MRI verified STN stimulation site – gait improvement and clinical outcome
Identifieur interne : 000643 ( Main/Corpus ); précédent : 000642; suivant : 000644MRI verified STN stimulation site – gait improvement and clinical outcome
Auteurs : E. L. Johnsen ; N. Sunde ; P. H. Mogensen ; K. StergaardSource :
- European Journal of Neurology [ 1351-5101 ] ; 2010-05.
English descriptors
Abstract
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson’s disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact. Methods: The active contact was visualized on peri‐operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS‐III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN. Results: Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS‐III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation. Conclusions: Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.
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DOI: 10.1111/j.1468-1331.2010.02962.x
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ISTEX:D5C382F7765706D50D642E9490C069D8D388DFC1Le document en format XML
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Mogensen</name><affiliation><mods:affiliation>Gait Laboratory, Hammel Neurocenter, Hammel, Denmark</mods:affiliation></affiliation></author><author><name sortKey=" Stergaard, K" sort=" Stergaard, K" uniqKey=" Stergaard K" first="K." last=" Stergaard">K. Stergaard</name><affiliation><mods:affiliation>Departments of Neurology</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:D5C382F7765706D50D642E9490C069D8D388DFC1</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1111/j.1468-1331.2010.02962.x</idno><idno type="url">https://api.istex.fr/document/D5C382F7765706D50D642E9490C069D8D388DFC1/fulltext/pdf</idno><idno type="wicri:Area/Main/Corpus">000643</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">MRI verified STN stimulation site – gait improvement and clinical outcome</title><author><name sortKey="Johnsen, E L" sort="Johnsen, E L" uniqKey="Johnsen E" first="E. L." last="Johnsen">E. L. Johnsen</name><affiliation><mods:affiliation>Departments of Neurology</mods:affiliation></affiliation></author><author><name sortKey="Sunde, N" sort="Sunde, N" uniqKey="Sunde N" first="N." last="Sunde">N. 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Stergaard</name><affiliation><mods:affiliation>Departments of Neurology</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">European Journal of Neurology</title><idno type="ISSN">1351-5101</idno><idno type="eISSN">1468-1331</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2010-05">2010-05</date><biblScope unit="volume">17</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="746">746</biblScope><biblScope unit="page" to="753">753</biblScope></imprint><idno type="ISSN">1351-5101</idno></series><idno type="istex">D5C382F7765706D50D642E9490C069D8D388DFC1</idno><idno type="DOI">10.1111/j.1468-1331.2010.02962.x</idno><idno type="ArticleID">ENE2962</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1351-5101</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>MRI</term><term>Parkinson’s disease</term><term>deep brain stimulation</term><term>gait analysis</term><term>subthalamic nucleus</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson’s disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact. Methods: The active contact was visualized on peri‐operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS‐III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN. Results: Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS‐III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation. Conclusions: Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>E. L. Johnsen</name><affiliations><json:string>Departments of Neurology</json:string></affiliations></json:item><json:item><name>N. Sunde</name><affiliations><json:string>Neurosurgery, Aarhus University Hospital, Aarhus</json:string></affiliations></json:item><json:item><name>P. H. Mogensen</name><affiliations><json:string>Gait Laboratory, Hammel Neurocenter, Hammel, Denmark</json:string></affiliations></json:item><json:item><name>K. Østergaard</name><affiliations><json:string>Departments of Neurology</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>gait analysis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>MRI</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson’s disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic nucleus</value></json:item></subject><articleId><json:string>ENE2962</json:string></articleId><language><json:string>eng</json:string></language><abstract>Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson’s disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact. Methods: The active contact was visualized on peri‐operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS‐III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN. Results: Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS‐III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation. Conclusions: Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. 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L.</forename><surname>Johnsen</surname></persName><affiliation>Departments of Neurology</affiliation></author><author><persName><forename type="first">N.</forename><surname>Sunde</surname></persName><affiliation>Neurosurgery, Aarhus University Hospital, Aarhus</affiliation></author><author><persName><forename type="first">P. H.</forename><surname>Mogensen</surname></persName><affiliation>Gait Laboratory, Hammel Neurocenter, Hammel, Denmark</affiliation></author><author><persName><forename type="first">K.</forename><surname>Østergaard</surname></persName><affiliation>Departments of Neurology</affiliation></author></analytic><monogr><title level="j">European Journal of Neurology</title><idno type="pISSN">1351-5101</idno><idno type="eISSN">1468-1331</idno><idno type="DOI">10.1111/(ISSN)1468-1331</idno><imprint><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2010-05"></date><biblScope unit="volume">17</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="746">746</biblScope><biblScope unit="page" to="753">753</biblScope></imprint></monogr><idno type="istex">D5C382F7765706D50D642E9490C069D8D388DFC1</idno><idno type="DOI">10.1111/j.1468-1331.2010.02962.x</idno><idno type="ArticleID">ENE2962</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson’s disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact. Methods: The active contact was visualized on peri‐operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS‐III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN. Results: Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS‐III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation. Conclusions: Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>Keywords</head><item><term>deep brain stimulation</term></item><item><term>gait analysis</term></item><item><term>MRI</term></item><item><term>Parkinson’s disease</term></item><item><term>subthalamic nucleus</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-05">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/D5C382F7765706D50D642E9490C069D8D388DFC1/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1468-1331</doi><issn type="print">1351-5101</issn><issn type="electronic">1468-1331</issn><idGroup><id type="product" value="ENE"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="EUROPEAN JOURNAL OF NEUROLOGY">European Journal of Neurology</title></titleGroup></publicationMeta><publicationMeta level="part" position="05005"><doi origin="wiley">10.1111/ene.2010.17.issue-5</doi><numberingGroup><numbering type="journalVolume" number="17">17</numbering><numbering type="journalIssue" number="5">5</numbering></numberingGroup><coverDate startDate="2010-05">May 2010</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="18" status="forIssue"><doi origin="wiley">10.1111/j.1468-1331.2010.02962.x</doi><idGroup><id type="unit" value="ENE2962"></id></idGroup><countGroup><count type="pageTotal" number="8"></count></countGroup><titleGroup><title type="tocHeading1">Original Articles</title></titleGroup><copyright>© 2010 The Author(s). Journal compilation © 2010 EFNS</copyright><eventGroup><event type="firstOnline" date="2010-03-22"></event><event type="publishedOnlineFinalForm" date="2010-04-12"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.6 mode:FullText source:FullText result:FullText" date="2010-05-18"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-24"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-16"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="746">746</numbering><numbering type="pageLast" number="753">753</numbering></numberingGroup><correspondenceTo>Erik L. Johnsen, MD, Department of Neurology, Aarhus University Hospital, DK‐8000 Aarhus, Denmark (tel.: +45 8949 3447; fax: +45 8949 3300; e‐mail: <email>erik.johnsen@ki.au.dk</email>).</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:ENE.ENE2962.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Received 19 August 2009 Accepted 25 November 2009</unparsedEditorialHistory><countGroup><count type="figureTotal" number="3"></count><count type="tableTotal" number="3"></count></countGroup><titleGroup><title type="main">MRI verified STN stimulation site – gait improvement and clinical outcome</title><title type="shortAuthors">E. L. Johnsen <i>et al.</i></title><title type="short">MRI verified STN stimulation site</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>E. L.</givenNames><familyName>Johnsen</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a2"><personName><givenNames>N.</givenNames><familyName>Sunde</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a3"><personName><givenNames>P. H.</givenNames><familyName>Mogensen</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a1"><personName><givenNames>K.</givenNames><familyName>Østergaard</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Departments of Neurology</unparsedAffiliation></affiliation><affiliation xml:id="a2"><unparsedAffiliation>Neurosurgery, Aarhus University Hospital, Aarhus</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="DK"><unparsedAffiliation>Gait Laboratory, Hammel Neurocenter, Hammel, Denmark</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">deep brain stimulation</keyword><keyword xml:id="k2">gait analysis</keyword><keyword xml:id="k3">MRI</keyword><keyword xml:id="k4">Parkinson’s disease</keyword><keyword xml:id="k5">subthalamic nucleus</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><p><b>Background: </b> Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson’s disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact.</p><p><b>Methods: </b> The active contact was visualized on peri‐operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS‐III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN.</p><p><b>Results: </b> Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS‐III significantly more than ventral STN DBS (<i>P</i> = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (<i>P</i> = 0.03 and <i>P</i> = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation.</p><p><b>Conclusions: </b> Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>MRI verified STN stimulation site – gait improvement and clinical outcome</title></titleInfo><titleInfo type="abbreviated"><title>MRI verified STN stimulation site</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>MRI verified STN stimulation site – gait improvement and clinical outcome</title></titleInfo><name type="personal"><namePart type="given">E. L.</namePart><namePart type="family">Johnsen</namePart><affiliation>Departments of Neurology</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N.</namePart><namePart type="family">Sunde</namePart><affiliation>Neurosurgery, Aarhus University Hospital, Aarhus</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P. H.</namePart><namePart type="family">Mogensen</namePart><affiliation>Gait Laboratory, Hammel Neurocenter, Hammel, Denmark</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K.</namePart><namePart type="family">Østergaard</namePart><affiliation>Departments of Neurology</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2010-05</dateIssued><edition>Received 19 August 2009 Accepted 25 November 2009</edition><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">3</extent><extent unit="tables">3</extent></physicalDescription><abstract lang="en">Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson’s disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact. Methods: The active contact was visualized on peri‐operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS‐III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN. Results: Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS‐III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation. Conclusions: Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.</abstract><subject lang="en"><genre>Keywords</genre><topic>deep brain stimulation</topic><topic>gait analysis</topic><topic>MRI</topic><topic>Parkinson’s disease</topic><topic>subthalamic nucleus</topic></subject><relatedItem type="host"><titleInfo><title>European Journal of Neurology</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">1351-5101</identifier><identifier type="eISSN">1468-1331</identifier><identifier type="DOI">10.1111/(ISSN)1468-1331</identifier><identifier type="PublisherID">ENE</identifier><part><date>2010</date><detail type="volume"><caption>vol.</caption><number>17</number></detail><detail type="issue"><caption>no.</caption><number>5</number></detail><extent unit="pages"><start>746</start><end>753</end><total>8</total></extent></part></relatedItem><identifier type="istex">D5C382F7765706D50D642E9490C069D8D388DFC1</identifier><identifier type="DOI">10.1111/j.1468-1331.2010.02962.x</identifier><identifier type="ArticleID">ENE2962</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2010 The Author(s). 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