Safety and efficacy of subthalamic nucleus deep brain stimulation performed with limited intraoperative mapping for treatment of Parkinson's disease.
OBJECTIVE
The aim of this study is to establish the safety and efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients with disabling motor fluctuations performed with an expedient procedure with limited intraoperative mapping.


METHODS
Bilateral STN DBS systems were implanted in 110 PD patients. Targeting of STN was achieved with T2-weighted magnetic resonance imaging guidance and a stereotactic navigation system confirmed by limited electrophysiological mapping. The safety of the procedure was analyzed in all 110 patients. The efficacy of the procedure was assessed in the practically-defined off medication state in the 72 patients who underwent evaluations 3 to 12 months after electrode implantation.


RESULTS
Adverse effects were infrequent and transient with no incidence of death, hemiparesis, or seizure. In the 72 patients, STN DBS reduced total Unified Parkinson's Disease Rating Scale motor scores at the time of the follow-up evaluation by 47% from 43.4 +/- 16.1 with stimulators off to 22.8 +/- 11.6 with stimulators on (P < 0.001). The changes in Unified Parkinson's Disease Rating Scale motor subscores improved as follows: rest tremor, 74% (P < 0.001); rigidity, 58% (P < 0.001); bradykinesia, 37% (P < 0.001); pull test, 35% (P < 0.001); gait, 44% (P < 0.001); axial signs, 42% (P < 0.001); and speech, 13% (P = 0.002). The prescribed total daily levodopa-equivalent dose decreased 45 +/- 32%. We averaged 1.3 +/- 0.9 electrodes passes per lead implantation. The mean operating time from the mounting of the stereotactic frame to its removal was 5 hours 42 minutes (median, 5 h 25 min; standard deviation, 1 h 12 min).


CONCLUSIONS
This STN DBS surgical technique for PD is expedient with effective outcomes and low complication rates.
Tabbal
Samer D
SD
Department of Neurology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. tabbals@neuro.wustl.edu
Revilla
Fredy J
FJ
Mink
Jonathan W
JW
Schneider-Gibson
Patricia
P
Wernle
Angela R
AR
de Erausquin
Gabriel A
GA
Perlmutter
Joel S
JS
Rich
Keith M
KM
Dowling
Joshua L
JL
D000368:Aged; D001931:Brain Mapping / Q000379:methods*; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000534:rehabilitation; D020531:Subthalamic Nucleus; D016896:Treatment Outcome