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Published on: May 31, 2016
Optimal target localization for subthalamic stimulation in patients with Parkinson disease
Marie-Laure Welter1, Michael Schüpbach, Virginie Czernecki
1From the Université Pierre et Marie Curie-Paris 6 (M.-L.W., M.S., V.C., C.K., S.F.-V., J.-L.G., A.H., V.M., F.P., Y.W., D. Grabli, D. Galanaud, D.D., M.V., L.M., E.B., J.Y., Y.A.), Centre de Recherche de l'Institut du Cerveau et de, la Moelle épinière, UMR-S975, Paris; Inserm (M.-L.W., M.S., V.C., C.K., S.F.-V., A.H., V.M., F.P., Y.W., D. Grabli, D. Galanaud, D.D., M.V., L.M., E.B., J.Y., Y.A.), U975, Paris; CNRS (M.-L.W., M.S., C.K., S.F.-V., A.H., V.M., F.P., Y.W., D. Grabli, D. Galanaud, D.D., M.V., L.M., E.B., J.Y., Y.A.), UMR 7225, Paris; Centre d'Investigation Clinique (M.-L.W., M.S., C.K., G.S., A.H., V.M., F.P., Y.W., P.Z., D. Grabli, A.-M.B., M.V., Y.A.), Département de Neurologie (M.-L.W., V.C., A.W., A.H., V.M., D. Grabli, A.-M.B., M.V., Y.A.), IM2A (V.C., F.P.), Service de Neurochirurgie (C.K., S.N., P.C., H.B.), Department of Clinical Neurophysiology (B.P.), and Service de Neuroradiologie Diagnostique et Fonctionnelle (D. Galanaud, D.D.), Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (M.S.), University Hospital, Bern, Switzerland; Centre de Neuroimagerie de Recherche (S.F.-V., D. Galanaud, D.D.), Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France; Département de Biostatistiques et Information Médicale (J.-L.G.), Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Assistance Publique-Hôpitaux de Paris, ER4 (ex EA3974) Modélisation en Recherche Clinique, Paris, France; Department of Neurology (P.Z.), 251 Hellenic Air Force General Hospital, Athens, Greece; and Department of Neurology (J.-L.H.), CHU Poitiers, France.
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.
