Pilot Study for Considering Subthalamic Nucleus Anatomy during Stimulation Using Directional Leads

Takashi Asahi; Kiyonobu Ikeda; Jiro Yamamoto; Hiroyuki Tsubono; Shuji Sato

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자료유형: 학술저널

저자정보: Takashi Asahi (Kanazawa Neurosurgical Hospital) Kiyonobu Ikeda (Kanazawa Neurosurgical Hospital) Jiro Yamamoto (Kanazawa Neurosurgical Hospital) Hiroyuki Tsubono (Kanazawa Neurosurgical Hospital) Shuji Sato (Kanazawa Neurosurgical Hospital)

저널정보: 대한파킨슨병및이상운동질환학회 Journal Of Movement Disorders Journal Of Movement Disorders Vol.12 No.2

발행연도: 2019.1

수록면: 97 - 102 (6page)

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ObjectiveDirectional leads are used for deep brain stimulation (DBS). Two of the four contacts of the leads are divided into three parts, enabling controlled stimulation in a circumferential direction. The direction of adverse effects evoked by DBS in the subthalamic nucleus (STN) and stimulation strategies using directional leads were evaluated. MethodsDirectional leads were implanted into the bilateral STN of six parkinsonian patients (1 man, 5 women; mean age 66.2 years). The contact centers were located within the upper border of the STN, and the locations were identified electrically using microrecordings. Adverse effects were evaluated with electrical stimulation (30 μs, 130 Hz, limit 11 mA) using the directional part of each lead after surgery, and the final stimulation direction was investigated. Unified Parkinson’s disease rating scale (UPDRS) scores were evaluated before and after DBS. ResultsFifty-six motor and four sensory symptoms were evoked by stimulation; no adverse effect was evoked in 14 contacts. Motor and sensory symptoms were evoked by stimulation in the anterolateral direction and medial to posterolateral direction, respectively. Stimulation in the posteromedial direction produced adverse effects less frequently. The most frequently used contacts were located above the STN (63%), followed by the upper part of the STN (32%). The mean UPDRS part III and dyskinesia scores decreased after DBS from 30.2 ± 11.7 to 7.2 ± 2.9 and 3.3 ± 2.4 to 0.5 ± 0.8, respectively. ConclusionThe incidence of adverse effects was low for the posteromedial stimulation of the STN. Placing the directional part of the lead above the STN may facilitate the control of dyskinesia.

#Parkinson's disease #deep brain stimulation #directional lead #subthalamic nucleus

참고문헌 (18)

참고문헌 신청

Krack P / 2003 / Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson’s disease / N Engl J Med 349:1925~1934

Deuschl G / 2006 / A randomized trial of deep-brain stimulation for Parkinson’s disease / N Engl J Med 355:896~908

Steigerwald F / 2016 / Directional deep brain stimulation of the subthalamic nucleus: a pilot study using a novel neurostimulation device / Mov Disord 31:1240~1243

Reich MM / 2015 / Short pulse width widens the therapeutic window of subthalamic neurostimulation / Ann Clin Transl Neurol 2:427~432

McDermott H / 2015 / Comment on: short pulse width widens the therapeutic window of subthalamic neurostimulation / Ann Clin Transl Neurol 2:984~985

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