Optimal target localization for subthalamic stimulation in patients with Parkinson disease

Welter, Marie-Laure; Schüpbach, Michael; Czernecki, Virginie; Karachi, Carine; Fernandez-Vidal, Sara; Golmard, Jean-Louis; Serra, Giulia; Navarro, Soledad; Welaratne, Arlette; Hartmann, Andréas; Mesnage, Valérie; Pineau, Fanny; Cornu, Philippe; Pidoux, Bernard; Worbe, Yulia; Zikos, Panayiotis; Grabli, David; Galanaud, Damien; Bonnet, Anne-Marie; Belaid, Hayat; ... (2014). Optimal target localization for subthalamic stimulation in patients with Parkinson disease. Neurology, 82(15), pp. 1352-1361. Lippincott Williams & Wilkins 10.1212/WNL.0000000000000315

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OBJECTIVE To further determine the causes of variable outcome from deep brain stimulation of the subthalamic nucleus (DBS-STN) in patients with Parkinson disease (PD). METHODS Data were obtained from our cohort of 309 patients with PD who underwent DBS-STN between 1996 and 2009. We examined the relationship between the 1-year motor, cognitive, and psychiatric outcomes and (1) preoperative PD clinical features, (2) MRI measures, (3) surgical procedure, and (4) locations of therapeutic contacts. RESULTS Pre- and postoperative results were obtained in 262 patients with PD. The best motor outcome was obtained when stimulating contacts were located within the STN as compared with the zona incerta (64% vs 49% improvement). Eighteen percent of the patients presented a postoperative cognitive decline, which was found to be principally related to the surgical procedure. Other factors predictive of poor cognitive outcome were perioperative confusion and psychosis. Nineteen patients showed a stimulation-induced hypomania, which was related to both the form of the disease (younger age, shorter disease duration, higher levodopa responsiveness) and the ventral contact location. Postoperative depression was more frequent in patients already showing preoperative depressive and/or residual axial motor symptoms. CONCLUSION In this homogeneous cohort of patients with PD, we showed that (1) the STN is the best target to improve motor symptoms, (2) postoperative cognitive deficit is mainly related to the surgery itself, and (3) stimulation-induced hypomania is related to a combination of both the disease characteristics and a more ventral STN location.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schüpbach, Michael

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

12 Sep 2014 08:13

Last Modified:

12 Dec 2014 16:18

Publisher DOI:

10.1212/WNL.0000000000000315

PubMed ID:

24647024

BORIS DOI:

10.7892/boris.53843

URI:

https://boris.unibe.ch/id/eprint/53843

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