V J Geraedts1, R A P van Ham1, J Marinus1, J J van Hilten1, A Mosch2, C F E Hoffmann3, N A van der Gaag4, M F Contarino5. 1. Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands. 2. Department of Neurology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands. 3. Department of Neurosurgery, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands. 4. Department of Neurosurgery, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands; Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands. 5. Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA, Leiden, the Netherlands; Department of Neurology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands. Electronic address: m.f.contarino@lumc.nl.
Abstract
BACKGROUND: It is unknown whether intraoperative testing during awake Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) can be used to postoperatively identify the best settings for chronic stimulation. OBJECTIVE: To determine whether intraoperative test stimulation is indicative of postoperative stimulation results. METHODS: Records of consecutive Parkinson's Disease patients who received STN DBS between September 2012 and December 2017 were retrospectively analyzed. The best depth identified after intraoperative stimulation via the microelectrode's stimulation tip was compared with the depth of the contact selected for chronic stimulation after a standard monopolar contact review. Moreover, thresholds for induction of clinical effects (optimal improvement of rigidity and induction of side-effects) were compared between stimulation at the postoperatively selected contact and at the corresponding intraoperative depth. RESULTS: Records of 119 patients were analyzed (mean (SD) age 60.5 (6.5) years, 31.9% female, 238 STNs). In 75% of cases, the postoperatively selected contact corresponded with the intraoperative depth with the largest therapeutic window or was immediately dorsal to it. Higher stimulation intensities were required postoperatively than intraoperatively to relieve rigidity (p = 0.002) and induce capsular side-effects (p = 0.016). CONCLUSION: In the majority of cases, the postoperative contact for chronic stimulation was at a similar level or immediately dorsal with respect to the identified best intraoperative depth. Postoperatively, relief of rigidity and induction of capsular side-effects occur at higher stimulation intensities than during intraoperative test stimulation.
BACKGROUND: It is unknown whether intraoperative testing during awake Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) can be used to postoperatively identify the best settings for chronic stimulation. OBJECTIVE: To determine whether intraoperative test stimulation is indicative of postoperative stimulation results. METHODS: Records of consecutive Parkinson's Diseasepatients who received STN DBS between September 2012 and December 2017 were retrospectively analyzed. The best depth identified after intraoperative stimulation via the microelectrode's stimulation tip was compared with the depth of the contact selected for chronic stimulation after a standard monopolar contact review. Moreover, thresholds for induction of clinical effects (optimal improvement of rigidity and induction of side-effects) were compared between stimulation at the postoperatively selected contact and at the corresponding intraoperative depth. RESULTS: Records of 119 patients were analyzed (mean (SD) age 60.5 (6.5) years, 31.9% female, 238 STNs). In 75% of cases, the postoperatively selected contact corresponded with the intraoperative depth with the largest therapeutic window or was immediately dorsal to it. Higher stimulation intensities were required postoperatively than intraoperatively to relieve rigidity (p = 0.002) and induce capsular side-effects (p = 0.016). CONCLUSION: In the majority of cases, the postoperative contact for chronic stimulation was at a similar level or immediately dorsal with respect to the identified best intraoperative depth. Postoperatively, relief of rigidity and induction of capsular side-effects occur at higher stimulation intensities than during intraoperative test stimulation.
Authors: Wardell E Amerika; Saskia van der Gaag; Arne Mosch; Niels A van der Gaag; Carel F E Hoffmann; Rodi Zutt; Johan Marinus; Maria Fiorella Contarino Journal: Mov Disord Clin Pract Date: 2022-05-24
Authors: Victor J Geraedts; Rogier A P van Ham; Jacobus J van Hilten; Arne Mosch; Carel F E Hoffmann; Niels A van der Gaag; Maria Fiorella Contarino Journal: Front Neurol Date: 2021-12-24 Impact factor: 4.003