The Anatomical and Electrophysiological Subthalamic Nucleus Visualized by 3T MRI.

1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA 2Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA 3Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA 4Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
Neurosurgery (Impact Factor: 3.03). 08/2012; DOI: 10.1227/NEU.0b013e318270611f
Source: PubMed

ABSTRACT BACKGROUND:: Accurate localization of the subthalamic nucleus (STN) is critical to the success of deep brain stimulation (DBS) surgery for Parkinson's disease (PD). Recent developments in high field strength magnetic resonance imaging (MRI) have made it possible to visualize the STN in greater detail. However, the relationship of the MR-visualized STN to the anatomic, electrophysiological, or atlas-predicted STN remains controversial. OBJECTIVE:: To evaluate the size of the STN visualized on 3T MRI compared to anatomic measurements in cadaver studies, and to compare the predictions of 3T MRI to those of the Schaltenbrand-Wahren (SW) atlas for intraoperative STN microelectrode recordings (MER). METHODS:: We evaluated the STN by 3T MRI and intraoperative MER in twenty PD patients undergoing DBS surgery. We compared our findings to anatomic cadaver studies and to the individually scaled SW-atlas based predictions for each patient. RESULTS:: The dimensions of the 3T MR-visualized STN were very similar to those of the largest anatomic study (MRI length, width, and height: 9.8 ± 1.6 mm, 11.5 ± 1.6 mm, and 3.7 ± 0.7 mm, n = 40; cadaver length, width, and height: 9.3 ± 0.7 mm, 10.6 ± 0.9 mm, and 3.1 ± 0.5 mm, n = 100). The amount of STN traversed during intraoperative MER recording was better correlated to the 3T MR-visualized STN than the SW-atlas predicted STN (R = 0.38 versus R = -0.17). CONCLUSION:: The STN as visualized on 3T MRI corresponds well with cadaveric anatomical studies and intraoperative electrophysiology. STN visualization with 3T MRI may be an improvement over SW-atlas-based localization for STN DBS surgery in PD.

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    ABSTRACT: Background: Little is known about caregiver burden in Parkinson disease (PD) patients undergoing brain stimulation (DBS) surgery. Objective: The aim of this exploratory analysis was to evaluate whether caregiver burden improves after bilateral subthalamic nucleus (STN) DBS for PD patients and identify baseline factors associated with caregiver burden. Methods: We analyzed the motor, cognitive and behavioral data of 12 PD patients (9 men/3 women) who underwent bilateral STN DBS and whose caregivers completed the Caregiver Burden Inventory (CBI) both before and approximately 6 months after bilateral STN DBS. Results: Total CBI score did not change from baseline (17.8 ± 10.7) to the 6 month evaluation (18.7 ± 13.1), despite a 29% improvement in the MDS-UPDRS motor score (baseline 40.3 ± 12.1 compared to 28.7 ± 8.4 at 6 months, p = 0.01). Change in total CBI score did not correlate with change in MDS-UPDRS Parts I-IV or MoCA from baseline to 6 months. In post-hoc analyses looking at baseline characteristics that may correlate with caregiver burden, only the disinhibition subscore on the Frontal Systems Behavioral Scale correlated positively with the baseline total CBI score (ρ = 0.763, p = 0.004). Conclusion: Caregiver burden for PD patients (as measured by the CBI) does not change 6 months after bilateral STN DBS, despite significant improvement in motor function. Only baseline behavioral problems, specifically disinhibition, correlated with higher baseline caregiver burden. Clinicians may need to better counsel patients on expectations for caregiver burden after DBS.
    Journal of Parkinson's Disease 06/2014; 4(3). DOI:10.3233/JPD-140380 · 1.10 Impact Factor


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Jun 1, 2014