Coordinate-Based Lead Location Does Not Predict Parkinson's Disease Deep Brain Stimulation Outcome
Open Access
- 1 April 2014
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 9 (4), e93524
- https://doi.org/10.1371/journal.pone.0093524
Abstract
Effective target regions for deep brain stimulation (DBS) in Parkinson's disease (PD) have been well characterized. We sought to study whether the measured Cartesian coordinates of an implanted DBS lead are predictive of motor outcome(s). We tested the hypothesis that the position and trajectory of the DBS lead relative to the mid-commissural point (MCP) are significant predictors of clinical outcomes. We expected that due to neuroanatomical variation among individuals, a simple measure of the position of the DBS lead relative to MCP (commonly used in clinical practice) may not be a reliable predictor of clinical outcomes when utilized alone. 55 PD subjects implanted with subthalamic nucleus (STN) DBS and 41 subjects implanted with globus pallidus internus (GPi) DBS were included. Lead locations in AC-PC space (x, y, z coordinates of the active contact and sagittal and coronal entry angles) measured on high-resolution CT-MRI fused images, and motor outcomes (Unified Parkinson's Disease Rating Scale) were analyzed to confirm or refute a correlation between coordinate-based lead locations and DBS motor outcomes. Coordinate-based lead locations were not a significant predictor of change in UPDRS III motor scores when comparing pre- versus post-operative values. The only potentially significant individual predictor of change in UPDRS motor scores was the antero-posterior coordinate of the GPi lead (more anterior lead locations resulted in a worse outcome), but this was only a statistical trend (p<.082). The results of the study showed that a simple measure of the position of the DBS lead relative to the MCP is not significantly correlated with PD motor outcomes, presumably because this method fails to account for individual neuroanatomical variability. However, there is broad agreement that motor outcomes depend strongly on lead location. The results suggest the need for more detailed identification of stimulation location relative to anatomical targets.This publication has 49 references indexed in Scilit:
- The influence of intraoperative microelectrode recordings and clinical testing on the location of final stimulation sites in deep brain stimulation for Parkinson’s diseaseActa Neurochirurgica, 2012
- Probabilistic analysis of activation volumes generated during deep brain stimulationNeuroImage, 2011
- Deep brain stimulation plus best medical therapy versus best medical therapy alone for advanced Parkinson's disease (PD SURG trial): a randomised, open-label trialThe Lancet Neurology, 2010
- MRI verified STN stimulation site – gait improvement and clinical outcomeEuropean Journal of Neurology, 2010
- Clinical effects of deep brain stimulation on gait disorders in Parkinson’s diseaseEuropean Journal of Neurology, 2010
- Identification and management of deep brain stimulation intra- and postoperative urgencies and emergenciesParkinsonism & Related Disorders, 2010
- Relationship between neuropsychological outcome and DBS surgical trajectory and electrode locationJournal of the Neurological Sciences, 2009
- Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: The COMPARE TrialAnnals of Neurology, 2009
- Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients With Advanced Parkinson DiseaseA Randomized Controlled TrialJAMA, 2009
- Factors involved in long-term efficacy of deep brain stimulation of the thalamus for essential tremorJournal of Neurosurgery, 2008