Localization of motor and verbal fluency effects in subthalamic DBS for Parkinson's disease |
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| Institution: | 1. Department of Neurosurgery, National Hospital Organization Miyagi Hospital, Miyagi, Japan;2. Department of Neurology, National Hospital Organization Miyagi Hospital, Miyagi, Japan;3. Department of Neurosurgery, Tohoku University, Graduate School of Medicine, Miyagi, Japan;1. Department of Neurology, University Hospital Cologne, Cologne, Germany;2. Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany;3. Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany;1. Department of Neurology, University Hospital Cologne, Kerpener Str. 62, D-50937 Cologne, Germany;2. Department of Psychology, University of Muenster, Fliednerstr. 21, D-48149 Münster, Germany;3. Max Planck Institute for Metabolism Research, Gleueler Str. 50, D-50931 Cologne, Germany;4. Center for Behavioral Brain Sciences, Otto-von-Guericke-University Magdeburg, Universitaetsplatz 2, 39106 Magdeburg, Germany;5. Faculty of Economics and Management, Otto-von-Guericke-University Magdeburg, Universitaetsplatz 2, 39106 Magdeburg, Germany;6. Institute of Neuroscience and Medicine (INM3), Cognitive Neuroscience, Research Centre Jülich, Leo-Brandt-Straße, D-52425 Jülich, Germany;1. Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;2. Department of Surgery, Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA;1. Department of Neurology, Baylor Scott and White Health, Temple, TX, USA;2. Parkinson''s Disease and Movement Disorders Center, Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Scottsdale, AZ, USA;3. Civin Laboratory for Neuropathology, Banner Sun Health Research Institute, Sun City, AZ, USA;4. Cleo Roberts Center, Banner Sun Health System, Sun City, AZ, USA;5. Barrow Neurological Institute, Phoenix, AZ, USA;6. Texas A&M College of Medicine, Temple, TX, USA;7. Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA |
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| Abstract: | IntroductionSubthalamic nucleus deep brain stimulation (STN DBS) improves cardinal motor symptoms of Parkinson's disease (PD) but can worsen verbal fluency (VF). An optimal site of stimulation for overall motor improvement has been previously identified using an atlas-independent, fully individualized, field-modeling approach. This study examines if cardinal motor components (bradykinesia, tremor, and rigidity) share this identified optimal improvement site and if there is co-localization with a site that worsens VF.MethodsAn atlas-independent, field-modeling approach was used to identify sites of maximal STN DBS effect on overall and cardinal motor symptoms and VF in 60 patients. Anatomic coordinates were referenced to the STN midpoint. Symptom severity was assessed with the MDS-UPDRS part III and established VF scales.ResultsSites for improved bradykinesia and rigidity co-localized with each other and the overall part III site (0.09 mm lateral, 0.93 mm posterior, 1.75 mm dorsal). The optimal site for tremor was posterior to this site (0.10 mm lateral, 1.40 mm posterior, 1.93 mm dorsal). Semantic and phonemic VF sites were indistinguishable and co-localized medial to the motor sites (0.32 mm medial, 1.18 mm posterior, 1.74 mm dorsal).ConclusionThis study identifies statistically distinct, maximally effective stimulation sites for tremor improvement, VF worsening, and overall and other cardinal motor improvements in STN DBS. Current electrode sizes and voltage settings stimulate all of these sites simultaneously. However, future targeted lead placement and focused directional stimulation may avoid VF worsening while maintaining motor improvements in STN DBS. |
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| Keywords: | Parkinson's disease Subthalamic nucleus Deep brain stimulation Verbal fluency Motor symptoms |
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