title: Correlation among anatomic landmarks, location of subthalamic deep brain stimulation electrodes, stimulation parameters, and side effects during programming monopolar review.
abstract: BACKGROUND
  Clinical benefits of deep brain stimulation can be limited by the presence of side effects produced by current spread to adjacent structures.
  
  
  OBJECTIVE
  To identify a correlation between coordinates for each individual contact, neighboring structures, and pattern of side effects.
  
  
  METHODS
  Coordinates of the electrodes and anatomic landmarks were obtained with a stereotactic surgical planning software and were correlated with stimulation-related side effects by using univariate and multivariable analyses.
  
  
  RESULTS
  Monopolar stimulation elicited capsular side effects (CSEs) in 208 of 316 contacts (65.8%) and noncapsular side effects (NCSEs) in 223 of 316 contacts (70.6%). The occurrence of CSEs was correlated with contact number (P = .009) and with the "Z" (P = .03), whereas voltage threshold to CSEs exhibited correlation with the internal capsule angle (P = .035). The occurrence of NCSEs was correlated with contact number (P = .005), "X" (P = .03), "Y" (P = .004), and the distance to the red nucleus (P = .001 and P = .003). There was correlation between voltage threshold to NCSEs and the internal capsule angle (P = .006), electrode's coronal angle (P = .02), "X" (P = .001), "Y" (P < .001), "Z" (P < .001), and the distances to the internal capsule (P = .02) and to the red nucleus (P = .004 and P < .001).
  
  
  CONCLUSIONS
  A better understanding how patient anatomy, stimulation parameters, and lead location in relation to neighboring structures influence the occurrence of side effects can be useful to inform targeting strategies.
authors.affiliation: *Center for Neurological Restoration, Cleveland Clinic Neurological Institute, Cleveland, Ohio; ‡Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; §University of Texas Health Science Center, Houston, Texas; ¶Department of Neurology, Cleveland Clinic Neurological Institute, Cleveland, Ohio; ‖Department of Neurosurgery, Cleveland Clinic Neurological Institute, Cleveland, Ohio; #Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Caio M
authors.initials: CM
authors.lastname: Matias
authors.forename: Raja
authors.initials: R
authors.lastname: Mehanna
authors.forename: Scott E
authors.initials: SE
authors.lastname: Cooper
authors.forename: Amit
authors.initials: A
authors.lastname: Amit
authors.forename: Scott F
authors.initials: SF
authors.lastname: Lempka
authors.forename: Danilo
authors.initials: D
authors.lastname: Silva
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Carlotti
authors.forename: Robert S
authors.initials: RS
authors.lastname: Butler
authors.forename: Andre G
authors.initials: AG
authors.lastname: Machado
mesh_terms: D059925:Anatomic Landmarks; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000379:methods*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D006801:Humans; D012189:Retrospective Studies; D012984:Software; D020531:Subthalamic Nucleus / Q000502:physiology