title: Stereotactic coordinates associated with facial musculature contraction during high-frequency stimulation of the subthalamic nucleus.
abstract: OBJECTIVE
  High-frequency stimulation of the subthalamic nucleus (STN) in patients with parkinsonian symptoms is often used to ameliorate debilitating motor symptoms associated with this condition. However, individual variability in the shape and orientation of this relatively small nucleus results in multiple side effects related to the spread of electrical current to surrounding structures. Specifically, contraction of the muscles of facial expression is noted in a small percentage of patients, although the precise mechanism remains poorly understood.
  
  
  METHODS
  Facial muscle contraction was triggered by high-frequency stimulation of 49 contacts in 18 patients undergoing deep brain stimulation of the STN. The mean coordinates of these individual contacts relative to the anterior commissure-posterior commissure midpoint (also called the midcommissural point) were calculated to determine the location or structure(s) most often associated with facial contraction during physiological macrostimulation.
  
  
  RESULTS
  The x, y, and z coordinates associated with contraction of the facial musculature were found to be 11.52, 1.29, and 1.15 mm lateral, posterior, and inferior to the midcommissural point, respectively. This location, along the lateral-anterior-superior border of the STN, may allow for the spread of electrical current to the fields of Forel, zona incerta, and/or descending corticospinal/corticobulbar tracts. Because stimulation of corticobulbar tracts produces similar findings, these results are best explained by the spread of electrical current to nearby internal capsule axons coursing lateral to the STN.
  
  
  CONCLUSIONS
  Thus, if intraoperative deep brain stimulation lead testing results in facial musculature contraction, placement of the electrode in a more medial, posterior position may reduce the amount of current spread to corticobulbar fibers and resolve this side effect.
authors.affiliation: Division of Neurosurgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA. agorgulho@mednet.ucla.edu
authors.forename: Alessandra A
authors.initials: AA
authors.lastname: Gorgulho
authors.forename: Donald C
authors.initials: DC
authors.lastname: Shields
authors.forename: Dennis
authors.initials: D
authors.lastname: Malkasian
authors.forename: Eric
authors.initials: E
authors.lastname: Behnke
authors.forename: Antonio A F
authors.initials: AA
authors.lastname: Desalles
mesh_terms: D001931:Brain Mapping; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects; D004567:Electrodes, Implanted; D005152:Facial Muscles / Q000503:physiopathology*; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology*; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology*