Lead location as a determinant of motor benefit in subthalamic nucleus deep brain stimulation for Parkinson’s disease

Jerrold L. Vitek, Rémi Patriat, Lisa Ingham, Martin M. Reich, Jens Volkmann, Noam Harel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is regarded as an effective treatment for patients with advanced Parkinson’s disease (PD). Clinical benefit, however, varies significantly across patients. Lead location has been hypothesized to play a critical role in determining motor outcome and may account for much of the observed variability reported among patients. Objective: To retrospectively evaluate the relationship of lead location to motor outcomes in patients who had been implanted previously at another center by employing a novel visualization technology that more precisely determines the location of the DBS lead and its contacts with respect to each patient’s individually defined STN. Methods: Anatomical models were generated using novel imaging in 40 PD patients who had undergone bilateral STN DBS (80 electrodes) at another center. Patient-specific models of each STN were evaluated to determine DBS electrode contact locations with respect to anterior to posterior and medial to lateral regions of the individualized STNs and compared to the change in the contralateral hemi-body Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III) motor score. Results: The greatest improvement in hemi-body motor function was found when active contacts were located within the posterolateral portion of the STN (71.5%). Motor benefit was 52 and 36% for central and anterior segments, respectively. Active contacts within the posterolateral portion also demonstrated the greatest reduction in levodopa dosage (77%). Conclusion: The degree of motor benefit was dependent on the location of the stimulating contact within the STN. Although other factors may play a role, we provide further evidence in support of the hypothesis that lead location is a critical factor in determining clinical outcomes in STN DBS.

Original languageEnglish (US)
Article number1010253
JournalFrontiers in Neuroscience
Volume16
DOIs
StatePublished - Oct 4 2022

Bibliographical note

Funding Information:
The original study in which the subjects were enrolled was sponsored by the Interdisziplinäres Zentrum für Klinische Forschung (IZKF) of the University Hospital Wüerzburg (Grant Number Z-2/64). MR and JV were supported by the German Research Foundation (DFG, Project-ID424778381, TRR 295). JLV, RP, and NH were supported by the NIH Grant Numbers P50 NS123109, R01 NS081118, and R01 NS113746.

Publisher Copyright:
Copyright © 2022 Vitek, Patriat, Ingham, Reich, Volkmann and Harel.

Keywords

  • brain imaging
  • deep brain stimulation
  • lead localization
  • Parkinson’s disease
  • subthalamic nucleus

PubMed: MeSH publication types

  • Journal Article

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