Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease.
OBJECTIVE
It is still debated to what extent intraoperative electrophysiological techniques contribute to the outcome of subthalamic nucleus (STN) deep brain stimulation (DBS). Intraoperative electrophysiological recordings for identification of the STN can be made with one electrode or with multiple, simultaneously implanted electrodes. The latter provide more detailed information about the electrophysiological boundaries of the STN; however, implantation of several electrodes at one time might increase the risk of bleeding. Here we report the results of a study of patients with advanced Parkinson's disease, in which one group of patients underwent bilateral STN DBS with electrophysiological recordings from a single electrode, and the other group received STN DBS with multiple (five or fewer) simultaneously implanted electrodes.


METHODS
Fifty-five patients suffering from advanced Parkinson's disease who underwent bilateral STN stimulation were included in this study. Thirty-two patients underwent STN DBS guided by a single semi-microelectrode, and 23 patients underwent STN DBS guided with simultaneously implanted multiple microelectrodes. All patients were examined preoperatively and 3 and 12 months postoperatively with regard to activities of daily living, motor functions, and neuropsychological functions.


RESULTS
We found that the simultaneous implantation of multiple electrodes does not increase the risk of bleeding or any other major intracranial complication. The use of multiple electrodes resulted in better motor results when compared with patients who underwent STN DBS guided with a single recording electrode. There were significantly more improvements in patients' tremor and rigidity, and as a consequence, a better total Unified Parkinson Disease Rating Scale, Part III score was identified during the medication-off phase. Despite better motor effects, patients treated with multiple electrodes showed subtle deterioration in neuropsychological functions, particularly in memory function.


CONCLUSIONS
STN DBS performed with multiple electrophysiological recording electrodes resulted in better motor outcome but induced specific mild declines in neuropsychological functions.
Temel
Yasin
Y
Department of Neurosurgery, University Hospital Maastricht, and European Graduate School of Neuroscience, Maastricht, The Netherlands. y.temel@np.unimaas.nl
Wilbrink
Poldi
P
Duits
Annelien
A
Boon
Peter
P
Tromp
Selma
S
Ackermans
Linda
L
van Kranen-Mastenbroek
Vivianne
V
Weber
Wim
W
Visser-Vandewalle
Veerle
V
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020531:Subthalamic Nucleus / Q000502:physiology* / Q000528:radiation effects