Document Detail

Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlas-magnetic resonance imaging coregistration method.
MedLine Citation:
PMID:  12854749     Owner:  NLM     Status:  MEDLINE    
OBJECT: The aim of this study was to correlate the clinical improvement in patients with Parkinson disease (PD) treated using deep brain stimulation (DBS) of the subthalamic nucleus (STN) with the precise anatomical localization of stimulating electrodes. METHODS: Localization was determined by superimposing figures from an anatomical atlas with postoperative magnetic resonance (MR) images obtained in each patient. This approach was validated by an analysis of experimental and clinical MR images of the electrode, and the development of a three-dimensional (3D) atlas-MR imaging coregistration method. The PD motor score was assessed through two contacts for each of two electrodes implanted in 10 patients: the "therapeutic contact" and the "distant contact" (that is, the next but one to the therapeutic contact). Seventeen therapeutic contacts were located within or on the border of the STN, most of which were associated with significant improvement of the four PD symptoms tested. Therapeutic contacts located in other structures (zona incerta, lenticular fasciculus, or midbrain reticular formation) were also linked to a significant positive effect. Stimulation applied through distant contacts located in the STN improved symptoms of PD, whereas that delivered through distant contacts in the remaining structures had variable effects ranging from worsening of symptoms to their improvement. CONCLUSIONS: The authors have demonstrated that 3D atlas-MR imaging coregistration is a reliable method for the precise localization of DBS electrodes on postoperative MR images. In addition, they have confirmed that although the STN is the main target during DBS treatment for PD, stimulation of surrounding regions, particularly the zona incerta or the lenticular fasciculus, can also improve symptoms of PD.
Jérôme Yelnik; Philippe Damier; Sophie Demeret; David Gervais; Eric Bardinet; Boulos-Paul Bejjani; Chantal François; Jean-Luc Houeto; Isabelle Arnule; Didier Dormont; Damien Galanaud; Bernard Pidoux; Philippe Cornu; Yves Agid
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  99     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-11     Completed Date:  2003-08-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  89-99     Citation Subset:  AIM; IM    
Institut National de la Santé et de la Recherche Médicale U289, Hôpital de la Salpêtrière, Paris, France.
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MeSH Terms
Basal Ganglia / pathology
Brain / anatomy & histology*,  pathology
Electric Stimulation Therapy / instrumentation*
Imaging, Three-Dimensional
Magnetic Resonance Imaging*
Parkinson Disease / surgery,  therapy*
Postoperative Period

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