Journal Mobile Options
Table of Contents
Vol. 87, No. 5, 2009
Issue release date: September 2009

Surgical Repositioning of Misplaced Subthalamic Electrodes in Parkinson’s Disease: Location of Effective and Ineffective Leads

Richardson R.M. · Ostrem J.L. · Starr P.A.
To view the fulltext, log in and/or choose pay-per-view option

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

There is no clear consensus regarding the optimal location for placing deep brain stimulation (DBS) electrodes within the subthalamic nucleus (STN) target region in Parkinson’s disease. In cases of poor symptom control or adverse effects following lead placement, leads presumed to be inadequately positioned may be corrected by surgical revision. We retrospectively analyzed a series of 8 patients who underwent surgical lead revision, to study the anatomic boundaries of effective lead placement. Reoperation to achieve changes of 2–5 mm in DBS lead position targeting the dorsolateral part of the STN produced significant clinical improvement in these patients. Improvements were due to better symptom control, reduction of stimulation-induced adverse effects or both. In many cases, leads in a peripheral zone of the STN were repositioned to a more central location within the sensorimotor territory of the nucleus. These results are contrasted with findings in other studies demonstrating optimal lead placement in STN border zones or neighboring white-matter tracts.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Deuschl G, Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K, Daniels C, Deutschlander A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR, Oertel W, Pinsker MO, Reichmann H, Reuss A, Schneider GH, Schnitzler A, Steude U, Sturm V, Timmermann L, Tronnier V, Trottenberg T, Wojtecki L, Wolf E, Poewe W, Voges J: A randomized trial of deep-brain stimulation for Parkinson’s disease. N Engl J Med 2006;355:896–908.
  2. Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, Le Bas JF, Benabid AL, Pollak P: Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 2003;349:1925–1934.
  3. Abosch A, Hutchison WD, Saint-Cyr JA, Dostrovsky JO, Lozano AM: Movement-related neurons of the subthalamic nucleus in patients with Parkinson disease. J Neurosurg 2002;97:1167–1172.
  4. Rodriguez-Oroz MC, Rodriguez M, Guridi J, Mewes K, Chockkman V, Vitek J, De Long MR, Obeso JA: The subthalamic nucleus in Parkinson’s disease: somatotopic organization and physiological characteristics. Brain 2001;124:1777–1790.
  5. Theodosopoulos PV, Marks WJ Jr, Christine C, Starr PA: Locations of movement-related cells in the human subthalamic nucleus in Parkinson’s disease. Mov Disord 2003;18:791–798.
  6. Romanelli P, Heit G, Hill BC, Kraus A, Hastie T, Bronte-Stewart HM: Microelectrode recording revealing a somatotopic body map in the subthalamic nucleus in humans with Parkinson disease. J Neurosurg 2004;100:611–618.
  7. Plaha P, Ben-Shlomo Y, Patel NK, Gill SS: Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral parkinsonism. Brain 2006;129:1732–1747.
  8. Kitagawa M, Murata J, Uesugi H, Kikuchi S, Saito H, Tashiro K, Sawamura Y: Two-year follow-up of chronic stimulation of the posterior subthalamic white matter for tremor-dominant Parkinson’s disease. Neurosurgery 2005;56:281–289.
  9. Yokoyama T, Ando N, Sugiyama K, Akamine S, Namba H: Relationship of stimulation site location within the subthalamic nucleus region to clinical effects on parkinsonian symptoms. Stereotact Funct Neurosurg 2006;84:170–175.
  10. Herzog J, Fietzek U, Hamel W, Morsnowski A, Steigerwald F, Schrader B, Weinert D, Pfister G, Muller D, Mehdorn HM, Deuschl G, Volkmann J: Most effective stimulation site in subthalamic deep brain stimulation for Parkinson’s disease. Mov Disord 2004;19:1050–1054.
  11. Voges J, Volkmann J, Allert N, Lehrke R, Koulousakis A, Freund HJ, Sturm V: Bilateral high-frequency stimulation in the subthalamic nucleus for the treatment of Parkinson disease: correlation of therapeutic effect with anatomical electrode position. J Neurosurg 2002;96:269–279.
  12. McClelland S 3rd, Ford B, Senatus PB, Winfield LM, Du YE, Pullman SL, Yu Q, Frucht SJ, McKhann GM 2nd, Goodman RR: Subthalamic stimulation for Parkinson disease: determination of electrode location necessary for clinical efficacy. Neurosurg Focus 2005;19:E12.

    External Resources

  13. Tsai ST, Lin SH, Lin SZ, Chen JY, Lee CW, Chen SY: Neuropsychological effects after chronic subthalamic stimulation and the topography of the nucleus in Parkinson’s disease. Neurosurgery 2007;61:E1024–E1029, discussion E1029–E1030.
  14. Ellis TM, Foote KD, Fernandez HH, Sudhyadhom A, Rodriguez RL, Zeilman P, Jacobson CE, Okun MS: Reoperation for suboptimal outcomes after deep brain stimulation surgery. Neurosurgery 2008;63:754–760, discussion 760–751.
  15. Anheim M, Batir A, Fraix V, Silem M, Chabardes S, Seigneuret E, Krack P, Benabid AL, Pollak P: Improvement in Parkinson disease by subthalamic nucleus stimulation based on electrode placement: effects of reimplantation. Arch Neurol 2008;65:612–616.
  16. Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosley A, Marks WJ Jr: Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 2002;97:370–387.
  17. Pollo C, Villemure JG, Vingerhoets F, Ghika J, Maeder P, Meuli R: Magnetic resonance artifact induced by the electrode Activa 3389: an in vitro and in vivo study. Acta Neurochir 2004;146:161–164.
  18. Andrade-Souza YM, Schwalb JM, Hamani C, Hoque T, Saint-Cyr J, Lozano AM: Comparison of 2-dimensional magnetic resonance imaging and 3-planar reconstruction methods for targeting the subthalamic nucleus in Parkinson disease. Surg Neurol 2005;63:357–362, discussion 362–363.
  19. Schaltenbrand G, Wahren W: Atlas for Stereotaxy of the Human Brain. Stuttgart, Thieme, 1992.
  20. Plaha P, Khan S, Gill SS: Bilateral stimulation of the caudal zona incerta nucleus for tremor control. J Neurol Neurosurg Psychiatry 2008;79:504–513.
  21. Velasco F, Jimenez F, Perez ML, Carrillo-Ruiz JD, Velasco AL, Ceballos J, Velasco M: Electrical stimulation of the prelemniscal radiation in the treatment of Parkinson’s disease: an old target revised with new techniques. Neurosurgery 2001;49:293–306, discussion 306–308.
  22. Carrillo-Ruiz JD, Velasco F, Jimenez F, Castro G, Velasco AL, Hernandez JA, Ceballos J, Velasco M: Bilateral electrical stimulation of prelemniscal radiations in the treatment of advanced Parkinson’s disease. Neurosurgery 2008;62:347–357, discussion 357–359.
  23. Ashby P, Kim YJ, Kumar R, Lang AE, Lozano AM: Neurophysiological effects of stimulation through electrodes in the human subthalamic nucleus. Brain 1999;122:1919–1931.
  24. Rodriguez-Oroz MC, Rodriguez M, Leiva C, Rodriguez-Palmero M, Nieto J, Garcia-Garcia D, Luis Zubieta J, Cardiel C, Obeso JA: Neuronal activity of the red nucleus in Parkinson’s disease. Mov Disord 2008;23:908–911.
  25. Lanotte MM, Rizzone M, Bergamasco B, Faccani G, Melcarne A, Lopiano L: Deep brain stimulation of the subthalamic nucleus: anatomical, neurophysiological, and outcome correlations with the effects of stimulation. J Neurol Neurosurg Psychiatry 2002;72:53–58.
  26. Zonenshayn M, Sterio D, Kelly PJ, Rezai AR, Beric A: Location of the active contact within the subthalamic nucleus (STN) in the treatment of idiopathic Parkinson’s disease. Surg Neurol 2004;62:216–225, discussion 225–226.
  27. Hamel W, Fietzek U, Morsnowski A, Schrader B, Herzog J, Weinert D, Pfister G, Muller D, Volkmann J, Deuschl G, Mehdorn HM: Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: evaluation of active electrode contacts. J Neurol Neurosurg Psychiatry 2003;74:1036–1046.
  28. Bejjani BP, Damier P, Arnulf I, Thivard L, Bonnet AM, Dormont D, Cornu P, Pidoux B, Samson Y, Agid Y: Transient acute depression induced by high-frequency deep-brain stimulation. N Engl J Med 1999;340:1476–1480.
  29. Guiot G, Hertzog E, Rondot P, Molina P: Arrest or acceleration of speech evoked by thalamic stimulation in the course of stereotaxic procedures for parkinsonism. Brain 1961;84:363–379.
  30. Tripoliti E, Zrinzo L, Martinez-Torres I, Tisch S, Frost E, Borrell E, Hariz MI, Limousin P: Effects of contact location and voltage amplitude on speech and movement in bilateral subthalamic nucleus deep brain stimulation. Mov Disord 2008;23:2377–2383.
  31. Bardinet E, Bhattacharjee M, Dormont D, Pidoux B, Malandain G, Schupbach M, Ayache N, Cornu P, Agid Y, Yelnik J: A three-dimensional histological atlas of the human basal ganglia. II. Atlas deformation strategy and evaluation in deep brain stimulation for Parkinson disease. J Neurosurg 2009;110:208–219.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50