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Hiroyuki Tsubono 1 Article
Pilot Study for Considering Subthalamic Nucleus Anatomy during Stimulation Using Directional Leads
Takashi Asahi, Kiyonobu Ikeda, Jiro Yamamoto, Hiroyuki Tsubono, Shuji Sato
J Mov Disord. 2019;12(2):97-102.   Published online April 5, 2019
DOI: https://doi.org/10.14802/jmd.18054
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  • 6 Citations
AbstractAbstract PDF
Objective
Directional leads are used for deep brain stimulation (DBS). Two of the four contacts of the leads are divided into three parts, enabling controlled stimulation in a circumferential direction. The direction of adverse effects evoked by DBS in the subthalamic nucleus (STN) and stimulation strategies using directional leads were evaluated. Methods Directional leads were implanted into the bilateral STN of six parkinsonian patients (1 man, 5 women; mean age 66.2 years). The contact centers were located within the upper border of the STN, and the locations were identified electrically using microrecordings. Adverse effects were evaluated with electrical stimulation (30 μs, 130 Hz, limit 11 mA) using the directional part of each lead after surgery, and the final stimulation direction was investigated. Unified Parkinson’s disease rating scale (UPDRS) scores were evaluated before and after DBS. Results Fifty-six motor and four sensory symptoms were evoked by stimulation; no adverse effect was evoked in 14 contacts. Motor and sensory symptoms were evoked by stimulation in the anterolateral direction and medial to posterolateral direction, respectively. Stimulation in the posteromedial direction produced adverse effects less frequently. The most frequently used contacts were located above the STN (63%), followed by the upper part of the STN (32%). The mean UPDRS part III and dyskinesia scores decreased after DBS from 30.2 ± 11.7 to 7.2 ± 2.9 and 3.3 ± 2.4 to 0.5 ± 0.8, respectively. Conclusion The incidence of adverse effects was low for the posteromedial stimulation of the STN. Placing the directional part of the lead above the STN may facilitate the control of dyskinesia.

Citations

Citations to this article as recorded by  
  • Surgical Strategy for Directional Deep Brain Stimulation
    Hiroshi MASUDA, Hiroshi SHIROZU, Yosuke ITO, Masafumi FUKUDA, Yukihiko FUJII
    Neurologia medico-chirurgica.2022; 62(1): 1.     CrossRef
  • Do directional deep brain stimulation leads rotate after implantation?
    Marie T. Krüger, Yashar Naseri, Fabian Cavalloni, Peter C. Reinacher, Georg Kägi, Johannes Weber, Deborah Brogle, Oliver Bozinov, Stefan Hägele-Link, Florian Brugger
    Acta Neurochirurgica.2021; 163(1): 197.     CrossRef
  • Stimulation-Induced Dyskinesia After Subthalamic Nucleus Deep Brain Stimulation in Patients With Meige Syndrome
    Ning Wang, Kailiang Wang, Qiao Wang, Shiying Fan, Zonghui Fu, Feng Zhang, Lin Wang, Fangang Meng
    Neuromodulation: Technology at the Neural Interface.2021; 24(2): 286.     CrossRef
  • Deep brain stimulation programming strategies: segmented leads, independent current sources, and future technology
    Bhavana Patel, Shannon Chiu, Joshua K. Wong, Addie Patterson, Wissam Deeb, Matthew Burns, Pamela Zeilman, Aparna Wagle-Shukla, Leonardo Almeida, Michael S. Okun, Adolfo Ramirez-Zamora
    Expert Review of Medical Devices.2021; 18(9): 875.     CrossRef
  • Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes
    Christian Iorio-Morin, Anton Fomenko, Suneil K. Kalia
    Brain Sciences.2020; 10(12): 925.     CrossRef
  • Dyskinesia‐inducing lead contacts optimize outcome of subthalamic stimulation in Parkinson's disease
    Walid Bouthour, Matthieu Béreau, Astrid Kibleur, André Zacharia, Emilie Tomkova Chaoui, Vanessa Fleury, Damien Benis, Shahan Momjian, Julien Bally, Christian Lüscher, Paul Krack, Pierre R. Burkhard
    Movement Disorders.2019; 34(11): 1728.     CrossRef

JMD : Journal of Movement Disorders