| Autor: |
Boex, Colette, Tyrand, Rémi, Horvath, Judit, Fleury-Nissen, Vanessa, Corniola, Marco, Sadri, Sarvenaz, Lüscher, Christian, Pollak, Pierre, Burkhard, Pierre, Momjian, Shahan |
| Zdroj: |
Stereotactic & Functional Neurosurgery; 2016 Supplement 1, Vol. 94, p31-31, 2/3p |
| Abstrakt: |
Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is advocated in patients with advanced Parkinson's disease (PD). Microelectrode recording (MER) is one of the intraoperative targeting modalities performed in conjunction with stimulation. In addition, the occurrence of β oscillations of the local field potentials (LFP) has been suggested as another targeting modality. The goal of this observational study was to evaluate which intraoperative neurophysiological markers are most predictive of the STN-DBS efficacy. Methods: Thirty-nine consecutive patients with PD and with a follow up of to at least one year post surgery were included. The efficacy of STN-DBS was evaluated using the MDS-UPDRS part III (score OFF antiparkinsonian medication and ON DBS at one year, versus preoperative OFF antiparkisonian medication). MER were recorded and intraoperative stimulation thresholds were determined for the therapeutic effects on rigidity and for the internal capsule stimulation (Neurostar, GE; 130 Hz, 60 µs). LFP were recorded from the macrocontact of the microelectrodes (FHC, USA) at the time it was positioned for stimulation (MR plus, GE). β power, computed from LFP [11-31 Hz], recorded at the site chosen for stimulation were compared to that recorded above the STN. Coefficients of determination (R2) were computed to analyze which proportion of the variance of the STN-DBS efficacy could be explained by these neurophysiological markers. Results: None significant linear regression was found between the STN-DBS efficacy and the stimulation thresholds of either the effects on rigidity, the magnitude of rigidity improvement, the threshold of internal capsule stimulation or the stimulation range (R² = 0.03, p = 0.34; R² = 0.09; R² = 0.09, p = 0.07; R² = 0.07; p = 0.16; respectively). Again none significant linear correlation was found between the STN-DBS efficacy and the lenght over which STN cells were recorded (R2 = 0.03, p = 0.33). On the contrary, linear regression was significant between the change in β power and the STN-DBS efficacy (R² =0.35, p < 0.05). To better analyze the role of b oscillations, additional sigmoidal regression was performed between the change in β power and the STN-DBS efficacy (R² = 0.75). Discussion and Conclusion: Here intraoperative stimulation thresholds had no determinant predictive value of the STNDBS success. New directional electrodes, allowing adaptation of the electrical field dedicated to avoid stimulation of the internal capsule, should reduce again the role of intraoperative stimulation. Changes in β power accounted for 75% of the variance of the STNDBS efficacy, confirming the major interest of this intraoperative neurophysiological marker, which could contribute to simplify intraoperative procedure and improve patients comfort. Acknowledgements: This work was supported by the Swiss National Science Foundation [SNF grants no. 320030- 149804]. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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