Short communicationCorrespondence of optimal stimulation and beta power varies regionally in STN DBS for Parkinson disease
Introduction
Deep brain stimulation (DBS) in the region of the subthalamic nucleus (STN) alleviates the motor symptoms of medically intractable Parkinson disease (PD). However, the optimal locus of STN DBS remains imprecisely defined. Anatomical studies have identified optimal stimulation loci within the STN, at the dorsal border of the STN (DB-STN), and in the zona incerta above the STN (for review, see Caire et al., 2013 [1]). Other studies have defined the optimal locus of STN DBS electrophysiologically, corresponding to the location of peak beta power of the local field potential (LFP, 13–30Hz) [[2], [3], [4]]. However, peak beta power has been localized not only to the dorsal STN, which corresponds to a proposed region of optimal stimulation [4,5], but also more centrally within the STN, ventral to the expected region of optimal stimulation [6] (for technical discussion, see Marmor et al., 2017 [7]). The objective of this study was to better understand these seemingly conflicting results by measuring the correspondence of maximal beta power and optimal STN DBS in a precise, atlas-independent and fully individualized manner, using high-resolution intraoperative electrophysiology, MRI, and CT imaging. Our hypothesis is that regional variation in the relative lead trajectory locations of the DBS active contact and beta power may explain these conflicting findings.
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Study participants
We prospectively studied 13 consecutive subjects with advanced idiopathic PD, undergoing STN DBS surgery at our institution (9 men, 4 women; age, 66 ± 6 years; range, 52–73 years; for selection criteria, see Ref. [8,9]). The study was performed with MEDIRB approval. Each subject provided individual written informed consent.
Target selection and surgical procedure
All subjects underwent validated 3T MR imaging, allowing direct visualization of the STN (MR-visualized STN) [8]. During surgery, an electrophysiologist performed
Results
A total of 26 STN-targeted MER trajectories from 13 PD subjects were initially available for analysis. In 4 of 26 trajectories, the DBS lead was repositioned after microelectrode recording. In an additional 3 of 26 trajectories, large intermittent low-frequency noise artifacts obscured LFP recording. The remaining 19 of 26 trajectories were analyzed for this study.
We observed excellent correspondence between the electrophysiological STN on MER and the MR-visualized STN. The trajectory span of
Discussion
In this study, we quantitatively examine the spatial relationships among the optimal (active) contact, peak beta power along the lead trajectory, and the dorsal border of STN (DB-STN) for patients with PD treated with STN DBS. Unlike previous atlas-based studies, these spatial relationships are defined in an atlas-independent, fully individualized manner, using direct imaging of the STN and DBS contacts and high-resolution intraoperative MER. Our findings, consistent with previous studies,
Authorship
All authors contributed to (1) the conception and design of the study, acquisition of data, and analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the submitted manuscript. The authors agree to be accountable for all aspects of the work.
Funding sources
This research was funded by the Taubman Medical Research Institute and the Wallace H. Coulter Foundation. Sponsors had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Declaration of competing interest
None.
Acknowledgements
We thank Sunjay Dodani for contributions to an earlier version of the manuscript. We thank J. Wayne Aldridge, Kelly J. Lupo, and the members of the STIM program for clinical and technical assistance.
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