Brain penetration effects of microelectrodes and DBS leads in STN or GPi
Identifieur interne : 000B51 ( Main/Exploration ); précédent : 000B50; suivant : 000B52Brain penetration effects of microelectrodes and DBS leads in STN or GPi
Auteurs : J M Mann [États-Unis] ; K D Foote [États-Unis] ; C W Garvan [États-Unis] ; H H Fernandez [États-Unis] ; C E Jacobson [États-Unis] ; R L Rodriguez [États-Unis] ; I U Haq [États-Unis] ; M S Siddiqui [États-Unis] ; I A Malaty [États-Unis] ; T. Morishita [États-Unis] ; C J Hass [États-Unis] ; M S Okun [États-Unis]Source :
- Journal of Neurology, Neurosurgery & Psychiatry [ 0022-3050 ] ; 2009-07.
Abstract
Objective: To determine how intraoperative microelectrode recordings (MER) and intraoperative lead placement acutely influence tremor, rigidity, and bradykinesia. Secondarily, to evaluate whether the longevity of the MER and lead placement effects were influenced by target location (subthalamic nucleus (STN) or globus pallidus interna (GPi)). Background: Currently most groups who perform deep brain stimulation (DBS) for Parkinson disease (PD) use MER, as well as macrostimulation (test stimulation), to refine DBS lead position. Following MER and/or test stimulation, however, there may be a resultant “collision/implantation” or “microlesion” effect, thought to result from disruption of cells and/or fibres within the penetrated region. These effects have not been carefully quantified. Methods: 47 consecutive patients with PD undergoing unilateral DBS for PD (STN or GPi DBS) were evaluated. Motor function was measured at six time points with a modified motor Unified Parkinson Disease Rating Scale (UPDRS): (1) preoperatively, (2) immediately after MER, (3) immediately after lead implantation/collision, (4) 4 months following surgery—off medications, on DBS (12 h medication washout), (5) 6 months postoperatively—off medication and off DBS (12 h washout) and (6) 6 months—on medication and off DBS (12 h washout). Results: Significant improvements in motor scores (p<0.05) (tremor, rigidity, bradykinesia) were observed as a result of MER and lead placement. The improvements were similar in magnitude to what was observed at 4 and 6 months post-DBS following programming and medication optimisation. When washed out (medications and DBS) for 12 h, UPDRS motor scores were still improved compared with preoperative testing. There was a larger improvement in STN compared with GPi following MER (p<0.05) and a trend for significance following lead placement (p<0.08) but long term outcome was similar. Conclusion: This study demonstrated significant acute intraoperative penetration effects resulting from MER and lead placement/collision in PD. Clinicians rating patients in the operating suite should be aware of these effects, and should consider pre- and post-lead placement rating scales prior to activating DBS. The collision/implantation effects were greater intraoperatively with STN compared with GPi, and with greater disease duration there was a larger effect.
Url:
DOI: 10.1136/jnnp.2008.159558
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last="Mann">J M Mann</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Foote, K D" sort="Foote, K D" uniqKey="Foote K" first="K D" last="Foote">K D Foote</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Garvan, C W" sort="Garvan, C W" uniqKey="Garvan C" first="C W" last="Garvan">C W Garvan</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Office of Educational Research, College of Education, University of Florida, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Fernandez, H H" sort="Fernandez, H H" uniqKey="Fernandez H" first="H H" last="Fernandez">H H Fernandez</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Jacobson, C E" sort="Jacobson, C E" uniqKey="Jacobson C" first="C E" last="Jacobson">C E Jacobson</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Rodriguez, R L" sort="Rodriguez, R L" uniqKey="Rodriguez R" first="R L" last="Rodriguez">R L Rodriguez</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Haq, I U" sort="Haq, I U" uniqKey="Haq I" first="I U" last="Haq">I U Haq</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Siddiqui, M S" sort="Siddiqui, M S" uniqKey="Siddiqui M" first="M S" last="Siddiqui">M S Siddiqui</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, Wake Forest University, Winston Salem, North Carolina</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Malaty, I A" sort="Malaty, I A" uniqKey="Malaty I" first="I A" last="Malaty">I A Malaty</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Morishita, T" sort="Morishita, T" uniqKey="Morishita T" first="T" last="Morishita">T. Morishita</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Hass, C J" sort="Hass, C J" uniqKey="Hass C" first="C J" last="Hass">C J Hass</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Applied Physiology and Kinesiology, University of Florida, Movement Disorders Center, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Okun, M S" sort="Okun, M S" uniqKey="Okun M" first="M S" last="Okun">M S Okun</name><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurology, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation><affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Movement Disorders Center, McKnight Brain Institute, Gainesville, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></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="2009-07">2009-07</date><biblScope unit="volume">80</biblScope><biblScope unit="issue">7</biblScope><biblScope unit="page" from="794">794</biblScope></imprint><idno type="ISSN">0022-3050</idno></series><idno type="istex">49B97A2569F830C765A297499F274B05497DC861</idno><idno type="DOI">10.1136/jnnp.2008.159558</idno><idno type="href">jnnp-80-794.pdf</idno><idno type="ArticleID">jn159558</idno><idno type="PMID">19237386</idno><idno type="local">jnnp;80/7/794</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">Objective: To determine how intraoperative microelectrode recordings (MER) and intraoperative lead placement acutely influence tremor, rigidity, and bradykinesia. Secondarily, to evaluate whether the longevity of the MER and lead placement effects were influenced by target location (subthalamic nucleus (STN) or globus pallidus interna (GPi)). Background: Currently most groups who perform deep brain stimulation (DBS) for Parkinson disease (PD) use MER, as well as macrostimulation (test stimulation), to refine DBS lead position. Following MER and/or test stimulation, however, there may be a resultant “collision/implantation” or “microlesion” effect, thought to result from disruption of cells and/or fibres within the penetrated region. These effects have not been carefully quantified. Methods: 47 consecutive patients with PD undergoing unilateral DBS for PD (STN or GPi DBS) were evaluated. Motor function was measured at six time points with a modified motor Unified Parkinson Disease Rating Scale (UPDRS): (1) preoperatively, (2) immediately after MER, (3) immediately after lead implantation/collision, (4) 4 months following surgery—off medications, on DBS (12 h medication washout), (5) 6 months postoperatively—off medication and off DBS (12 h washout) and (6) 6 months—on medication and off DBS (12 h washout). Results: Significant improvements in motor scores (p<0.05) (tremor, rigidity, bradykinesia) were observed as a result of MER and lead placement. The improvements were similar in magnitude to what was observed at 4 and 6 months post-DBS following programming and medication optimisation. When washed out (medications and DBS) for 12 h, UPDRS motor scores were still improved compared with preoperative testing. There was a larger improvement in STN compared with GPi following MER (p<0.05) and a trend for significance following lead placement (p<0.08) but long term outcome was similar. Conclusion: This study demonstrated significant acute intraoperative penetration effects resulting from MER and lead placement/collision in PD. Clinicians rating patients in the operating suite should be aware of these effects, and should consider pre- and post-lead placement rating scales prior to activating DBS. The collision/implantation effects were greater intraoperatively with STN compared with GPi, and with greater disease duration there was a larger effect.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Caroline du Nord</li><li>Floride</li></region></list><tree><country name="États-Unis"><region name="Floride"><name sortKey="Mann, J M" sort="Mann, J M" uniqKey="Mann J" first="J M" last="Mann">J M Mann</name></region><name sortKey="Fernandez, H H" sort="Fernandez, H H" uniqKey="Fernandez H" first="H H" last="Fernandez">H H Fernandez</name><name sortKey="Foote, K D" sort="Foote, K D" uniqKey="Foote K" first="K D" last="Foote">K D Foote</name><name sortKey="Garvan, C W" sort="Garvan, C W" uniqKey="Garvan C" first="C W" last="Garvan">C W Garvan</name><name sortKey="Haq, I U" sort="Haq, I U" uniqKey="Haq I" first="I U" last="Haq">I U Haq</name><name sortKey="Hass, C J" sort="Hass, C J" uniqKey="Hass C" first="C J" last="Hass">C J Hass</name><name sortKey="Jacobson, C E" sort="Jacobson, C E" uniqKey="Jacobson C" first="C E" last="Jacobson">C E Jacobson</name><name sortKey="Malaty, I A" sort="Malaty, I A" uniqKey="Malaty I" first="I A" last="Malaty">I A Malaty</name><name sortKey="Morishita, T" sort="Morishita, T" uniqKey="Morishita T" first="T" last="Morishita">T. Morishita</name><name sortKey="Okun, M S" sort="Okun, M S" uniqKey="Okun M" first="M S" last="Okun">M S Okun</name><name sortKey="Okun, M S" sort="Okun, M S" uniqKey="Okun M" first="M S" last="Okun">M S Okun</name><name sortKey="Rodriguez, R L" sort="Rodriguez, R L" uniqKey="Rodriguez R" first="R L" last="Rodriguez">R L Rodriguez</name><name sortKey="Siddiqui, M S" sort="Siddiqui, M S" uniqKey="Siddiqui M" first="M S" last="Siddiqui">M S Siddiqui</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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