Abstract
Objectives While the efficacy of deep brain stimulation (DBS) to treat various neurological
disorders is undisputed, the surgical methods differ widely and the importance of
intraoperative microelectrode recording (MER) or macrostimulation (MS) remains controversially
debated. The objective of this study is to evaluate the impact of MER and MS on intraoperative
lead placement.
Patients and Methods We included 101 patients who underwent awake bilateral implantation of electrodes
in the subthalamic nucleus with MER and MS for Parkinson's disease from 2009 to 2017
in a retrospective observational study. We analyzed intraoperative motor outcomes
between anatomically planned stimulation point (PSP) and definite stimulation point
(DSP), lead adjustments and Unified Parkinson's Disease Rating Scale Item III (UPDRS-III),
levodopa equivalent daily dose (LEDD), and adverse events (AE) after 6 months.
Results We adjusted 65/202 leads in 47/101 patients. In adjusted leads, MS results improved
significantly when comparing PSP and DSP (p < 0.001), resulting in a number needed to treat of 9.6. After DBS, UPDRS-III and
LEDD improved significantly after 6 months in adjusted and nonadjusted patients (p < 0.001). In 87% of leads, the active contact at 6 months still covered the optimal
stimulation point during surgery. In total, 15 AE occurred.
Conclusion MER and MS have a relevant impact on the intraoperative decision of final lead placement
and prevent from a substantial rate of poor stimulation outcome. The optimal stimulation
points during surgery and chronic stimulation strongly overlap. Follow-up UPDRS-III
results, LEDD reductions, and DBS-related AE correspond well to previously published
data.
Keywords
DBS - deep brain stimulation - intraoperative neurophysiology - neuromodulation -
Parkinson's disease
