title: Multichannel microelectrode recording influences final electrode placement in pallidal deep brain stimulation for Parkinson's disease: report of twenty consecutive cases.
abstract: OBJECTIVE
  Stereotactic placement of the permanent deep brain stimulating electrode     can be based upon imaging guidance with or without microelectrode recordings     (MER).
  
  
  METHODS
  We conducted a retrospective study of 20 PD     patients who underwent bilateral pallidal DBS placement with MER. There were 14     males and 6 females. The mean age at implantation was 67 years (range 42 - 80     years). Paired t-tests were used to compare initial imaging target coordinates     versus final electrode coordinates based on intraoperative MER. United     Parkinson's Disease Rating Scale (UPDRS) scores pre-operatively (medication off)     and at 6 months post-operatively (medication off, stimulation on) and daily     levodopa equivalents preoperatively and 6 months post-operatively were analyzed.
  
  
  RESULTS
  The mean difference between calculated imaging target and final     electrophysiological target was 3 mm (SD + 1.53 mm; p < 0.0001) in the     dorsal-ventral plane and 1.2 mm the axial plane, resulting in a calculated final     electrophysiology-based target adjustment of 3.4 mm (SD = 1.4 mm). Patients'     average daily levodopa equivalent dose dropped by 52% at six months     post-operatively (SD=40.9; p = 0.002). UPDRS scores dropped 26.9 points six     months postoperatively (SD=20.4; p = 0.0003).
  
  
  CONCLUSIONS
  In our experience     intraoperative microelectrode recordings can facilitate final electrode     placement.
authors.affiliation: Mayo Clinic Arizona, Department of Neurological Surgery, Phoenix, AZ, USA. lyons.mark2@mayo.edu
authors.forename: Mark K
authors.initials: MK
authors.lastname: Lyons
authors.forename: Kristine
authors.initials: K
authors.lastname: Ziemba
authors.forename: Virgilio
authors.initials: V
authors.lastname: Evidente
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000008:administration & dosage; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D004567:Electrodes, Implanted / Q000592:standards*; D004594:Electrophysiology / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005917:Globus Pallidus / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007980:Levodopa / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013238:Stereotaxic Techniques / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa