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Pyramidal tract side effects induced by deep brain stimulation of the subthalamic nucleus
  1. Giorgio Tommasi (giorgio.tommasi{at}libero.it)
  1. Department of Neurology, University Hospital, Joseph Fourier University, Grenoble, France
    1. Paul Krack (paul.krack{at}ujf-grenoble.fr)
    1. Department of Neurology, University Hospital and INSERM U318, Joseph Fourier University, Grenoble, France
      1. Valérie Fraix (valerie.fraix{at}ujf-grenoble.fr)
      1. Department of Neurology, University Hospital and INSERM U318, Joseph Fourier University, Grenoble, France
        1. Jean-François LeBas (jflebas{at}chu-grenoble.fr)
        1. Magnetic Resonance Imaging Unit, University Hospital, Joseph Fourier University, Grenoble, France
          1. Stephan Chabardes (schabardes{at}chu-grenoble.fr)
          1. Department of Neurosurgery, University Hospital and INSERM U318, Joseph Fourier University, Grenoble, France
            1. Alim Louis Benabid (alimlouis{at}aol.com)
            1. Department of Neurosurgery, University Hospital and INSERM U318, Joseph Fourier University, Grenoble, France
              1. Pierre Pollak (pierre.pollak{at}ujf-grenoble.fr)
              1. Department of Neurology, University Hospital and INSERM U318, Joseph Fourier University, Grenoble, France

                Abstract

                Objective: To study the pyramidal tract side effects (PTSEs) induced by the spread of current from the subthalamic nucleus (STN) to the pyramidal tract (PT), in parkinsonian patients undergoing STN stimulation.

                Methods: We assessed 14 patients bilaterally implanted with tetrapolar electrodes. For each side separately, we detected the threshold of adverse effects induced by monopolar stimulation delivered by the chronically used contact. The voltage was progressively increased until the patient experienced discomfort. We videotaped all the PTSEs induced at 130 Hz - high-frequency stimulation (HFS) - and at 2 or 3 Hz - low-frequency stimulation (LFS). Superimposing the pre- and postoperative MRIs, we measured the distance (R) from the centre of the used contact (cC) to the medial border of the PT.

                Results: The progressive increase in voltage at HFS induced tonic motor contractions, mainly located in the face, in 27/28 electrodes. LFS induced synchronous rhythmic myoclonus in the same territory. PTSEs induced at threshold voltage by HFS were observed in the upper face at 13/28 electrodes (bilaterally in 6 cases) and in the contralateral lower face at 5 electrodes. A positive correlation was found between the stimulus intensity capable of eliciting motor contractions at HFS and R.

                Conclusions: HFS of the STN preferentially activates the corticobulbar tract in comparison with the corticospinal tract. Therefore, cranial motor contractions need to be looked for during electrical parameter setting. The positive correlation between the electrical intensity threshold for PTSEs and R reflects the need for millimetre accuracy in electrode positioning.

                • Deep brain stimulation
                • Parkinson's disease
                • Pyramidal tract
                • Subthalamic nucleus

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