MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and safety
Identifieur interne : 002D70 ( Main/Corpus ); précédent : 002D69; suivant : 002D71MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and safety
Auteurs : T. Foltynie ; L. Zrinzo ; I. Martinez-Torres ; E. Tripoliti ; E. Petersen ; E. Holl ; I. Aviles-Olmos ; M. Jahanshahi ; M. Hariz ; P. LimousinSource :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2011-04.
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a commonly employed therapeutic procedure for patients with Parkinson's disease uncontrolled by medical therapies. This series describes the outcomes of 79 consecutive patients that underwent bilateral STN DBS at the National Hospital for Neurology and Neurosurgery between November 2002 and November 2008 using an MRI-guided surgical technique without microelectrode recording. Patients underwent immediate postoperative stereotactic MR imaging. The mean (SD) error in electrode placement was 1.3 (0.6) mm. There were no haemorrhagic complications. At a median follow-up period of 12 months, there was a mean improvement in the off-medication motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) of 27.7 points (SD 13.8) equivalent to a mean improvement of 52% (p<0.0001). In addition, there were significant improvements in dyskinesia duration, disability and pain, with a mean reduction in on-medication dyskinesia severity (sum of dyskinesia duration, disability and pain from UPDRS IV) from 3.15 (SD 2.33) pre-operatively, to 1.56 (SD 1.92) post-operatively (p=0.0001). Quality of life improved by a mean of 5.5 points (median 7.9 points, SD 17.3) on the Parkinson's disease Questionnaire 39 summary index. This series confirms that image-guided STN DBS without microelectrode recording can lead to substantial improvements in motor disability of well-selected PD patients with accompanying improvements in quality of life and most importantly, with very low morbidity.
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DOI: 10.1136/jnnp.2010.205542
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Zrinzo</name><affiliation><mods:affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Martinez Torres, I" sort="Martinez Torres, I" uniqKey="Martinez Torres I" first="I" last="Martinez-Torres">I. Martinez-Torres</name><affiliation><mods:affiliation>Department of Neurology, Hospital La Fe, Valencia, Spain</mods:affiliation></affiliation></author><author><name sortKey="Tripoliti, E" sort="Tripoliti, E" uniqKey="Tripoliti E" first="E" last="Tripoliti">E. 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Foltynie</name><affiliation><mods:affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: t.foltynie@ion.ucl.ac.uk</mods:affiliation></affiliation></author><author><name sortKey="Zrinzo, L" sort="Zrinzo, L" uniqKey="Zrinzo L" first="L" last="Zrinzo">L. Zrinzo</name><affiliation><mods:affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Martinez Torres, I" sort="Martinez Torres, I" uniqKey="Martinez Torres I" first="I" last="Martinez-Torres">I. Martinez-Torres</name><affiliation><mods:affiliation>Department of Neurology, Hospital La Fe, Valencia, Spain</mods:affiliation></affiliation></author><author><name sortKey="Tripoliti, E" sort="Tripoliti, E" uniqKey="Tripoliti E" first="E" last="Tripoliti">E. Tripoliti</name><affiliation><mods:affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Petersen, E" sort="Petersen, E" uniqKey="Petersen E" first="E" last="Petersen">E. Petersen</name><affiliation><mods:affiliation>Department of Neurosurgery, University of Texas, Southwestern, Dallas, Texas, USA</mods:affiliation></affiliation></author><author><name sortKey="Holl, E" sort="Holl, E" uniqKey="Holl E" first="E" last="Holl">E. 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Jahanshahi</name><affiliation><mods:affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Hariz, M" sort="Hariz, M" uniqKey="Hariz M" first="M" last="Hariz">M. Hariz</name><affiliation><mods:affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Neurosurgery, University Hospital, Umea, Sweden</mods:affiliation></affiliation></author><author><name sortKey="Limousin, P" sort="Limousin, P" uniqKey="Limousin P" first="P" last="Limousin">P. Limousin</name><affiliation><mods:affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="ISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2011-04">2011-04</date><biblScope unit="volume">82</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="358">358</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">89033BF4AE1C9312D7E16D19AFFFFEA818B7954B</idno><idno type="DOI">10.1136/jnnp.2010.205542</idno><idno type="href">jnnp-82-358.pdf</idno><idno type="ArticleID">jnnp205542</idno><idno type="PMID">20571041</idno><idno type="Related-article-Href">10.1136/jnnp.2010.222497</idno><idno type="related-article-ID">RA1</idno><idno type="local">jnnp;82/4/358</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3050</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a commonly employed therapeutic procedure for patients with Parkinson's disease uncontrolled by medical therapies. This series describes the outcomes of 79 consecutive patients that underwent bilateral STN DBS at the National Hospital for Neurology and Neurosurgery between November 2002 and November 2008 using an MRI-guided surgical technique without microelectrode recording. Patients underwent immediate postoperative stereotactic MR imaging. The mean (SD) error in electrode placement was 1.3 (0.6) mm. There were no haemorrhagic complications. At a median follow-up period of 12 months, there was a mean improvement in the off-medication motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) of 27.7 points (SD 13.8) equivalent to a mean improvement of 52% (p<0.0001). In addition, there were significant improvements in dyskinesia duration, disability and pain, with a mean reduction in on-medication dyskinesia severity (sum of dyskinesia duration, disability and pain from UPDRS IV) from 3.15 (SD 2.33) pre-operatively, to 1.56 (SD 1.92) post-operatively (p=0.0001). Quality of life improved by a mean of 5.5 points (median 7.9 points, SD 17.3) on the Parkinson's disease Questionnaire 39 summary index. This series confirms that image-guided STN DBS without microelectrode recording can lead to substantial improvements in motor disability of well-selected PD patients with accompanying improvements in quality of life and most importantly, with very low morbidity.</div></front></TEI><istex><corpusName>bmj</corpusName><author><json:item><name>T Foltynie</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string><json:string>E-mail: t.foltynie@ion.ucl.ac.uk</json:string></affiliations></json:item><json:item><name>L Zrinzo</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string><json:string>Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK</json:string></affiliations></json:item><json:item><name>I Martinez-Torres</name><affiliations><json:string>Department of Neurology, Hospital La Fe, Valencia, Spain</json:string></affiliations></json:item><json:item><name>E Tripoliti</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string></affiliations></json:item><json:item><name>E Petersen</name><affiliations><json:string>Department of Neurosurgery, University of Texas, Southwestern, Dallas, Texas, USA</json:string></affiliations></json:item><json:item><name>E Holl</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string><json:string>Department of Neurosurgery, Medical University, Graz, Austria</json:string></affiliations></json:item><json:item><name>I Aviles-Olmos</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string></affiliations></json:item><json:item><name>M Jahanshahi</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string></affiliations></json:item><json:item><name>M Hariz</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string><json:string>Department of Neurosurgery, University Hospital, Umea, Sweden</json:string></affiliations></json:item><json:item><name>P Limousin</name><affiliations><json:string>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Research paper</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Editor's choice</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>stereotaxic surgery</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a commonly employed therapeutic procedure for patients with Parkinson's disease uncontrolled by medical therapies. This series describes the outcomes of 79 consecutive patients that underwent bilateral STN DBS at the National Hospital for Neurology and Neurosurgery between November 2002 and November 2008 using an MRI-guided surgical technique without microelectrode recording. Patients underwent immediate postoperative stereotactic MR imaging. The mean (SD) error in electrode placement was 1.3 (0.6) mm. There were no haemorrhagic complications. At a median follow-up period of 12 months, there was a mean improvement in the off-medication motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) of 27.7 points (SD 13.8) equivalent to a mean improvement of 52% (p>0.0001). In addition, there were significant improvements in dyskinesia duration, disability and pain, with a mean reduction in on-medication dyskinesia severity (sum of dyskinesia duration, disability and pain from UPDRS IV) from 3.15 (SD 2.33) pre-operatively, to 1.56 (SD 1.92) post-operatively (p=0.0001). Quality of life improved by a mean of 5.5 points (median 7.9 points, SD 17.3) on the Parkinson's disease Questionnaire 39 summary index. This series confirms that image-guided STN DBS without microelectrode recording can lead to substantial improvements in motor disability of well-selected PD patients with accompanying improvements in quality of life and most importantly, with very low morbidity.</abstract><qualityIndicators><score>7.57</score><pdfVersion>1.4</pdfVersion><pdfPageSize>595.276 x 793.701 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>1557</abstractCharCount><pdfWordCount>4418</pdfWordCount><pdfCharCount>30889</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>221</abstractWordCount></qualityIndicators><title>MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and 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Ltd</publisher><availability><p>BMJ</p></availability><date>2010-06-22</date></publicationStmt><notesStmt><note>See Editorial Commentary, p 356</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and safety</title><author corresp="yes"><persName><forename type="first">T</forename><surname>Foltynie</surname></persName><email>t.foltynie@ion.ucl.ac.uk</email><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation></author><author><persName><forename type="first">L</forename><surname>Zrinzo</surname></persName><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><affiliation>Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK</affiliation></author><author><persName><forename type="first">I</forename><surname>Martinez-Torres</surname></persName><affiliation>Department of Neurology, Hospital La Fe, Valencia, Spain</affiliation></author><author><persName><forename type="first">E</forename><surname>Tripoliti</surname></persName><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation></author><author><persName><forename type="first">E</forename><surname>Petersen</surname></persName><affiliation>Department of Neurosurgery, University of Texas, Southwestern, Dallas, Texas, USA</affiliation></author><author><persName><forename type="first">E</forename><surname>Holl</surname></persName><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><affiliation>Department of Neurosurgery, Medical University, Graz, Austria</affiliation></author><author><persName><forename type="first">I</forename><surname>Aviles-Olmos</surname></persName><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation></author><author><persName><forename type="first">M</forename><surname>Jahanshahi</surname></persName><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation></author><author><persName><forename type="first">M</forename><surname>Hariz</surname></persName><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><affiliation>Department of Neurosurgery, University Hospital, Umea, Sweden</affiliation></author><author><persName><forename type="first">P</forename><surname>Limousin</surname></persName><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation></author></analytic><monogr><title level="j">Journal of Neurology, Neurosurgery & Psychiatry</title><title level="j" type="abbrev">J Neurol Neurosurg Psychiatry</title><idno type="pISSN">0022-3050</idno><idno type="eISSN">1468-330X</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2011-04"></date><biblScope unit="volume">82</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="358">358</biblScope></imprint></monogr><idno type="istex">89033BF4AE1C9312D7E16D19AFFFFEA818B7954B</idno><idno type="DOI">10.1136/jnnp.2010.205542</idno><idno type="href">jnnp-82-358.pdf</idno><idno type="ArticleID">jnnp205542</idno><idno type="PMID">20571041</idno><idno type="Related-article-Href">10.1136/jnnp.2010.222497</idno><idno type="related-article-ID">RA1</idno><idno type="local">jnnp;82/4/358</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010-06-22</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a commonly employed therapeutic procedure for patients with Parkinson's disease uncontrolled by medical therapies. This series describes the outcomes of 79 consecutive patients that underwent bilateral STN DBS at the National Hospital for Neurology and Neurosurgery between November 2002 and November 2008 using an MRI-guided surgical technique without microelectrode recording. Patients underwent immediate postoperative stereotactic MR imaging. The mean (SD) error in electrode placement was 1.3 (0.6) mm. There were no haemorrhagic complications. At a median follow-up period of 12 months, there was a mean improvement in the off-medication motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) of 27.7 points (SD 13.8) equivalent to a mean improvement of 52% (p<0.0001). In addition, there were significant improvements in dyskinesia duration, disability and pain, with a mean reduction in on-medication dyskinesia severity (sum of dyskinesia duration, disability and pain from UPDRS IV) from 3.15 (SD 2.33) pre-operatively, to 1.56 (SD 1.92) post-operatively (p=0.0001). Quality of life improved by a mean of 5.5 points (median 7.9 points, SD 17.3) on the Parkinson's disease Questionnaire 39 summary index. This series confirms that image-guided STN DBS without microelectrode recording can lead to substantial improvements in motor disability of well-selected PD patients with accompanying improvements in quality of life and most importantly, with very low morbidity.</p></abstract><textClass><keywords scheme="keyword"><list><head>hwp-journal-coll</head><item><term>Editor's choice</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>stereotaxic surgery</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010-06-22">Created</change><change when="2011-04">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/89033BF4AE1C9312D7E16D19AFFFFEA818B7954B/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus bmj" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="no"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Archiving and Interchange DTD v2.3 20070202//EN" URI="archivearticle.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnnp</journal-id><journal-id journal-id-type="nlm-ta">J Neurol Neurosurg Psychiatry</journal-id><journal-id journal-id-type="publisher-id">jnnp</journal-id><journal-title>Journal of Neurology, Neurosurgery & Psychiatry</journal-title><abbrev-journal-title abbrev-type="publisher">J Neurol Neurosurg Psychiatry</abbrev-journal-title><abbrev-journal-title>J Neurol Neurosurg Psychiatry</abbrev-journal-title><issn pub-type="ppub">0022-3050</issn><issn pub-type="epub">1468-330X</issn><publisher><publisher-name>BMJ Publishing Group Ltd</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">jnnp205542</article-id><article-id pub-id-type="doi">10.1136/jnnp.2010.205542</article-id><article-id pub-id-type="other">jnnp;82/4/358</article-id><article-id pub-id-type="other">jnnp;jnnp.2010.205542</article-id><article-id pub-id-type="pmid">20571041</article-id><article-id pub-id-type="other">358</article-id><article-id pub-id-type="other">jnnp.2010.205542</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research paper</subject></subj-group><subj-group subj-group-type="hwp-journal-coll"><subject>Editor's choice</subject></subj-group></article-categories><title-group><article-title>MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and safety</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Foltynie</surname><given-names>T</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Zrinzo</surname><given-names>L</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Martinez-Torres</surname><given-names>I</given-names></name><xref ref-type="aff" rid="aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Tripoliti</surname><given-names>E</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Petersen</surname><given-names>E</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Holl</surname><given-names>E</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Aviles-Olmos</surname><given-names>I</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Jahanshahi</surname><given-names>M</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Hariz</surname><given-names>M</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Limousin</surname><given-names>P</given-names></name><xref ref-type="aff" rid="aff1">1</xref></contrib></contrib-group><aff id="aff1"><label>1</label>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</aff><aff id="aff2"><label>2</label>Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK</aff><aff id="aff3"><label>3</label>Department of Neurology, Hospital La Fe, Valencia, Spain</aff><aff id="aff4"><label>4</label>Department of Neurosurgery, University of Texas, Southwestern, Dallas, Texas, USA</aff><aff id="aff5"><label>5</label>Department of Neurosurgery, Medical University, Graz, Austria</aff><aff id="aff6"><label>6</label>Department of Neurosurgery, University Hospital, Umea, Sweden</aff><author-notes><corresp><label>Correspondence to</label> Thomas Foltynie, Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, Box 146, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; <email>t.foltynie@ion.ucl.ac.uk</email></corresp><fn fn-type="other"><p><bold>See Editorial Commentary, p <related-article id="RA1" related-article-type="commentary" ext-link-type="doi" xlink:href="10.1136/jnnp.2010.222497">356</related-article></bold></p></fn></author-notes><pub-date pub-type="epub-original"><day>22</day><month>6</month><year>2010</year></pub-date><pub-date pub-type="ppub"><month>4</month><year>2011</year></pub-date><pub-date pub-type="epub"><day>22</day><month>6</month><year>2010</year></pub-date><volume>82</volume><volume-id pub-id-type="other">82</volume-id><volume-id pub-id-type="other">82</volume-id><issue>4</issue><issue-id pub-id-type="other">jnnp;82/4</issue-id><issue-id pub-id-type="other">4</issue-id><issue-id pub-id-type="other">82/4</issue-id><fpage>358</fpage><history><date date-type="received"><day>12</day><month>1</month><year>2010</year></date><date date-type="rev-recd"><day>7</day><month>4</month><year>2010</year></date><date date-type="rev-recd"><day>12</day><month>4</month><year>2010</year></date></history><permissions><copyright-statement>© 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</copyright-statement><copyright-year>2011</copyright-year></permissions><self-uri content-type="pdf" xlink:role="full-text" xlink:href="jnnp-82-358.pdf"></self-uri><abstract><p>Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a commonly employed therapeutic procedure for patients with Parkinson's disease uncontrolled by medical therapies. This series describes the outcomes of 79 consecutive patients that underwent bilateral STN DBS at the National Hospital for Neurology and Neurosurgery between November 2002 and November 2008 using an MRI-guided surgical technique without microelectrode recording. Patients underwent immediate postoperative stereotactic MR imaging. The mean (SD) error in electrode placement was 1.3 (0.6) mm. There were no haemorrhagic complications. At a median follow-up period of 12 months, there was a mean improvement in the off-medication motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) of 27.7 points (SD 13.8) equivalent to a mean improvement of 52% (p<0.0001). In addition, there were significant improvements in dyskinesia duration, disability and pain, with a mean reduction in on-medication dyskinesia severity (sum of dyskinesia duration, disability and pain from UPDRS IV) from 3.15 (SD 2.33) pre-operatively, to 1.56 (SD 1.92) post-operatively (p=0.0001). Quality of life improved by a mean of 5.5 points (median 7.9 points, SD 17.3) on the Parkinson's disease Questionnaire 39 summary index. This series confirms that image-guided STN DBS without microelectrode recording can lead to substantial improvements in motor disability of well-selected PD patients with accompanying improvements in quality of life and most importantly, with very low morbidity.</p></abstract><kwd-group><kwd>Parkinson's disease</kwd><kwd>stereotaxic surgery</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and safety</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and safety</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">T</namePart><namePart type="family">Foltynie</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><affiliation>E-mail: t.foltynie@ion.ucl.ac.uk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">L</namePart><namePart type="family">Zrinzo</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><affiliation>Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I</namePart><namePart type="family">Martinez-Torres</namePart><affiliation>Department of Neurology, Hospital La Fe, Valencia, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E</namePart><namePart type="family">Tripoliti</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E</namePart><namePart type="family">Petersen</namePart><affiliation>Department of Neurosurgery, University of Texas, Southwestern, Dallas, Texas, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E</namePart><namePart type="family">Holl</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><affiliation>Department of Neurosurgery, Medical University, Graz, Austria</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">I</namePart><namePart type="family">Aviles-Olmos</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M</namePart><namePart type="family">Jahanshahi</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M</namePart><namePart type="family">Hariz</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><affiliation>Department of Neurosurgery, University Hospital, Umea, Sweden</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">P</namePart><namePart type="family">Limousin</namePart><affiliation>Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><genre>hwp-journal-coll</genre><topic>Editor's choice</topic></subject><originInfo><publisher>BMJ Publishing Group Ltd</publisher><dateIssued encoding="w3cdtf">2011-04</dateIssued><dateCreated encoding="w3cdtf">2010-06-22</dateCreated><copyrightDate encoding="w3cdtf">2011</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a commonly employed therapeutic procedure for patients with Parkinson's disease uncontrolled by medical therapies. This series describes the outcomes of 79 consecutive patients that underwent bilateral STN DBS at the National Hospital for Neurology and Neurosurgery between November 2002 and November 2008 using an MRI-guided surgical technique without microelectrode recording. Patients underwent immediate postoperative stereotactic MR imaging. The mean (SD) error in electrode placement was 1.3 (0.6) mm. There were no haemorrhagic complications. At a median follow-up period of 12 months, there was a mean improvement in the off-medication motor part of the Unified Parkinson's Disease Rating Scale (UPDRS III) of 27.7 points (SD 13.8) equivalent to a mean improvement of 52% (p<0.0001). In addition, there were significant improvements in dyskinesia duration, disability and pain, with a mean reduction in on-medication dyskinesia severity (sum of dyskinesia duration, disability and pain from UPDRS IV) from 3.15 (SD 2.33) pre-operatively, to 1.56 (SD 1.92) post-operatively (p=0.0001). Quality of life improved by a mean of 5.5 points (median 7.9 points, SD 17.3) on the Parkinson's disease Questionnaire 39 summary index. This series confirms that image-guided STN DBS without microelectrode recording can lead to substantial improvements in motor disability of well-selected PD patients with accompanying improvements in quality of life and most importantly, with very low morbidity.</abstract><note type="footnotes">See Editorial Commentary, p 356</note><subject><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>stereotaxic surgery</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Neurology, Neurosurgery & Psychiatry</title></titleInfo><titleInfo type="abbreviated"><title>J Neurol Neurosurg Psychiatry</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0022-3050</identifier><identifier type="eISSN">1468-330X</identifier><identifier type="PublisherID">jnnp</identifier><identifier type="PublisherID-hwp">jnnp</identifier><identifier type="PublisherID-nlm-ta">J Neurol Neurosurg Psychiatry</identifier><part><date>2011</date><detail type="volume"><caption>vol.</caption><number>82</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>358</start></extent></part></relatedItem><identifier type="istex">89033BF4AE1C9312D7E16D19AFFFFEA818B7954B</identifier><identifier type="DOI">10.1136/jnnp.2010.205542</identifier><identifier type="href">jnnp-82-358.pdf</identifier><identifier type="ArticleID">jnnp205542</identifier><identifier type="PMID">20571041</identifier><identifier type="Related-article-Href">10.1136/jnnp.2010.222497</identifier><identifier type="related-article-ID">RA1</identifier><identifier type="local">jnnp;82/4/358</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2011, Published by the BMJ Publishing Group Limited. 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