title: Optimizing Prelemniscal Radiations as a Target for Motor Symptoms in Parkinson's Disease Treatment.
abstract: OBJECTIVE
  To better define prelemniscal radiations (Raprl) as a target for the control of tremor and rigidity in Parkinson's disease (PD).
  
  
  METHODS
  A total of 36 deep brain stimulation (DBS) electrodes were stereotactically implanted in Raprl contralateral to the extremities to be treated. Effects on symptoms were evaluated using UPDRS-III before and after DBS, and significance was determined using the Wilcoxon test. The location of DBS contacts in cases with optimum versus suboptimum results was evaluated using Student's t test and percentage improvement correlated through a bivariable Pearson test. The power and percentage of spike components for microelectrode recordings were statistically compared between the target point and structures located above and below.
  
  
  RESULTS
  Raprl-DBS improved tremor and rigidity (p < 0.01). The potency of microelectrode recordings indicated that the target was formed by fibers. There was no correlation between demographic characteristics and clinical outcome, and there were no significant differences in stereotactic placement between cases with optimum and suboptimum results. Tremor and rigidity were selectively improved in cases with suboptimum results.
  
  
  CONCLUSIONS
  Raprl-DBS is an effective treatment for the motor symptoms of PD. Selective improvement of symptoms suggests that the target has different fiber components related to either tremor or rigidity, and variations in improvement between cases may derive from individual variations of the location of these fibers.
authors.affiliation: Unit for Stereotactic and Functional Neurosurgery, Hospital General de México, Mexico City, Mexico.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Castro
authors.forename: José D
authors.initials: JD
authors.lastname: Carrillo-Ruiz
authors.forename: Víctor
authors.initials: V
authors.lastname: Salcido
authors.forename: Julián
authors.initials: J
authors.lastname: Soto
authors.forename: Guadalupe
authors.initials: G
authors.lastname: García-Gomar
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Velasco
authors.forename: Francisco
authors.initials: F
authors.lastname: Velasco
mesh_terms: D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008839:Microelectrodes; D008875:Middle Aged; D009127:Muscle Rigidity / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009412:Nerve Fibers / Q000502:physiology; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D013238:Stereotaxic Techniques; D020530:Subthalamus / Q000473:pathology / Q000503:physiopathology*; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D066127:White Matter / Q000473:pathology / Q000503:physiopathology