The dominant-STN phenomenon in bilateral STN DBS for Parkinson's disease.
In some patients with Parkinson's disease (PD) and bilateral STN-DBS the motor benefit from one STN alone appears similar to the improvement obtained with bilateral STN-DBS. Thus, we hypothesized that some patients have a "dominant-STN," whose stimulation achieves similar results than bilateral stimulation. Twenty-two consecutive PD patients with bilateral STN-DBS were assessed in 4 randomized conditions: bilateral off-stimulation, bilateral on-stimulation, unilateral right- and unilateral left-stimulation. A hierarchical agglomerative cluster analysis of the motor UPDRS scores in these 4 conditions showed that 11 patients (50%) presented with a "dominant-STN." Interestingly, in 3 of these patients the dominant-STN was ipsilateral to the most affected side of the body. Our results support the presence of different phenotypes of response to bilateral STN stimulation. In our sample 50% of the patients presented with a dominant-STN, suggesting that a non-negligible part of PD patients might not need bilateral STN-DBS surgery.
Castrioto
Anna
A
Movement Disorders Center, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada.
Meaney
Christopher
C
Hamani
Clement
C
Mazzella
Filomena
F
Poon
Yu-Yan
YY
Lozano
Andres M
AM
Hodaie
Mojgan
M
Moro
Elena
E
D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000502:physiology; D017063:Outcome Assessment, Health Care / Q000379:methods; D010300:Parkinson Disease / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function / Q000502:physiology; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome