Subthalamic versus Posterior Subthalamic Stimulation for Optimal Tremor Control in Parkinson's Disease

Area of Science:

• Neurosurgery
• Neurology
• Movement Disorders

Background:

• Tremor-predominant Parkinson's disease (TPPD) often benefits from Deep Brain Stimulation (DBS).
• Subthalamic nucleus (STN) targeting is standard, but intraoperative results vary.
• Posterior subthalamic area (PSA), including caudal zona incerta (cZI), shows promise for tremor suppression.

Purpose of the Study:

• To compare intraoperative and clinical outcomes of STN versus PSA/cZI targeting for TPPD.
• To evaluate the efficacy of dual trajectory microelectrode recording (MER) in guiding DBS lead placement.

Main Methods:

• Retrospective analysis of 22 TPPD patients undergoing dual trajectory MER targeting STN and PSA/cZI.
• Comparison of neurophysiology and tremor response between central (STN) and posterior (PSA) trajectories.
• Analysis of outcomes for patients receiving STN (16) or PSA/cZI (12) lead implantation.

Main Results:

• Both STN and PSA/cZI DBS provided significant motor improvement.
• Intraoperative test stimulation of the posterior (PSA) trajectory yielded more consistent tremor arrest than the STN.
• Posterior lead placement may enhance tremor suppression without compromising other motor symptoms.

Conclusions:

• Intraoperative physiological feedback is crucial for trajectory selection in TPPD.
• PSA/cZI DBS is an effective, potentially superior target for managing tremor in Parkinson's disease.
• Further research supports PSA/cZI as a key target for TPPD management.