months after surgery, continuous STN stimulation was shown to have improved parkinsonian motor disability by 64% and 78% in the "off" and "on" medication states, respectively. Antiparkinsonian drug treatment was reduced by 70% in 10 patients and withdrawn in two patients. The severity of levodopainduced dyskinesias was reduced by 83% and motor fluctuations by 88%. Continuous high-frequency stimulation of the STN applied through electrodes implanted with the aid of 3D MR imaging and electrophysiological guidance is a safe and effective therapy for patients suffering from severe, advanced levodopa-responsive PD.</div>
</front>
</TEI>
<affiliations><list><country><li>France</li>
<li>Liban</li>
</country>
<region><li>Île-de-France</li>
</region>
<settlement><li>Paris</li>
</settlement>
<orgName><li>Hôpital de la Salpêtrière</li>
</orgName>
</list>
<tree><noCountry><name sortKey="Arnulf, I" sort="Arnulf, I" uniqKey="Arnulf I" first="I." last="Arnulf">I. Arnulf</name>
<name sortKey="Bonnet, A M" sort="Bonnet, A M" uniqKey="Bonnet A" first="A.-M." last="Bonnet">A.-M. Bonnet</name>
<name sortKey="Cornu, P" sort="Cornu, P" uniqKey="Cornu P" first="P." last="Cornu">P. Cornu</name>
<name sortKey="Damier, P" sort="Damier, P" uniqKey="Damier P" first="P." last="Damier">P. Damier</name>
<name sortKey="Dormont, D" sort="Dormont, D" uniqKey="Dormont D" first="D." last="Dormont">D. Dormont</name>
<name sortKey="Marsault, C" sort="Marsault, C" uniqKey="Marsault C" first="C." last="Marsault">C. Marsault</name>
<name sortKey="Philippon, J" sort="Philippon, J" uniqKey="Philippon J" first="J." last="Philippon">J. Philippon</name>
<name sortKey="Pidoux, B" sort="Pidoux, B" uniqKey="Pidoux B" first="B." last="Pidoux">B. Pidoux</name>
<name sortKey="Yelnik, J" sort="Yelnik, J" uniqKey="Yelnik J" first="J." last="Yelnik">J. Yelnik</name>
</noCountry>
<country name="France"><region name="Île-de-France"><name sortKey="Bejjani, B P" sort="Bejjani, B P" uniqKey="Bejjani B" first="B.-P." last="Bejjani">B.-P. Bejjani</name>
</region>
<name sortKey="Agid, Y" sort="Agid, Y" uniqKey="Agid Y" first="Y." last="Agid">Yves Agid</name>
</country>
<country name="Liban"><noRegion><name sortKey="Bejjani, B P" sort="Bejjani, B P" uniqKey="Bejjani B" first="B.-P." last="Bejjani">B.-P. Bejjani</name>
</noRegion>
</country>
</tree>
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