1
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Park HR, Im HJ, Park J, Yoon BW, Lim YH, Song EJ, Kim KR, Lee JM, Park K, Park KH, Park HJ, Shin JH, Woo KA, Lee JY, Park S, Kim HJ, Jeon B, Paek SH. Long-Term Outcomes of Bilateral Subthalamic Nucleus Deep Brain Stimulation for Patients With Parkinson's Disease: 10 Years and Beyond. Neurosurgery 2022; 91:726-733. [PMID: 36084204 DOI: 10.1227/neu.0000000000002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) represents an effective treatment for severe Parkinson's disease (PD), but little is known about the long-term benefit. OBJECTIVE To investigate the survival rate and long-term outcome of DBS. METHODS We investigated all 81 patients including 37 males and 44 females who underwent bilateral STN DBS from March 2005 to March 2008 at a single institution. The current survival status of the patients was investigated. Preoperative and postoperative follow-up assessments were analyzed. RESULTS The mean age at the time of surgery was 62 (range 27-82) years, and the median clinical follow-up duration was 145 months. Thirty-five patients (43%) died during the follow-up period. The mean duration from DBS surgery to death was 110.46 ± 40.8 (range 0-155) months. The cumulative survival rate is as follows: 98.8 ± 1.2% (1 year), 95.1 ± 2.4% (5 years), and 79.0 ± 4.5% (10 years). Of the 81 patients, 33 (40%) were ambulatory up to more than 11 years. The Unified Parkinson's Disease Rating Scale (UPDRS) score was significantly improved until 5 years after surgery although it showed a tendency to increase again after 10 years. The patient group with both electrodes located within the STN showed a higher rate of survival and maintained ambulation. CONCLUSION STN DBS is a safe and effective treatment for patients with advanced PD. This study based on the long-term follow-up of large patient populations can be used to elucidate the long-term fate of patients who underwent bilateral STN DBS for PD.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyung-Jun Im
- Department of Applied Bioengineering, Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jeongbin Park
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Byung Woo Yoon
- Department of Internal Medicine, School of Medicine, Chung-Ang University, Seoul, Korea
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Eun Jin Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung Ran Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang Hyon Park
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Hyun Joo Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jung-Hwan Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Korea.,Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Hypoxia/Ischemia Disease Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Advanced Institutes of Convergence Technology, Suwon-si, Gyeonggi-do, Korea
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2
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Far R, Saez I, Sardo A, Ovruchesky E, Sperry L, Zhang L, Shahlaie K, Girgis F. Subthalamic nucleus deep brain stimulation programming settings do not correlate with Parkinson's disease severity. Acta Neurochir (Wien) 2022; 164:2271-2278. [PMID: 35751700 DOI: 10.1007/s00701-022-05279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). While the success of DBS is dependent on careful patient selection and accurate lead placement, programming parameters play a pivotal role in tailoring therapy on the individual level. Various algorithms have been developed to streamline the initial programming process, but the relationship between pre-operative patient characteristics and post-operative device settings is unclear. In this study, we investigated how PD severity correlates with DBS settings. METHODS We conducted a retrospective review of PD patients who underwent DBS of the subthalamic nucleus at one US tertiary care center between 2014 and 2018. Pre-operative patient characteristics and post-operative programming data at various intervals were collected. Disease severity was measured using the Unified Parkinson's Disease Rating Scale score (UPDRS) as well as levodopa equivalent dose (LED). Correlation analyses were conducted looking for associations between pre-operative disease severity and post-operative programming parameters. RESULTS Fifty-six patients were analyzed. There was no correlation between disease severity and any of the corresponding programming parameters. Pre-operative UPDRS scores on medication were similar to post-operative scores with DBS. Settings of amplitude, frequency, and pulse width increased significantly from 1 to 6 months post-operatively. Stimulation volume, inferred by the distance between contacts used, also increased significantly over time. CONCLUSIONS Interestingly, we found that patients with more advanced disease responded to electrical stimulation similarly to patients with less advanced disease. These data provide foundational knowledge of DBS programming parameters used in a single cohort of PD patients over time.
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Affiliation(s)
- Rena Far
- Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Ignacio Saez
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Angela Sardo
- School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Eric Ovruchesky
- School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Laura Sperry
- Department of Neurology, University of California Davis, Sacramento, CA, USA
| | - Lin Zhang
- Department of Neurology, University of California Davis, Sacramento, CA, USA
| | - Kiarash Shahlaie
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Fady Girgis
- Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
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3
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Lin Z, Zhang C, Li D, Sun B. Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2021; 9:140-155. [PMID: 35146054 DOI: 10.1002/mdc3.13379] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Research Center for Brain Science and Brain‐Inspired Intelligence Shanghai China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
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4
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Aubignat M, Lefranc M, Tir M, Krystkowiak P. Deep brain stimulation programming in Parkinson's disease: Introduction of current issues and perspectives. Rev Neurol (Paris) 2020; 176:770-779. [DOI: 10.1016/j.neurol.2020.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 12/11/2022]
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5
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Determination of Parkinson Disease Laterality After Deep Brain Stimulation Using 123I FP-CIT SPECT. Clin Nucl Med 2020; 45:e178-e184. [DOI: 10.1097/rlu.0000000000002955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Engelhardt J, Guehl D, Damon-Perrière N, Branchard O, Burbaud P, Cuny E. Localization of Deep Brain Stimulation Electrode by Image Registration Is Software Dependent: A Comparative Study between Four Widely Used Software Programs. Stereotact Funct Neurosurg 2018; 96:364-369. [PMID: 30566953 DOI: 10.1159/000494982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The control of the anatomic position of the active contacts is essential to understand the effects and adapt the settings of the neurostimulation. The localization is commonly assessed by a registration between the preoperative MRI and the postoperative CT scan. However, its accuracy depends on the quality of the registration algorithm and many software programs are available. OBJECTIVE To compare the localization of implanted deep brain stimulation (DBS) leads in the subthalamic nucleus (STN) between four registration devices. METHODS The preoperative stereotactic MRI was co-registered and fused with the 3-month postoperative CT scan in 27 patients implanted in the STN for Parkinson's disease (53 leads). Localizations of the active contacts were calculated in the stereotactic frame space and compared between software programs. RESULTS The coordinates of the active contacts were different between software programs in the 3 axes (p < 0.001) with a mean vectorial error between the deepest contact locations of 1.17 mm (95% CI 1.09-1.25). CONCLUSION We found a small but significant difference in the coordinates calculated on four different devices. These results have to be considered when performing studies comparing active contact locations or when following patients with an implanted DBS lead.
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Affiliation(s)
- Julien Engelhardt
- CHU de Bordeaux, Service de neurochirurgie B, Bordeaux, France, .,Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France,
| | - Dominique Guehl
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations fonctionnelles du système nerveux, Bordeaux, France
| | - Nathalie Damon-Perrière
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations fonctionnelles du système nerveux, Bordeaux, France
| | | | - Pierre Burbaud
- Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations fonctionnelles du système nerveux, Bordeaux, France
| | - Emmanuel Cuny
- CHU de Bordeaux, Service de neurochirurgie B, Bordeaux, France.,Université de Bordeaux, Institut des maladies neurodégénératives, UMR 5293, Bordeaux, France
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7
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Xia J, He P, Cai X, Zhang D, Xie N. Magnetic resonance and computed tomography image fusion technology in patients with Parkinson's disease after deep brain stimulation. J Neurol Sci 2017; 381:250-255. [PMID: 28991693 DOI: 10.1016/j.jns.2017.08.3267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
Electrode position after deep brain stimulation (DBS) for Parkinson's disease (PD) needs to be confirmed, but there are concerns about the risk of postoperative magnetic resonance imaging (MRI) after DBS. These issues could be avoided by fusion images obtained from preoperative MRI and postoperative computed tomography (CT). This study aimed to investigate image fusion technology for displaying the position of the electrodes compared with postoperative MRI. This was a retrospective study of 32 patients with PD treated with bilateral subthalamic nucleus (STN) DBS between April 2015 and March 2016. The postoperative (same day) CT and preoperative MRI were fused using the Elekta Leksell 10.1 planning workstation (Elekta Instruments, Stockholm, Sweden). The position of the electrodes was compared between the fusion images and postoperative 1-2-week MRI. The position of the electrodes was highly correlated between the fusion and postoperative MRI (all r between 0.865 and 0.996; all P<0.001). The differences of the left electrode position in the lateral and vertical planes was significantly different between the two methods (0.30 and 0.24mm, respectively, both P<0.05), but there were no significant differences for the other electrode and planes (all P>0.05). The position of the electrodes was highly correlated between the fusion and postoperative MRI. The CT-MRI fusion images could be used to avoid the potential risks of MRI after DBS in patients with PD.
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Affiliation(s)
- Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Pin He
- Department of Radiology, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Xiaodong Cai
- Department of Neurosurgery, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Doudou Zhang
- Department of Neurosurgery, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China
| | - Ni Xie
- Central Laboratory, Shenzhen Second People's Hospital (the First Affiliated Hospital of Shenzhen University), Shenzhen 518035, China.
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8
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Husch A, V Petersen M, Gemmar P, Goncalves J, Hertel F. PaCER - A fully automated method for electrode trajectory and contact reconstruction in deep brain stimulation. NEUROIMAGE-CLINICAL 2017; 17:80-89. [PMID: 29062684 PMCID: PMC5645007 DOI: 10.1016/j.nicl.2017.10.004] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/22/2017] [Accepted: 10/03/2017] [Indexed: 10/25/2022]
Abstract
Deep brain stimulation (DBS) is a neurosurgical intervention where electrodes are permanently implanted into the brain in order to modulate pathologic neural activity. The post-operative reconstruction of the DBS electrodes is important for an efficient stimulation parameter tuning. A major limitation of existing approaches for electrode reconstruction from post-operative imaging that prevents the clinical routine use is that they are manual or semi-automatic, and thus both time-consuming and subjective. Moreover, the existing methods rely on a simplified model of a straight line electrode trajectory, rather than the more realistic curved trajectory. The main contribution of this paper is that for the first time we present a highly accurate and fully automated method for electrode reconstruction that considers curved trajectories. The robustness of our proposed method is demonstrated using a multi-center clinical dataset consisting of N = 44 electrodes. In all cases the electrode trajectories were successfully identified and reconstructed. In addition, the accuracy is demonstrated quantitatively using a high-accuracy phantom with known ground truth. In the phantom experiment, the method could detect individual electrode contacts with high accuracy and the trajectory reconstruction reached an error level below 100 μm (0.046 ± 0.025 mm). An implementation of the method is made publicly available such that it can directly be used by researchers or clinicians. This constitutes an important step towards future integration of lead reconstruction into standard clinical care.
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Affiliation(s)
- Andreas Husch
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, 4 Rue Ernest Barble, Luxembourg City, Luxembourg; Systems Control Group, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 5 Avenue du Swing, Belvaux, Luxembourg.
| | - Mikkel V Petersen
- Department of Clinical Medicine - Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Peter Gemmar
- Trier University of Applied Sciences, Schneidershof, Trier, Germany; Systems Control Group, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 5 Avenue du Swing, Belvaux, Luxembourg
| | - Jorge Goncalves
- Systems Control Group, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 5 Avenue du Swing, Belvaux, Luxembourg
| | - Frank Hertel
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, 4 Rue Ernest Barble, Luxembourg City, Luxembourg
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9
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Lee WW, Ehm G, Yang HJ, Song IH, Lim YH, Kim MR, Kim YE, Hwang JH, Park HR, Lee JM, Kim JW, Kim HJ, Kim C, Kim HC, Park E, Kim IY, Kim DG, Jeon B, Paek SH. Bilateral Deep Brain Stimulation of the Subthalamic Nucleus under Sedation with Propofol and Fentanyl. PLoS One 2016; 11:e0152619. [PMID: 27018855 PMCID: PMC4809591 DOI: 10.1371/journal.pone.0152619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 03/16/2016] [Indexed: 11/18/2022] Open
Abstract
Awakening during deep brain stimulation (DBS) surgery may be stressful to patients. The aim of the current study was to evaluate the effect on MER signals and their applicability to subthalmic nucleus (STN) DBS surgery for patients with Parkinson’s disease (PD) under sedation with propofol and fentanyl. Sixteen consecutive patients with PD underwent STN-DBS surgery with propofol and fentanyl. Their MER signals were achieved during the surgery. To identify the microelectrodes positions, the preoperative MRI and postoperative CT were used. Clinical profiles were also collected at the baseline and at 6 months after surgery. All the signals were slightly attenuated and contained only bursting patterns, compared with our previous report. All electrodes were mostly located in the middle one third part of the STN on both sides of the brain in the fused images. Six months later, the patients were improved significantly in the medication-off state and they met with less dyskinesia and less off-duration. Our study revealed that the sedation with propofol and fentanyl was applicable to STN-DBS surgery. There were no significant problems in precise positioning of bilateral electrodes. The surgery also improved significantly clinical outcomes in 6-month follow-up.
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Affiliation(s)
- Woong-Woo Lee
- Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea
| | - Gwanhee Ehm
- Department of Neurology, Myongji Hospital, Gyeonggi, Republic of Korea
| | - Hui-Jun Yang
- Department of Neurology, Ulsan University Hospital, Ulsan, Republic of Korea
| | - In Ho Song
- Medical Device Development Center, Osong Medical Innovation Foundation, Chungcheong, Republic of Korea
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mi-Ryoung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Eun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Gyeonggi, Republic of Korea
| | - Jae Ha Hwang
- Department of Neurosurgery, Daejeon Woori Hospital, Gyeonggi, Republic of Korea
| | - Hye Ran Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheolyoung Kim
- Medical Imaging Laboratory, CyberMed Inc., Seoul, Republic of Korea
| | - Hee Chan Kim
- Department of Medical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eunkyoung Park
- Department of Biomedical Engineering, Han Yang University, Seoul, Republic of Korea
| | - In Young Kim
- Department of Biomedical Engineering, Han Yang University, Seoul, Republic of Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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10
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Hyam JA, Akram H, Foltynie T, Limousin P, Hariz M, Zrinzo L. What You See Is What You Get: Lead Location Within Deep Brain Structures Is Accurately Depicted by Stereotactic Magnetic Resonance Imaging. Neurosurgery 2016; 11 Suppl 3:412-9; discussion 419. [PMID: 26087006 DOI: 10.1227/neu.0000000000000848] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-verified deep brain stimulation relies on the correct interpretation of stereotactic imaging documenting lead location in relation to visible anatomic target. However, it has been suggested that local signal distortion from the lead itself renders its depiction on MRI unreliable. OBJECTIVE To compare lead location on stereotactic MRI with subsequent location of its brain track after removal. METHODS Patients underwent deep brain stimulation with the use of MRI-guided and MRI-verified Leksell frame approach. Infection or suboptimal efficacy required lead removal and subsequent reimplantation by using the same technique. Postimplantation stereotactic MR images were analyzed. Lateral (x) and anteroposterior (y) distances from midcommissural point to center of the lead hypointensity were recorded at the anterior commissure-posterior commissure plane (pallidal electrode) or z = -4 (subthalamic electrode). Stereotactic MRI before the second procedure, x and y distances from the center of the visible lead track hypointensity to midcommissural point were independently recorded. Vectorial distance from center of the lead hypointensity to the center of its track was calculated. RESULTS Sixteen electrode tracks were studied in 10 patients. Mean differences between lead artifact location and lead track location were: x coordinate 0.4 mm ± 0.2; y coordinate 0.6 mm ± 0.3. Mean vectorial distance was 0.7 mm ± 0.2. CONCLUSION Stereotactic distance between lead location and subsequent brain track location on MRI was small. The mean discrepancy was approximately half the deep brain stimulation lead width. This suggests that lead hypointensity seen on postimplantation MRI is indeed an accurate representation of its real location within deep brain structures.
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Affiliation(s)
- Jonathan A Hyam
- *Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, University College London, Queen Square, London, United Kingdom; ‡Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; §Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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11
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Lee JI. The Current Status of Deep Brain Stimulation for the Treatment of Parkinson Disease in the Republic of Korea. J Mov Disord 2015; 8:115-21. [PMID: 26413238 PMCID: PMC4572661 DOI: 10.14802/jmd.15043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/22/2015] [Accepted: 07/28/2015] [Indexed: 12/04/2022] Open
Abstract
Parkinson disease (PD) is a common neurodegenerative disease with an increasing prevalence in Korea. Deep brain stimulation (DBS) is a safe and effective surgical treatment option for this disease. The aim of this review was to provide an update regarding current DBS practices with respect to the treatment of PD in the Republic of Korea. The first DBS in Korea was performed in 2000; approximately 2,000 patients have undergone DBS for a variety of neurological disorders, the majority of whom were patients with PD. Approximately 150 new patients with PD receive DBS annually, and more than 20 centers perform DBS. However, DBS remains underutilized for many reasons, and the clinical case burden at many institutions is below the level presumed adequate for qualified practice. With a rapidly aging population and an evolving socioeconomic environment, the need for surgical intervention for PD is likely to increase significantly in the future. Many issues such as finances, education, and quality assurance must be resolved to cope with this need.
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Affiliation(s)
- Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Pourfar MH, Mogilner AY, Farris S, Giroux M, Gillego M, Zhao Y, Blum D, Bokil H, Pierre MC. Model-Based Deep Brain Stimulation Programming for Parkinson's Disease: The GUIDE Pilot Study. Stereotact Funct Neurosurg 2015; 93:231-9. [DOI: 10.1159/000375172] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 01/13/2015] [Indexed: 11/19/2022]
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13
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Kim W, Song IH, Lim YH, Kim MR, Kim YE, Hwang JH, Kim IK, Song SW, Kim JW, Lee WW, Kim HJ, Kim C, Kim HC, Kim IY, Park HP, Kim DG, Jeon BS, Paek SH. Influence of propofol and fentanyl on deep brain stimulation of the subthalamic nucleus. J Korean Med Sci 2014; 29:1278-86. [PMID: 25246748 PMCID: PMC4168183 DOI: 10.3346/jkms.2014.29.9.1278] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/26/2014] [Indexed: 12/03/2022] Open
Abstract
We investigated the effect of propofol and fentanyl on microelectrode recording (MER) and its clinical applicability during subthalamic nucleus (STN) deep brain stimulation (DBS) surgery. We analyzed 8 patients with Parkinson's disease, underwent bilateral STN DBS with MER. Their left sides were done under awake and then their right sides were done with a continuous infusion of propofol and fentanyl under local anesthesia. The electrode position was evaluated by preoperative MRI and postoperative CT. The clinical outcomes were assessed at six months after surgery. We isolated single unit activities from the left and the right side MERs. There was no significant difference in the mean firing rate between the left side MERs (38.7 ± 16.8 spikes/sec, n=78) and the right side MERs (35.5 ± 17.2 spikes/sec, n=66). The bursting pattern of spikes was more frequently observed in the right STN than in the left STN. All the electrode positions were within the STNs on both sides and the off-time Unified Parkinson's Disease Rating Scale part III scores at six months after surgery decreased by 67% of the preoperative level. In this study, a continuous infusion of propofol and fentanyl did not significantly interfere with the MER signals from the STN. The results of this study suggest that propofol and fentanyl can be used for STN DBS in patients with advanced Parkinson's disease improving the overall experience of the patients.
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Affiliation(s)
- Wonki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - In Ho Song
- Medical Device Development Center, Osong Medical Innovation Foundation, Cheongwon, Korea
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Mi-Ryoung Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Eun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Ha Hwang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - In Keyoung Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Woo Song
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Woong-Woo Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheolyoung Kim
- Medical Imaging Laboratory and CyberMed, Inc., Seoul, Korea
| | - Hee Chan Kim
- Department of Medical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - In Young Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Hee Pyoung Park
- Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Beom Seok Jeon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea. ; Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. ; Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
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Kim JW, Hwang JH, Kim IK, Kim YE, Yang HJ, Ehm G, Kim HJ, Kim DG, Paek SH, Jeon BS. Acute brain reaction to DBS electrodes after deep brain stimulation: chronological observation. Acta Neurochir (Wien) 2013; 155:2365-71; discussion 2371. [PMID: 24009047 DOI: 10.1007/s00701-013-1853-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND As increasing numbers of deep brain stimulation (DBS) procedures are performed, rare abnormal findings on postoperative images that are not attributable to well-known complications are reported. Between 2005 and 2012, we encountered several symptomatic patients with transient abnormal low-attenuation lesions on postoperative computed tomography (CT) scans. The aim of this study was to clarify this rare phenomenon using chronological observations and to suggest a feasible mechanism. RESULTS In this period, seven (3.2 %) patients displayed transient increased low-attenuation signals, circumferentially surrounding the DBS electrodes and extending into the subcortical white matter. All these patients suffered from unexpected but transient neurological symptoms during the postoperative period. The abnormal low-attenuation lesions only disappeared completely a considerable time after the clinical symptoms had disappeared, without treatment in most patients. CONCLUSIONS We report here our chronological observations of acute brain reactions after DBS procedures, which we believe are neither infectious nor vascular, but are possibly caused by the mechanical breakdown of the blood-brain barrier by microelectrode recordings or by anchored DBS electrodes. These lesions are thought to constitute a self-limiting disorder requiring no further treatment.
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15
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