title: Clinical outcomes of PD patients having bilateral STN DBS using high-field interventional MR-imaging for lead placement.
abstract: OBJECTIVE
  Recently, an iMRI-guided technique for implanting DBS electrodes without MER was developed at our center. Here we report the clinical outcomes of PD patients undergoing STN DBS surgery using this surgical approach.
  
  
  METHODS
  Consecutive PD patients undergoing bilateral STN DBS using this method were prospectively studied. Severity of PD was determined using the UPDRS scores, Hoehn and Yahr staging score, stand-sit-walk testing, and the dyskinesia rating scale. The primary outcome measure was the change in UPDRS III off medication score at 6 months. DBS stimulation parameters, adverse events, levodopa equivalent daily dose (LEDD), and DBS lead locations were also recorded. Seventeen advanced PD patients (9M/8F) were enrolled from 2007 to 2009.
  
  
  RESULTS
  The mean UPDRS III off medication score improved from 44.5 to 22.5 (49.4%) at 6 months (p=0.001). Other secondary outcome measures (UPDRS II, III on medication, and IV) significantly improved as well (p<0.01). LEDD decreased by an average of 24.7% (p=0.003). Average stimulation parameters were: 2.9V, 66.4μs, 154Hz.
  
  
  CONCLUSIONS
  This pilot study demonstrates that STN DBS leads placed using the iMRI-guided method results in significantly improved outcomes in PD symptoms, and these outcomes are similar to what has been reported using traditional frame-based, MER-guided stereotactic methods.
authors.affiliation: Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA. jill.ostrem@ucsf.edu
authors.forename: Jill L
authors.initials: JL
authors.lastname: Ostrem
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Galifianakis
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Markun
authors.forename: Jamie K
authors.initials: JK
authors.lastname: Grace
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Martin
authors.forename: Philip A
authors.initials: PA
authors.lastname: Starr
authors.forename: Paul S
authors.initials: PS
authors.lastname: Larson
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005471:Fluoroscopy; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D017060:Patient Satisfaction; D013238:Stereotaxic Techniques; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents