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Acta Neurochirurgica
Published in: Acta Neurochirurgica 5/2020

Open Access 01-05-2020 | Deep Brain Stimulation | Original Article - Functional Neurosurgery - Movement disorders

A comparison of indirect and direct targeted STN DBS in the treatment of Parkinson’s disease—surgical method and clinical outcome over 15-year timespan

Authors: Maija Johanna Lahtinen, Tarja Helena Haapaniemi, Mikko Tapio Kauppinen, Niina Salokorpi, Esa Raimo Heikkinen, Jani Petteri Katisko

Published in: Acta Neurochirurgica | Issue 5/2020

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Abstract

Background

Deep brain stimulation (DBS) in the subthalamic nucleus (STN) is used in advanced Parkinson’s disease (PD) for reducing motor fluctuations and the side effects of antiparkinsonian medication (APM). The development of neuroimaging has enabled the direct targeting of the STN. The aim of this study is to evaluate the outcome in patients with PD using STN DBS when changing from atlas-based indirect targeting method (iTM) to direct MRI-based targeting (dTM) assuming dTM is superior.

Methods

Twenty-five consecutive PD patients underwent dTM STN DBS surgery from 2014 to 2017 with follow-up for 1 year. The neuroimaging, surgical method, outcome in Unified Parkinson’s Disease Rating Scale (UPDRS) scores, and reduction of APM are described and compared with the results of an earlier iTM STN DBS study.

Results

Twelve months after a dTM STN DBS, significant improvement (p < 0.001) was seen in six out of seven parameters of UPDRS when patients had medication (medON) and stimulation (stimON). The activities of daily living (UPDRSII) and motor scores (UPDRSIII) improved by 41% and 62%, respectively. Dyskinesias and fluctuations were both reduced by 81%. In dTM STN DBS group, the levodopa equivalent dose (LED) and the total daily levodopa equivalent dose (LEDD) were significantly decreased by 62% and 55%, respectively, compared with the baseline (p < 0.001). Five patients (20%) were without levodopa medication 12 months after the operation.

Conclusions

The development of surgical technique based on advanced neuroimaging has improved the outcome of PD STN DBS.
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Metadata
Title
A comparison of indirect and direct targeted STN DBS in the treatment of Parkinson’s disease—surgical method and clinical outcome over 15-year timespan
Authors
Maija Johanna Lahtinen
Tarja Helena Haapaniemi
Mikko Tapio Kauppinen
Niina Salokorpi
Esa Raimo Heikkinen
Jani Petteri Katisko
Publication date
01-05-2020
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 5/2020
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-020-04269-x

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