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- Title
Directional deep brain stimulation guided by local field potentials in Parkinson Desease.
- Authors
Garcia, Carla Fernandez; Frech, Fernando Alonso; Barcia, Juan Antonio
- Abstract
Objective: Implementation of the new directional stimulation technique of subthalamic nucleus with segmented leads guided by local field potential recordings in order to personalize DBS parameters, optimize therapeutic window and minimizing side effects. Methods: Since March 2016 to January 2017, 8 patients have been implanted with 15 directional Vercise Cartesia leads (Boston SC). Mean age of patients were 57 years (38-70 years). Postoperatively CT scan and skull x-rays were performed to asses lead placement. Local field potentials of all contacts from each lead in bipolar montage were recorded 5 days after surgery to analyze beta band peaks and its correlation to therapeutic window effect for rigidity. Results: No postoperative complications after directional leads implantation have been observed in any patient. After analyzing data from local field potentials, contacts with higher beta peak amplitude have been selected to start stimulation parameters of the subthalamic nucleus with good clinical response, obtaining after 3 months on chronic stimulation, 75.5% improvement in UPDRS-III score and 85.5% reduction of dopaminergic medication. Directional deep brain stimulation guided by local field potentials in Parkinson Desease increased stimulation thresholds for side effects as compared to spherical stimulation. Statistically significant correlation (r= -0.31) between beta band peak amplitude and final score for rigidity was found. Conclusion: Deep brain stimulation of subthalamic nucleus with directional leads is safe and efficient. Local field potentials and beta oscillations could optimize settings parameters and alleviating programming burden as it seems to predict the optimal directional contact for improving rigidity and other motor symptoms. In advance, these neurophysiological parameters may be taken into consideration to personalize directional stimulation and can be time saving tools for programming.
- Publication
Stereotactic & Functional Neurosurgery, 2017, Vol 95, p383
- ISSN
1011-6125
- Publication type
Article