title: Methods for Surgical Targeting of the STN in Early-Stage Parkinson's Disease.
abstract: Patients with Parkinson's disease (PD) experience progressive neurological decline, and future interventional therapies are thought to show most promise in early stages of the disease. There is much interest in therapies that target the subthalamic nucleus (STN) with surgical access. While locating STN in advanced disease patients (Hoehn-Yahr Stage III or IV) is well understood and routinely performed at many centers in the context of deep brain stimulation surgery, the ability to identify this nucleus in early-stage patients has not previously been explored in a sizeable cohort. We report surgical methods used to target the STN in 15 patients with early PD (Hoehn-Yahr Stage II), using a combination of image guided surgery, microelectrode recordings, and clinical responses to macrostimulation of the region surrounding the STN. Measures of electrophysiology (firing rates and root mean squared activity) have previously been found to be lower than in later-stage patients, however, the patterns of electrophysiology seen and dopamimetic macrostimulation effects are qualitatively similar to those seen in advanced stages. Our experience with surgical implantation of Parkinson's patients with minimal motor symptoms suggest that it remains possible to accurately target the STN in early-stage PD using traditional methods.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Corrie R
authors.initials: CR
authors.lastname: Camalier
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Konrad
authors.affiliation: Stritch School of Medicine, Loyola University Chicago , Chicago, IL , USA.
authors.forename: Chandler E
authors.initials: CE
authors.lastname: Gill
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Kao
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Remple
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Hana M
authors.initials: HM
authors.lastname: Nasr
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Davis
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Hedera
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Fenna T
authors.initials: FT
authors.lastname: Phibbs
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Molinari
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Neimat
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA.
authors.forename: David
authors.initials: D
authors.lastname: Charles
keywords: Parkinson’s disease; early stage; neurosurgery; subthalamic nucleus; surgical targeting