Optimal target localization for subthalamic stimulation in patients with Parkinson disease

Marie-Laure Welter (1) , Michael Schüpbach (1, 2) , Virginie Czernecki (3) , Carine Karachi (1) , Sara Fernandez-Vidal (3) , Jean-Louis Golmard (4) , Giulia Serra (5) , Soledad Navarro (6) , Arlette Welaratne (2) , Andréas Hartmann (7) , Valérie Mesnage , Fanny Pineau (2) , Philippe Cornu (2) , Bernard Pidoux (2) , Yulia Worbe (8) , Panayiotis Zikos (9, 10) , David Grabli (11) , Damien Galanaud (2, 12) , Anne-Marie Bonnet (13) , Hayat Belaid (14) , Didier Dormont (1, 12, 2) , Marie Vidailhet (1) , Luc Mallet (1) , Jean-Luc Houeto (9) , Eric Bardinet (15) , Jerome Yelnik (1) , Yves Agid (2)

1 ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
2 CHU Pitié-Salpêtrière [AP-HP]
3 CRICM - Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
4 Département de Biostatistiques [Paris]
5 Dipartimento di Scienze della Terra [Cagliari]
6 TIMR - Transformation Intégrée de la Matière Renouvelable
7 IMB - Institut de Mathématiques de Bordeaux
8 CIC AP-HP (pitie-Salpetriere)/inserm
9 Service de neurologie [Poitiers]
10 Hellenic Air Force General Hospital [Athens]
11 UPMC - Université Pierre et Marie Curie - Paris 6
12 ARAMIS - Algorithms, models and methods for images and signals of the human brain = Algorithmes, modèles et méthodes pour les images et les signaux du cerveau humain [ICM Paris]
13 CRESSON - Centre de recherche sur l'espace sonore et l'environnement urbain
14 LaPhyMNE - Laboratory of Physics of Materials and Nanomaterials Applied at Environment
15 CENIR - Plateforme de neuroimagerie CENIR = Center for NeuroImaging Research-Human MRI Neuroimaging core facility for clinical research [ICM Paris]

To further determine the causes of variable outcome from deep brain stimulation of the subthalamic nucleus (DBS-STN) in patients with Parkinson disease (PD). Data were obtained from our cohort of 309 patients with PD who underwent DBS-STN between 1996 and 2009. We examined the relationship between the 1-year motor, cognitive, and psychiatric outcomes and (1) preoperative PD clinical features, (2) MRI measures, (3) surgical procedure, and (4) locations of therapeutic contacts. Pre- and postoperative results were obtained in 262 patients with PD. The best motor outcome was obtained when stimulating contacts were located within the STN as compared with the zona incerta (64% vs 49% improvement). Eighteen percent of the patients presented a postoperative cognitive decline, which was found to be principally related to the surgical procedure. Other factors predictive of poor cognitive outcome were perioperative confusion and psychosis. Nineteen patients showed a stimulation-induced hypomania, which was related to both the form of the disease (younger age, shorter disease duration, higher levodopa responsiveness) and the ventral contact location. Postoperative depression was more frequent in patients already showing preoperative depressive and/or residual axial motor symptoms. In this homogeneous cohort of patients with PD, we showed that (1) the STN is the best target to improve motor symptoms, (2) postoperative cognitive deficit is mainly related to the surgery itself, and (3) stimulation-induced hypomania is related to a combination of both the disease characteristics and a more ventral STN location.

Domaines: Traitement du signal et de l'image [eess.SP]; Vision par ordinateur et reconnaissance de formes [cs.CV]; Imagerie médicale; Traitement des images [eess.IV]; Imagerie; Neurobiologie

Marie-Laure Welter, Michael Schüpbach, Virginie Czernecki, Carine Karachi, Sara Fernandez-Vidal, et al.. Optimal target localization for subthalamic stimulation in patients with Parkinson disease. Neurology, 2014, 82 (15), pp.1352-61. ⟨10.1212/WNL.0000000000000315⟩. ⟨hal-01251658⟩