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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp.2010.222497
  • Editorial commentary

Subthalamic stimulation for Parkinson's disease: a new benchmark

  1. Paul Krack
  1. Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Grenoble, France and Grenoble Institute of Neuroscience, Grenoble, France
  1. Correspondence to Professor Paul Krack, Service de Neurologie, CHU de Grenoble, BP 217, 38043 Grenoble Cedex 9, France; paul.krack{at}ujf-grenoble.fr
  • Received 23 July 2010
  • Revised 12 January 2011
  • Accepted 18 January 2011
  • Published Online First 18 February 2011

Foltynie et al recently reported on the outcome of bilateral subthalamic stimulation (STN DBS) in Parkinson's disease (PD) using MRI-based targeting without microrecording and using one single trajectory per target, followed by immediate stereotactic MRI to verify targeting accuracy. The outcome in this series of 79 consecutive patients managed in the Unit of Functional Neurosurgery at the Queen Square in London is remarkable in terms of both safety and efficacy.1

The leitmotif of this surgical school2 is that the first aim of elective functional surgery is not to harm, and so ventriculography was replaced by stereotactic CT early on,3 before moving to direct MRI-based targeting.4 Stereotactic imaging has become an integral part of the functional stereotactic procedure, performed under surgeons' direct supervision.1 Furthermore, the authors do not use microelectrode recording with multiple brain trajectories, in order to minimise the risk of brain haemorrhage.5 6 This is different from the practice in the vast majority of surgical centres …

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