title: Clinical outcome of subthalamic stimulation in Parkinson's disease is improved by intraoperative multiple trajectories microelectrode recording.
abstract: OBJECTIVE
  The use of multiple trajectories microelectrode recording (MER) during implantation of deep brain stimulation (DBS) electrodes into the subthalamic nucleus (STN) in patients with Parkinson's disease (PD) is discussed controversially because of possible risks and unclear benefits. The aim of the study is to investigate whether MER combined with intraoperative evaluation of stimulation effects improve clinical outcome in PD patients undergoing STN DBS surgery.
  
  
  METHODS
  Prior to final DBS electrode implantation, we performed multiple trajectories MER and intraoperative test stimulations after magnetic resonance imaging (MRI)-guided planning in 32 PD patients. In further 10 patients no MER (only intraoperative test stimulation) was used.
  
  
  RESULTS
  We found a significantly better clinical outcome (Unified Parkinson's Disease Rating Scale [UPDRS] III) in patients undergoing MER compared with non-MER patients. In MER patients, DBS electrode placement was performed using the central trajectory in 73%. Another than the central trajectory was taken in 27% of the patients. No difference in clinical outcome between DBS electrodes implanted on the central or a decentral trajectory was observed.
  
  
  CONCLUSIONS
  DBS surgery based on intraoperative multiple trajectories MER and test stimulation improves clinical outcome if compared with intraoperative test stimulation alone. The data suggest that DBS surgery solely based on MRI and intraoperative test stimulation without MER may lead to nonoptimal placement of DBS electrodes and consequently poorer clinical outcome.
authors.affiliation: Department of Neurology, University Hospital Cologne, Cologne, Germany. christiane.reck@uk-koeln.de
authors.forename: Christiane
authors.initials: C
authors.lastname: Reck
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.forename: Lars
authors.initials: L
authors.lastname: Wojtecki
authors.forename: Stefan Jun
authors.initials: SJ
authors.lastname: Groiss
authors.forename: Esther
authors.initials: E
authors.lastname: Florin
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
authors.forename: Alfons
authors.initials: A
authors.lastname: Schnitzler
authors.forename: Lars
authors.initials: L
authors.lastname: Timmermann
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010300:Parkinson Disease / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome