How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease?

Autor: Marko Milicevic, San San Xu, Wesley Thevathasan, Kristian J Bulluss, Boaz Kim, Patrick Pearce, Thushara Perera
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Parkinson's disease
Medical Implants
medicine.medical_treatment
Electrode Recording
Stimulation
Diagnostic Radiology
030218 nuclear medicine & medical imaging
Electronics Engineering
Medical Conditions
0302 clinical medicine
Medicine and Health Sciences
Electrochemistry
Membrane Electrophysiology
Movement Disorders
Multidisciplinary
medicine.diagnostic_test
Radiology and Imaging
Parkinson Disease
Neurodegenerative Diseases
Middle Aged
Magnetic Resonance Imaging
Electrodes
Implanted
Chemistry
Subthalamic nucleus
Bioassays and Physiological Analysis
Neurology
Physical Sciences
Engineering and Technology
Medicine
Research Article
Biotechnology
Deep brain stimulation
Imaging Techniques
Science
Bioengineering
Surgical and Invasive Medical Procedures
Research and Analysis Methods
03 medical and health sciences
Subthalamic Nucleus
Diagnostic Medicine
medicine
Humans
Functional electrical stimulation
Electrodes
Functional Electrical Stimulation
business.industry
Electrode Potentials
Electrophysiological Techniques
Biology and Life Sciences
Magnetic resonance imaging
medicine.disease
Microelectrode
Medical Devices and Equipment
Implant
Electronics
business
Microelectrodes
030217 neurology & neurosurgery
Biomedical engineering
Zdroj: PLoS ONE, Vol 16, Iss 7, p e0254504 (2021)
PLoS ONE
ISSN: 1932-6203
Popis: Introduction The efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson’s disease (PD) depends on how closely electrodes are implanted relative to an individual’s ideal stimulation location. Yet, previous studies have assessed how closely electrodes are implanted relative to the planned location, after homogenizing data to a reference. Thus here, we measured how accurately electrodes are implanted relative to an ideal, dorsal STN stimulation location, assessed on each individual’s native imaging. This measure captures not only the technical error of stereotactic implantation but also constraints imposed by planning a suitable trajectory. Methods This cross-sectional study assessed 226 electrodes in 113 consecutive PD patients implanted with bilateral STN-DBS by experienced clinicians utilizing awake, microelectrode guided, surgery. The error (Euclidean distance) between the actual electrode trajectory versus a nominated ideal, dorsal STN stimulation location was determined in each hemisphere on native imaging and predictive factors sought. Results The median electrode location error was 1.62 mm (IQR = 1.23 mm). This error exceeded 3 mm in 28/226 electrodes (12.4%). Location error did not differ between hemispheres implanted first or second, suggesting brain shift was minimised. Location error did not differ between electrodes positioned with (48/226), or without, a preceding microelectrode trajectory shift (suggesting such shifts were beneficial). There was no relationship between location error and case order, arguing against a learning effect. Discussion/Conclusion The proximity of STN-DBS electrodes to a nominated ideal, dorsal STN, stimulation location is highly variable, even when implanted by experienced clinicians with brain shift minimized, and without evidence of a learning effect. Using this measure, we found that assessments on awake patients (microelectrode recordings and clinical examination) likely yielded beneficial intraoperative decisions to improve positioning. In many patients the error is likely to have reduced therapeutic efficacy. More accurate methods to implant STN-DBS electrodes relative to the ideal stimulation location are needed.
Databáze: OpenAIRE
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