Background & Purpose

Globus pallidus internus (GPi) and Subthalamic nucleus (STN) are the two main target for deep brain stimulation (DBS) in treatment for patients with advanced Parkinson's disease (PD) not respond to medical therapies. MRI brain imaging is used for selection of patients for DBS and localize the target nucleus. This study presents the clinical outcomes of patients with PD treated with GPi/STN DBS using special MRI-guided sequences deep brain nuclei localization with intra-op microelectrode recording.

Materials and Methods

A cohort of 35 patients (17 male; mean age 55) who underwent GPi/STN DBS were recruited and followed-up clinically for a minimum period of 1 years. All patients underwent pre-op 3T MRI (Siemens Skyra) study, deep brain nuclei were localized using Magnetization-Prepared 2 Rapid Acquisition Gradient Echo (MP2RAGE) sequence, susceptibility weighted imaging sequence, and 3D T2 weighted fast spin echo sequence (SPACE). Preoperative and postoperative motor status was evaluated using Unified Parkinson's Disease Rating Scale part III clinical-scored monitored motor evaluation (UPDRS-III), in on- and off-medication/on-stimulation conditions. Preoperative and postoperative assessments further included self-evaluation of activities of daily living (UPDRS-II), neuropsychological and speech assessments. Active contacts localisation was calculated and compared with clinical outcomes.

Results and Discussion

All pre-op MR imaging deep brain nuclei stereotactic data obtained excellent precision with verification of intra-op microelectrode monitoring. MRI guided GPi/STN DBS significantly improved 1st year off-medication UPDRS-II & III scores, compared with baseline (preoperative UPDRS II 21.9 +/-10.9. UPDRS III 53.3 +/-15.9; postoperative UPDRS II 13.2 +/- 7.8, UPDRS III 25.5 +/- 8.6; p<0.05). Dyskinesia scale (preoperative dyskinesia scale 76 +/- 12.1; postoperative dyskinesia scale 41.9 +/-12.0; p<0.05), motor fluctuations and demands in dopaminergic medication remained significantly reduced. Only one complication, perioperative subarachnoid hemorrhage, encountered out of 35 patients. In this study, we used new MRI sequence (MP2RAGE) and other MRI sequences for accurate localization of Gpi/STN and achieved correct placement of deep brain stimulation electrodes. This can be used as a sole navigation technique without the use of physiologic monitoring, such as microelectrode recording.

Conclusions

Our data confirm that GPi/STN-DBS may be placed with high accuracy by using a correct and optimal MRI-guided sequences. Correct deep brain stimulation electodes placement can provides a safe and effective treatment for severe Parkinson’s disease not responsive to medical therapies.

Acknowledgements

No acknowledgement found.

References

No reference found.