Skip to main content

Advertisement

SpringerLink
Log in

A systematic review of studies on anatomical position of electrode contacts used for chronic subthalamic stimulation in Parkinson’s disease

  • Review Article - Functional
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The dorso-lateral part of the subthalamic nucleus (STN) is considered as the usual target of deep brain stimulation for Parkinson’s disease. Nevertheless, the exact anatomical location of the electrode contacts used for chronic stimulation is still a matter of debate. The aim of this study was to perform a systematic review of the existing literature on this issue.

Method

We searched for studies on the anatomical location of active contacts published until December 2012.

Results

We identified 13 studies, published between 2002 and 2010, including 260 patients and 466 electrodes. One hundred and sixty-four active contacts (35 %) were identified within the STN, 117 (25 %) at the interface between STN and the surrounding structures, 184 (40 %) above the STN and one within the substantia nigra. We observed great discrepancies between the different series. The contra-lateral improvement was between 37 and 78.5 % for contacts located within the STN, between 48.6 and 73 % outside the STN, between 65.3 and 66 % at the interface. The authors report no clear correlation between anatomical location and stimulation parameters.

Conclusions

Post-operative analysis of the anatomical location of active contacts is difficult, and all the methods used are debatable. The relationship between the anatomical location of active contacts and the clinical effectiveness of stimulation is unclear. It would be necessary to take into account the volume of the electrode contacts and the diffusion of the stimulation. We can nevertheless assume that the interface between dorso-lateral STN, zona incerta and Forel’s fields could be directly involved in the effects of stimulation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bardinet E, Bhattacharjee M, Dormont D, Pidoux B, Malandain G, Schüpbach M, Ayache N, Cornu P, Agid Y, Yelnik J (2009) A 3D histological atlas of the human basal ganglia. II. Atlas deformation strategy and evaluation in DBS for Parkinson disease. J Neurosurg 108:208–219

    Google Scholar 

  2. Blomstedt P, Fytagoridis A, Aström M, Linder J, Forsgren L, Hariz MI (2012) Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. Parkinsonism Relat Disord 18(10):1062–1066

    Article  Google Scholar 

  3. Butson CR, Cooper SE, Henderson JM, McIntyre CC (2007) Patient-specific analysis of the volume of tissue activated during deep brain stimulation. NeuroImage 34(2):661–670

    Article  Google Scholar 

  4. Butson CR, Cooper SE, Henderson JM, Wolgamuth B, McIntyre CC (2011) Probabilistic analysis of activation volumes generated during deep brain stimulation. NeuroImage 54(3):2096–2104

    Article  Google Scholar 

  5. Caire F, Derost P, Coste J, Bonny JM, Durif F, Frenoux E, Villeger A, Lemaire JJ (2006) Stimulation sous-thalamique dans la maladie de Parkinson sévère: étude de la localisation des contacts effectifs. Neurochirurgie 52(1):15–25

    Article  CAS  Google Scholar 

  6. Cintas P, Simonetta-Moreau M, Ory F, Brefel-Courbon C, Fabre N, Chaynes P, Sabatier J, Sol JC, Rascol O, Berry I (2003) Deep brain stimulation for Parkinson’s disease: correlation between intraoperative subthalamic nucleus neurophysiology and most effective contacts. Stereotact Funct Neurosurg 80(1–4):108–113

    Article  CAS  Google Scholar 

  7. Garcia L, Audin J, D'Alessandro G, Bioulac B, Hammond C (2003) Dual effect of high-frequency stimulation on subthalamic neuron activity. J Neurosci 23(25):8743–8751

    CAS  Google Scholar 

  8. Godinho F, Thobois S, Magnin M, Guenot M, Polo G, Benatru I, Xie J, Salvetti A, Garcia-Larrea L, Broussolle E, Mertens P (2006) Subthalamic nucleus stimulation in Parkinson’s disease. Anatomical and electrophysiological localization of active contacts. J Neurol 253:1347–1355

    Article  CAS  Google Scholar 

  9. Guehl D, Vital A, Cuny E, Spampinato U, Rougier A, Bioulac B, Burbaud P (2008) Postmortem proof of effectiveness of zona incerta stimulation in Parkinsons disease. Neurology 70(16 Pt 2):1489–1490

    Article  CAS  Google Scholar 

  10. Guo S, Zhuang P, Hallett M, Zheng Z, Zhang Y, Li J, Li Y (2013) Subthalamic deep brain stimulation for Parkinson’s disease: correlation between locations of oscillatory activity and optimal site of stimulation. Parkinsonism Relat Disord 19(1):109–114

    Article  Google Scholar 

  11. Hamel W, Fietzek U, Morsnowski A, Schrader B, Herzog J, Weinert D, Pfister G, Müller D, Volkmann J, Deuschl G, Mehdorn HM (2003) Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: evaluation of active electrode contacts. J Neurol Neurosurg Psychiatry 74:1036–1046

    Article  CAS  Google Scholar 

  12. Heise CE, Mitrofanis J (2004) Evidence for glutamatergic projection from the zona incerta to the basal ganglia of rats. J Comp Neurol 468(4):482–495

    Article  CAS  Google Scholar 

  13. Hemm S, Caire F, Coste J, Vassal F, Nuti C, Derost P, Ouchchane L, Sarry L, Durif F, Lemaire JJ (2008) Postoperative control in deep brain stimulation of the subthalamic region: the contact membership concept. IJCARS 3(1–2):69–77

    Google Scholar 

  14. Henderson JM, Pell M, O’Sullivan DJ, McCusker EA, Fung VS, Hedges P, Halliday GM (2002) Postmortem analysis of bilateral subthalamic electrode implants in Parkinson’s disease. Mov Disord 17(1):133–137

    Article  Google Scholar 

  15. Herzog J, Fietzek U, Hamel W, Morsnowski A, Steigerwald F, Schrader B, Weinert D, Pfister G, Müller D, Mehdorn HM, Deuschl G, Volkmann J (2004) Most effective stimulation site in subthalamic deep brain stimulation for Parkinson’s disease. Mov Disord 19(9):1050–1054

    Article  Google Scholar 

  16. Johnsen EL, Sunde N, Mogensen PH, Østergaard K (2010) MRI verified STN stimulation site—gait improvement and clinical outcome. Eur J Neurol 17:746–753

    Article  CAS  Google Scholar 

  17. Lanotte MM, Rizzone M, Bergamasco B, Faccani G, Melcarne A, Lopiano L (2002) Deep brain stimulation of the subthalamic nucleus: anatomical, neurophysiological, and outcome correlations with the effects of stimulation. J Neurol Neurosurg Psychiatry 72:53–58

    Article  CAS  Google Scholar 

  18. Magnotta VA, Gold S, Andreasen NC, Ehrhardt JC, Yuh WT (2000) Visualization of subthalamic nuclei with cortex attenuated inversion recovery MR imaging. NeuroImage 11(4):341–346

    Article  CAS  Google Scholar 

  19. Maks CB, Butson CR, Walter BL, Vitek JL, McIntyre CC (2009) Deep brain stimulation activation volumes and their association with neurophysiological mapping and therapeutic outcomes. J Neurol Neurosurg Psychiatry 80(6):659–666

    Article  CAS  Google Scholar 

  20. McClelland S, Vonsattel JP, Garcia RE, Amaya MD, Winfield LM, Pullman SL, Yu Q, Fahn S, Ford B, Goodman RR (2007) Relationship of clinical efficacy of postmortem-determined anatomic subthalamic stimulation in Parkinson syndrome. Clin Neuropathol 26(6):267–275

    Google Scholar 

  21. Morel A, Magnin M, Jeanmonod D (1997) Multiarchitectonic and stereotactic atlas of the human thalamus. J Comp Neurol 387(4):588–630

    Article  CAS  Google Scholar 

  22. Paek SH, Han JH, Lee JY, Kim C, Jeon BS, Kim DG (2008) Electrode position determined by fused images of preoperative and postoperative magnetic resonance imaging and surgical outcome after subthalamic nucleus deep brain stimulation. Neurosurgery 63(5):925–936

    Article  Google Scholar 

  23. Paek SH, Lee JY, Kim HJ, Kang D, Lim YH, Kim MR, Kim C, Jeon BS, Kim DG (2011) Electrode position and the clinical outcome after bilateral subthalamic nucleus stimulation. J Korean Med Sci 26(10):1344–1355

    Article  CAS  Google Scholar 

  24. Plaha P, Ben-Shlomo Y, Patel NK, Gill SS (2006) Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral parkinsonism. Brain 129(Pt 7):1732–1747

    Article  Google Scholar 

  25. Pollo C, Vongerhoets F, Pralong E, Ghika J, Maeder P, Meuli R, Thiran JP, Villemure JG (2007) Localization of electrodes in the subthalamic nucleus on magnetic resonance imaging. J Neurosurg 106:36–44

    Article  Google Scholar 

  26. Saint-Cyr JA, Hoque T, Pereira LC, Dostrovsky JO, Hutchinson WD, Mikulis D, Abosch A, Sime E, Lang AE, Lozano AM (2002) Localization of clinically effective stimulating electrodes in the human subthalamic nucleus on magnetic resonance imaging. J Neurosurg 97:1152–1166

    Article  Google Scholar 

  27. Schaltenbrand G, Wahren P (eds) (1977) Atlas for stereotaxy of the human brain. Thieme, Stuttgart

    Google Scholar 

  28. Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosley A, Marks WJ Jr (2002) Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging–verified lead locations. J Neurosurg 97:370–387

    Article  Google Scholar 

  29. Sudhyadhom A, Haq IU, Foote KD, Okun MS, Bova FJ (2009) A high resolution and high contrast MRI for differentiation of subcortical structures for DBS targeting: the Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR). NeuroImage 47(Suppl 2):T44–T52

    Article  Google Scholar 

  30. Sun DA, Yu H, Spooner J, Tatsas AD, Davis T, Abel TW, Kao C, Konrad PE (2008) Postmortem analysis following 71 months of deep brain stimulation of the subthalamic nucleus for Parkinson disease. J Neurosurg 109(2):325–329

    Article  Google Scholar 

  31. Vergani F, Landi A, Antonini A, Parolin M, Cilia R, Grimaldi M, Ferrarese C, Gaini SM, Sganzerla EP (2007) Anatomical identification of active contacts in subthalamic deep brain stimulation. Surg Neurol 67:140–147

    Article  Google Scholar 

  32. Voges J, Volkmann J, Allert N, Lehrke R, Koulousakis A, Freund HJ, Sturm V (2002) Bilateral high-frequency stimulation in the subthalamic nucleus for the treatment of Parkinson disease: correlation of therapeutic effect with anatomical electrode position. J Neurosurg 96:269–279

    Article  Google Scholar 

  33. Volz S, Hattingen E, Preibisch C, Gasser T, Deichmann R (2009) Reduction of susceptibility-induced signal losses in multi-gradient-echo images: application to improved visualization of the subthalamic nucleus. NeuroImage 45(4):1135–1143

    Article  Google Scholar 

  34. Wodarg F, Herzog J, Reese R, Falk D, Pinsker MO, Steigerwald F, Jansen O, Deuschl G, Mehdorn HM, Volkmann J (2012) Stimulation site within the MRI-defined STN predicts postoperative motor outcome. Mov Disord 27(7):874–879

    Article  Google Scholar 

  35. Yelnik J, Damier P, Demeret S, Gervais D, Bardinet E, Bejjani BP, François C, Houeto JL, Arnule I, Dormont D, Galanaud D, Pidoux B, Cornu P, Agid Y (2003) Localization of stimulating electrodes in patients with Parkinson disease by using a three-dimensional atlas–magnetic resonance imaging coregistration method. J Neurosurg 99:89–99

    Article  Google Scholar 

  36. Yelnik J, Bardinet E, Dormont D, Malandain G, Ourselin S, Tandé D, Karachi K, Ayache N, Cornu P, Agid Y (2007) A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data. NeuroImage 34(2):618–638

    Article  Google Scholar 

  37. Zheng Z, Zhang YQ, Li JY, Zhang XH, Zhuang P, Li YJ (2009) Subthalamic deep brain stimulation for Parkinson’s disease: correlation of active contacts and electrophysiologically mapped subthalamic nucleus. Chin J Med 122(20):2419–2422

    Google Scholar 

  38. Zonenshayn M, Sterio D, Kelly PJ, Rezai AR, Beric A (2004) Location of the active contact within the subthalamic nucleus in the treatment of idiopathic Parkinson’s disease. Surg Neurol 62:216–226

    Article  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Service de Neurochirurgie, CHU de Limoges, 87000, Limoges, France

    François Caire & Danièle Ranoux

  2. Unité d’électrophysiologie et Exploration Fonctionnelle du Système Nerveux, CHU de Bordeaux, 33000, Bordeaux, France

    Dominique Guehl & Pierre Burbaud

  3. Service de Neurochirurgie A, CHU de Bordeaux, 33000, Bordeaux, France

    Emmanuel Cuny

  4. Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France

    François Caire, Dominique Guehl, Pierre Burbaud & Emmanuel Cuny

  5. Service de Neurochirurgie, CHU de Limoges, 2 avenue Martin Luther King, 87042, Limoges, France

    François Caire

Authors
  1. François Caire
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Danièle Ranoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dominique Guehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pierre Burbaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emmanuel Cuny
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to François Caire.

Additional information

Comment

This is a convenient review addressing two relevant questions: 1. Which is the proper target for DBS in PD and 2. If there is a need for intraoperative microelectrode recording and clinical testing versus the possibility of using radiological targeting only. The authors conclude that the proper subthalamic area target, instead of being exclusively at the dorsolateral part of the subthalamic nucleus, may lay in interface between the dorso-lateral subthalamic nucleus, the zona incerta and Forel's fields. This may stress the need for intraoperative electrophysiologic and clinical testing to find the individual's most effective stimulation site, while targeting with only radiological means could lead to less than effective electrode placements.

The main weakness of this study is one already recognized by the authors: how the exact position of the contacts is determined postoperatively. However, as the authors recognize, this may lead to the development of prospective clinical trials to further clarify this issue.

Juan A Barcia M.D.,Ph.D,

Madrid, Spain

Rights and permissions

Reprints and permissions

About this article

Cite this article

Caire, F., Ranoux, D., Guehl, D. et al. A systematic review of studies on anatomical position of electrode contacts used for chronic subthalamic stimulation in Parkinson’s disease. Acta Neurochir 155, 1647–1654 (2013). https://doi.org/10.1007/s00701-013-1782-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1782-1

Keywords

Search

Navigation