Subthalamic nucleus stimulation in Parkinson's disease : Anatomical and electrophysiological localization of active contacts

• Published in: Journal of neurology Vol. 253; no. 10; pp. 1347 - 1355
• Main Authors: GODINHO, F, THOBOIS, S, MERTENS, P, MAGNIN, M, GUENOT, M, POLO, G, BENATRU, I, XIE, J, SALVETTI, A, GARCIA-LARREA, L, BROUSSOLLE, E
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.10.2006; Springer Nature B.V
• Subjects: Action Potentials - physiology; Basal Ganglia - physiology; Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Electric Stimulation Therapy; Electrodes, Implanted; Electrophysiology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Parkinson Disease - pathology; Parkinson Disease - physiopathology; Parkinson Disease - therapy; Parkinson's disease; Postoperative Care; Stereotaxic Techniques; Subthalamic Nucleus - physiology; Nervous system diseases; Deep brain stimulation; Central nervous system; Parkinson disease; Basal ganglion; basal ganglia, subthalamic nucleus, zona incerta; Cerebral disorder; Parkinson's disease, deep brain stimulation; Central nervous system disease; Degenerative disease; Subthalamic nucleus; Localization; Extrapyramidal syndrome
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-006-0222-z

1 - To assess the anatomical localization of the active contacts of deep brain stimulation targeted to the subthalamic nucleus (STN) in Parkinson's disease patients. 2 - To analyze the stereotactic spatial distribution of the active contacts in relation to the dorsal and the ventral electrophysiologically-defined borders of the STN and the stereotactic theoretical target. Twenty-eight patients underwent bilateral high-frequency stimulation of the STN (HFS-STN). An indirect anatomical method based on ventriculography coupled to electrophysiological techniques were used to localize the STN. Clinical improvement was evaluated by Unified Parkinson's Disease Rating Scale motor score (UPDRS III). The normalized stereotactic coordinates of the active contact centres, dorsal and ventral electrophysiologically-defined borders of the STN were obtained from intraoperative X-rays images. These coordinates were represented in a three-dimensional stereotactic space and in the digitalized atlas of the human basal ganglia. HFS-STN resulted in significant improvement of motor function (62.8%) in off-medication state and levodopa-equivalent dose reduction of 68.7% (p < 0.05). Most of the active contacts (78.6%) were situated close to (+/- 1.6 mm) the dorsal border of the STN (STN-DB), while 16% were dorsal and 5.4% were ventral to it. Similar distribution was observed in the atlas. The euclidean distance between the STN-DB distribution center and the active contacts distribution center was 0.31 mm, while the distance between the active contacts distribution center and the stereotactic theoretical target was 2.15 mm. Most of the space defined by the active contacts distribution (53%) was inside that defined by the STN-DB distribution. In our series, most of the active electrodes were situated near the STN-DB. This suggests that HFS-STN could influence not only STN but also the dorsal adjacent structures (zona incerta and/or Fields of Forel).