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Outcomes from deep brain stimulation targeting subthalamic nucleus and caudal zona incerta for Parkinson's disease.

Mostofi, A; Evans, JM; Partington-Smith, L; Yu, K; Chen, C; Silverdale, MA (2019) Outcomes from deep brain stimulation targeting subthalamic nucleus and caudal zona incerta for Parkinson's disease. NPJ Parkinsons Dis, 5. p. 17. ISSN 2373-8057 https://doi.org/10.1038/s41531-019-0089-1
SGUL Authors: Mostofi, Abteen

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Abstract

Both subthalamic nucleus (STN) and caudal zona incerta (cZI) have been implicated as the optimal locus for deep brain stimulation (DBS) in Parkinson's disease (PD). We present a retrospective clinico-anatomical analysis of outcomes from DBS targeting both STN and cZI. Forty patients underwent bilateral DBS using an image-verified implantable guide tube/stylette technique. Contacts on the same quadripolar lead were placed in both STN and cZI. After pulse generator programming, contacts yielding the best clinical effect were selected for chronic stimulation. OFF-medication unified PD rating scale (UPDRS) part III scores pre-operatively and ON-stimulation at 1-2 year follow up were compared. Active contacts at follow-up were anatomically localised from peri-operative imaging. Overall, mean UPDRS part III score improvement was 55 ± 9% (95% confidence interval), with improvement in subscores for rigidity (59 ± 13%), bradykinesia (58 ± 13%), tremor (71 ± 24%) and axial features (36 ± 19%). Active contacts were distributed in the following locations: (1) within posterior/dorsal STN (50%); (2) dorsal to STN (24%); (3) in cZI (21%); and (4) lateral to STN (5%). When contacts were grouped by location, no significant differences between groups were seen in baseline or post-operative improvement in contralateral UPDRS part III subscores. We conclude that when both STN and cZI are targeted, active contacts are distributed most commonly within and immediately dorsal to STN. In a subgroup of cases, cZI contacts were selected for chronic stimulation in preference. Dual targeting of STN and cZI is feasible and may provide extra benefit compared with conventional STN DBS is some patients.

Item Type: Article
Additional Information: Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. © The Author(s) 2019
Keywords: Brain, Neurological manifestations, Parkinson's disease
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: NPJ Parkinsons Dis
ISSN: 2373-8057
Language: eng
Dates:
DateEvent
21 August 2019Published
24 June 2019Accepted
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 31453317
Web of Science ID: WOS:000482230200001
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111168
Publisher's version: https://doi.org/10.1038/s41531-019-0089-1

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