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Research paper
Deep brain stimulation for Parkinson’s disease: defining the optimal location within the subthalamic nucleus
  1. Maarten Bot1,
  2. P Richard Schuurman1,
  3. Vincent J J Odekerken2,
  4. Rens Verhagen1,2,
  5. Fiorella Maria Contarino2,3,4,
  6. Rob M A De Bie2,
  7. Pepijn van den Munckhof1
  1. 1 Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
  3. 3 Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
  4. 4 Department of Neurology, Haga Teaching Hospital, Den Haag, The Netherlands
  1. Correspondence to Dr Maarten Bot, Department of Neurosurgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; m.bot{at}amc.nl

Abstract

Background Individual motor improvement after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease (PD) varies considerably. Stereotactic targeting of the dorsolateral sensorimotor part of the STN is considered paramount for maximising effectiveness, but studies employing the midcommissural point (MCP) as anatomical reference failed to show correlation between DBS location and motor improvement. The medial border of the STN as reference may provide better insight in the relationship between DBS location and clinical outcome.

Methods Motor improvement after 12 months of 65 STN DBS electrodes was categorised into non-responding, responding and optimally responding body-sides. Stereotactic coordinates of optimal electrode contacts relative to both medial STN border and MCP served to define theoretic DBS ‘hotspots’.

Results Using the medial STN border as reference, significant negative correlation (Pearson’s correlation −0.52, P<0.01) was found between the Euclidean distance from the centre of stimulation to this DBS hotspot and motor improvement. This hotspot was located at 2.8 mm lateral, 1.7 mm anterior and 2.5 mm superior relative to the medial STN border. Using MCP as reference, no correlation was found.

Conclusion The medial STN border proved superior compared with MCP as anatomical reference for correlation of DBS location and motor improvement, and enabled defining an optimal DBS location within the nucleus. We therefore propose the medial STN border as a better individual reference point than the currently used MCP on preoperative stereotactic imaging, in order to obtain optimal and thus less variable motor improvement for individual patients with PD following STN DBS.

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Footnotes

  • Contributors MB, conception of the work, data collection, data analysis and interpretation, drafting the article, critical revision of the article, final approval of the version to be published. PRS, conception of the work, critical revision of the article, final approval of the version to be published. VJJO, critical revision of the article, data collection, final approval of the version to be published. RV, conception of the work, critical revision of the article, final approval of the version to be published. FMC, critical revision of the article, final approval of the version to be published. RMADB, critical revision of the article, final approval of the version to be published. PvdM, conception of the work, drafting the article, critical revision of the article, final approval of the version to be published.

  • Disclaimer The DBS team of the AMC received unrestricted research grants from Medtronic and received financial compensation for teaching courses for the European Continue Medical Training (ECMT) programme. The DBS team of the Haga Teaching Hospital/LUMC received compensation for DBS training activities from Medtronic. MB received travel grants from Medtronic. PRS acts as independent advisor for Boston Scientific, Elekta, Medtronic and Sapiens Steering Brain Stimulation. FMC received speaking fees from AbbVie, ECMT and Medtronic, received travel support from Boston Scientific, acts as an independent advisor for Boston Scientific and Medtronic. VJJO, RV, RMADB and PvdM have no disclosures.

  • Competing interests None declared.

  • Ethics approval Patients were selected from a multicentre randomised controlled study on the effectiveness of STN versus globus pallidus internus DBS that included patients between February 2007 and March 2011. Medical ethics committee of Academic Medical Center Amsterdam approved the study and patients provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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