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Dorsal subthalamic nucleus targeting in deep brain stimulation: microelectrode recording versus 7-Tesla connectivity
Naomi I Kremer1,2, Mark J Roberts3, Wouter V Potters4
1Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands.
Brain Communications
|November 29, 2023
Summary
Deep brain stimulation in the motor segment of the subthalamic nucleus, identified by 7-Tesla MRI, significantly improves Parkinson's disease motor function. However, microelectrode recording did not reliably distinguish this motor subdivision.
Area of Science:
- Neurosurgery
- Neurology
- Medical Imaging
Background:
- Deep brain stimulation (DBS) is a key treatment for Parkinson's disease (PD).
- Accurate subthalamic nucleus (STN) targeting is crucial for effective DBS.
- 7-Tesla MRI and microelectrode recording (MER) are advanced targeting tools.
Purpose of the Study:
- To investigate if DBS electrodes in the motor-connected STN segment (via 7T MRI) yield better motor outcomes in PD patients.
- To assess the efficacy of MER in differentiating the motor subdivision of the STN.
Main Methods:
- 25 PD patients undergoing DBS surgery.
- 7-Tesla MRI with connectivity segmentation to define motor-connected STN.
- Comparison of motor improvement (MDS-UPDRS III) and MER data between motor-connected and non-motor-connected STN groups.
Main Results:
- DBS in the motor-connected STN segment led to significantly greater hemi-body motor improvement (80%) compared to the non-motor-connected segment (52%).
- Multi-unit activity was slightly higher in the motor-connected STN, but single-unit activity showed no difference.
- MER did not accurately distinguish the motor subdivision within the STN.
Conclusions:
- Connectivity-derived 7-Tesla MRI segmentation accurately identifies STN subregions associated with superior motor outcomes in PD DBS.
- MER is not a reliable method for distinguishing the motor subdivision of the STN for DBS targeting.
- Optimizing STN targeting with advanced imaging may enhance DBS efficacy for Parkinson's disease.
