Microelectrode recording can be a good adjunct in magnetic resonance image-directed subthalamic nucleus deep brain stimulation for parkinsonism.
BACKGROUND
The contribution of MER to improving bilateral STN-DBS is debatable. To resolve the controversy and elucidate the role of MER in DBS, we compared the outcome of bilateral STN-DBS surgery with and without MER in parkinsonian patients.


METHODS
From February 2002 to November 2002, the first 7 of 13 consecutive parkinsonian patients received STN-DBS without MER (group A), and the last 6 received STN-DBS with MER (group B). Pre- and postoperative assessments included scoring of UPDRS with video taping, and MR images.


RESULTS
The mean Hoehn and Yahr stage was 3.6 in group A and 4.0 in group B. The mean follow-up was 7.4 months for group A and 5.3 months for group B. The mean coordinates of the tip of the permanent electrode relative to the mid-commissural point were x = 8.1 mm, y = 4.3 mm, and z = 5.9 mm for group A and x = 10.6 mm, y = 4.1 mm, and z = 6.9 mm for group B. When levodopa was withdrawn from group A for 12 hours at follow-up, the postoperative UPDRS total score improved by 27.6% (P = .01) and the motor score by 25.4% (P = .02); their LEDD decreased by 17.5% (P = .03). In group B, the postoperative UPDRS total score improved by 49.3% (P = .00002) and the motor score by 45.2% (P = .0004); LEDD decreased by 48.5% (P = .01).


CONCLUSIONS
Although STN-DBS is a promising surgical modality for advanced parkinsonian patients, there is an inevitable learning curve associated with adopting this new procedure. Intraoperative MER is an effective way to ensure correct electrode placement in the STN. With the assistance of intraoperative MER, the outcome of STN-DBS can be improved significantly.
Division of Functional Neuroscience, Department of Neurosurgery, Neuro-Medical Scientific Center, Tzu Chi General Hospital, Hualien 97002, Taiwan.
Shin-Yuan
SY
Chen
Chao-Chin
CC
Lee
Sheng-Huang
SH
Lin
Yue-Long
YL
Hsin
Tien-Wen
TW
Lee
Pao-Sheng
PS
Yen
Yu-Cheng
YC
Chou
Chi-Wei
CW
Lee
Wanhua
W
Annie Hsieh
Chain-Fa
CF
Su
Shinn-Zong
SZ
Lin
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004292:Dominance, Cerebral / Q000502:physiology; D004599:Electric Stimulation Therapy; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020734:Parkinsonian Disorders / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D007980:Levodopa