title: Interventional magnetic resonance imaging-guided subthalamic nucleus deep brain stimulation for Parkinson's disease: Patient selection.
abstract: BACKGROUND
  Interventional magnetic resonance imaging (iMRI) guided deep brain stimulation (DBS) for Parkinson's disease (PD) has been shown to be effective. The costs of a dedicated intraoperative MRI may be prohibitive. The procedure can also be performed in a diagnostic scanner, however this presents challenges for utilization of time when the scanner is used both as a diagnostic and an interventional unit. This report outlines our novel methodology for patient selection for implantation in a diagnostic MR scanner, as an attempt to streamline the use of resources. A retrospective review of our outcomes is also presented.
  
  
  METHODS
  DBS candidacy evaluation included a PD questionnaire-39. Anxiety, age, difficulties in communication and body habitus were factors that were assessed in selecting patients for this technique. Eleven patients underwent iMRI-guided DBS implantation in the subthalamic nucleus. All patients were implanted bilaterally. Unified PD rating scale (UPDRS) part III and L-dopa dose were compared pre- and post-stimulation. A cohort of 11 DBS patients not selected for iMRI-guided DBS were also reported for comparison.
  
  
  RESULTS
  For the iMRI-guided patients, mean "Off" UPDRS III score was 47.6 (standard deviation [SD] 8.26). Postoperative "On" medication, "On" stimulation UPDRS III was 13.6 (SD 5.23). Mean preoperative L-dopa dose was 1060 mg (SD 474.3) and mean postoperative L-dopa dose was 320 (SD 298.3).
  
  
  CONCLUSIONS
  iMRI-guided DBS is a newly emerging technique for surgical treatment of patients with PD. We present a novel scoring system for patient selection assessing anxiety, age, ability to communicate, and body habitus to identify patients who will be benefited most from this technique.
authors: Department of Neurosurgery, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Hooman
authors: H
authors: Azmi
authors: Department of Neurosurgery and Internal Medicine, Division of Neurology, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Fiona
authors: F
authors: Gupta
authors: Department of Internal Medicine, Division of Neurology, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Mario
authors: M
authors: Vukic
authors: Department of Radiology, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Jason
authors: J
authors: Kreitner
authors: Department of Psychiatry, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Elizabeth
authors: E
authors: Kera
authors: Department of Radiology, Division of Neuroradiology, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Gregory
authors: G
authors: Nicola
authors: Department of Radiology, Division of Neuroradiology, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Sean
authors: S
authors: Pierce
authors: Department of Radiology, Division of Neuroradiology, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: David
authors: D
authors: Panush
authors: Department of Anesthesiology, Hackensack University Medical Center, Hackensack, NJ, USA.
authors: Randy
authors: R
authors: Cohen
keywords: Anesthesia; Parkinson's disease; deep brain stimulation; magnetic resonance imaging-guided deep brain stimulation; patient selection