Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlas-magnetic resonance imaging coregistration method.
OBJECTIVE
The aim of this study was to correlate the clinical improvement in patients with Parkinson disease (PD) treated using deep brain stimulation (DBS) of the subthalamic nucleus (STN) with the precise anatomical localization of stimulating electrodes.


METHODS
Localization was determined by superimposing figures from an anatomical atlas with postoperative magnetic resonance (MR) images obtained in each patient. This approach was validated by an analysis of experimental and clinical MR images of the electrode, and the development of a three-dimensional (3D) atlas-MR imaging coregistration method. The PD motor score was assessed through two contacts for each of two electrodes implanted in 10 patients: the "therapeutic contact" and the "distant contact" (that is, the next but one to the therapeutic contact). Seventeen therapeutic contacts were located within or on the border of the STN, most of which were associated with significant improvement of the four PD symptoms tested. Therapeutic contacts located in other structures (zona incerta, lenticular fasciculus, or midbrain reticular formation) were also linked to a significant positive effect. Stimulation applied through distant contacts located in the STN improved symptoms of PD, whereas that delivered through distant contacts in the remaining structures had variable effects ranging from worsening of symptoms to their improvement.


CONCLUSIONS
The authors have demonstrated that 3D atlas-MR imaging coregistration is a reliable method for the precise localization of DBS electrodes on postoperative MR images. In addition, they have confirmed that although the STN is the main target during DBS treatment for PD, stimulation of surrounding regions, particularly the zona incerta or the lenticular fasciculus, can also improve symptoms of PD.
Yelnik
Jérôme
J
Institut National de la Santé et de la Recherche Médicale U289, Hôpital de la Salpêtrière, Paris, France. yelnik@ccr.jussieu.fr
Damier
Philippe
P
Demeret
Sophie
S
Gervais
David
D
Bardinet
Eric
E
Bejjani
Boulos-Paul
BP
François
Chantal
C
Houeto
Jean-Luc
JL
Arnule
Isabelle
I
Dormont
Didier
D
Galanaud
Damien
D
Pidoux
Bernard
B
Cornu
Philippe
P
Agid
Yves
Y
D000328:Adult; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000033:anatomy & histology* / Q000473:pathology; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D010300:Parkinson Disease / Q000601:surgery / Q000628:therapy*; D011184:Postoperative Period