Most effective stimulation site in subthalamic deep brain stimulation for Parkinson’s disease
Herzog J, Fietzek U, Hamel W, Morsnowski A, Steigerwald F, Schrader B, Weinert D, Pfister G, Muller D, Mehdorn HM, Deuschl G, Volkmann J Most effective stimulation site in subthalamic deep brain stimulation for Parkinson’s disease Movement Disorders, 2004 Sep;19(9):1050-4
These authors initially review the literature highlighting the efficacy of DBS-STN on rigidity, tremor, and bradykinesia in patients with PD. They also discuss the different areas in the STN that when stimulated may improve the symptoms of PD. They cited studies that suggest specifically stimulating the subthamalmic white matter (deep area of the brain around the thalamus) may account for these benefits and wanted to evaluate different stimulation areas for the best efficacy in improving symptoms. They looked at 14 patients that underwent DBS-STN and had positive results that lasted 4-10 months. They found that patients with contact placement in the dorsolateral (to the back and side) border of the STN or within the STN was most efficacious for improvement with motor symptoms. They discuss the limitations of their study, including possible imprecise localization due to not using postoperative MRI for various discussed reasons. They also discussed other literature that found contact location in different areas in the STN also produce improvement in symptoms of PD. Interestingly, they did not find that contacts located only in the subthalamic fibre tract did not result in the best improvement in PD symptoms. Instead they suggest that coverage in the dorsal subthalamic nucleus should be covered by contacts as it has shown the most improvements for patients across multiple studies.