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Stimulation site within the MRI-defined STN predicts postoperative motor outcome

Authors

  • Fritz Wodarg MD,

    1. Department of Neurology, Christian- Albrechts-University Kiel, Kiel, Germany
    2. Department of Neuroradiology, Christian- Albrechts-University Kiel, Kiel, Germany
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  • Jan Herzog MD,

    1. Department of Neurology, Christian- Albrechts-University Kiel, Kiel, Germany
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  • René Reese MD,

    1. Department of Neurology, Christian- Albrechts-University Kiel, Kiel, Germany
    Current affiliation:
    1. Department of Neurology, Julius-Maximilians-University, Würzburg, Würzburg, Germany
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  • Daniela Falk MD,

    1. Department of Neurosurgery, Christian- Albrechts-University Kiel, Kiel, Germany
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  • Markus O. Pinsker MD, PhD,

    1. Department of Neurosurgery, Christian- Albrechts-University Kiel, Kiel, Germany
    Current affiliation:
    1. Department of Stereotactic and Functional Neurosurgery, University Hospital Freiburg, Freiburg, Germany
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  • Frank Steigerwald MD,

    1. Department of Neurology, Christian- Albrechts-University Kiel, Kiel, Germany
    Current affiliation:
    1. Department of Neurology, Julius-Maximilians-University, Würzburg, Würzburg, Germany
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  • Olav Jansen MD, PhD,

    1. Department of Neuroradiology, Christian- Albrechts-University Kiel, Kiel, Germany
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  • Günther Deuschl MD, PhD,

    1. Department of Neurology, Christian- Albrechts-University Kiel, Kiel, Germany
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  • H. Maximillian Mehdorn MD, PhD,

    1. Department of Neurosurgery, Christian- Albrechts-University Kiel, Kiel, Germany
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  • Jens Volkmann MD, PhD

    Corresponding author
    1. Department of Neurology, Christian- Albrechts-University Kiel, Kiel, Germany
    Current affiliation:
    1. Department of Neurology, Julius-Maximilians-University, Würzburg, Würzburg, Germany
    • Klinik für Neurologie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, D-97080 Würzburg, Germany
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  • Relevant conflicts of interest/financial disclosures: René Reese received speaking honoraria from Medtronic. Daniela Falk received speaking honoraria from Medtronic. Markus O. Pinsker received speaking honoraria from Medtronic. Günther Deuschl received grant support for conducting a multicenter study. H. Maximillian Mehdorn received speaking honoraria and consultant fees from Medtronic. Jens Volkmann received honoraria for lectures, consulting fees, and grant support from Medtronic.

  • Full financial disclosures and author roles may be found in the online version of this article.

Abstract

High-frequency stimulation of the subthalamic nucleus (STN-HFS) is highly effective in treating motor symptoms in Parkinson's disease (PD) and medication side effects as well as in improving quality of life. Despite preoperative screening for patients as eligible candidates for this treatment, electrode position may furthermore influence treatment quality. Here, we investigated the relationship between the anatomical site of stimulation within the MRI-defined STN and the outcome of PD patients after STN-HFS. In 30 PD patients with bilateral STN stimulation, we retrospectively defined the boundaries of the STN within the axial target plane of the stereotactic T2-weighted MRI and determined the position of the active electrode contact in relation to the border of the STN. The position of the active contact within the STN was the only variable to predict the outcome of STN stimulation. In contrast, covariates such as age, disease duration, symptom severity, and response to levodopa had no effect. The lateral position of the stimulation contact within the STN led to significantly better clinical improvement, lower stimulation parameters, and less need for postoperative dopaminergic medication. The outcome of patients with stimulation contacts within the medial region of the STN was significantly worse. Precise targeting of the lateral region of the STN is essential for achieving sufficient stimulation efficacy. Preoperative T2-weighted MRI might be a useful component of the targeting procedure to improve the outcome of PD patients. © 2012 Movement Disorder Society

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