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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp.2008.159558

Brain Penetration Effects of Microelectrodes and DBS Leads in STN or GPi

  1. Justin M Mann (jmann12{at}ufl.edu)
  1. University of Florida, Department of Neurology, Movement Disorders Center, United States
    1. Kelly D Foote (foote{at}neurosurgery.ufl.edu)
    1. University of Florida Movement Disorders Center, Department of Neurosurgery, United States
      1. Cynthia W Garvan (cgarvan{at}ufl.edu)
      1. University of Florida Department of Education, United States
        1. Hubert H Fernandez (fernandez{at}neurology.ufl.edu)
        1. University of Florida, United States
          1. Charles E Jacobson, I V (jacobson{at}neurology.ufl.edu)
          1. University of Florida, United States
            1. Ramon L Rodriguez (ramon.rodriguez{at}neurology.ufl.edu)
            1. University of Florida, United States
              1. Ihtsham Haq (ihtsham.haq{at}neurology.ufl.edu)
              1. University of Florida, United States
                1. Mustafa S Siddiqui (mssiddiq{at}wfubmc.edu)
                1. Wake Forest University, United States
                  1. Irene A Malaty (irene.halkias{at}neurology.ufl.edu)
                  1. University of Florida, United States
                    1. Takashi Morishita (takashi.m.md{at}gmail.com)
                    1. University of Florida, United States
                      1. Christopher J Hass (cjhass{at}hhp.ufl.edu)
                      1. University of Florida, United States
                        1. Michael S Okun (okun{at}neurology.ufl.edu)
                        1. University of Florida McKnight Brain Institute, Neurology and Neurosurgery, United States
                          • Published Online First 22 February 2009

                          Abstract

                          Objective: To determine how intraoperative microelectrode recordings (MER) and intraoperative lead placement influence symptoms and also whether target location (subthalamic nucleus (STN) or globus pallidus interna (GPi)) was important.

                          Background: Following MER and/or test stimulation there may be a resultant “collision/implantation or microlesion” effect, thought to result from disruption of cells and/or fibers within the penetrated region.

                          Methods: Forty-seven consecutive Parkinson disease patients undergoing unilateral DBS for PD (either STN or GPi DBS) were evaluated. Motor function was measured at six time points with a modified UPDRS: 1) preoperative (before penetration on the day of surgery), 2) immediately post- MER, 3) immediately post lead implantation/collision, 4) four months following surgery- off medications, on DBS (12 hour medication washout), 5) six months postoperative- off medication and off DBS (12 hour washout), and 6) six months- on medication and off DBS (12 hour washout).

                          Results: Significant improvements in motor scores (p<.05) (tremor, rigidity, bradykinesia) were observed as a result of MER and lead placement. The improvements were similar in magnitude to what was observed at four and six months post-DBS following programming and medication optimization. When washed out (medications and DBS) for twelve hours, UPDRS motor scores were still improved compared to preoperative testing. There was a larger improvement in STN when compared to GPi following MER (p<.05), and a trend for significance following lead placement (p<.08), however long-term outcome was similar.

                          Conclusion: This study demonstrated significant intraoperative penetration effects resulting from MER and lead placement/collion in PD.

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