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Precision targeting in the globus pallidus interna: insights from the multicenter, prospective, blinded VA/NINDS CSP 468 study.
D'Souza, Shawn; Seshadri, Vikram; Toms, Jamie; D'Haese, Pierre; Dawant, Benoit M; Li, Rui; Shah, Harsh P; Koch, Paul; Larson, Paul; Holloway, Kathryn L.
Afiliación
  • D'Souza S; 1School of Medicine, Virginia Commonwealth University, Richmond, Virginia.
  • Seshadri V; 1School of Medicine, Virginia Commonwealth University, Richmond, Virginia.
  • Toms J; 2Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
  • D'Haese P; 3Department of Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia.
  • Dawant BM; 4Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee.
  • Li R; 4Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee.
  • Shah HP; 5Department of Neurosurgery, Virginia Commonwealth University Health, Richmond, Virginia.
  • Koch P; 5Department of Neurosurgery, Virginia Commonwealth University Health, Richmond, Virginia.
  • Larson P; 6Department of Neurosurgery, Richmond VA Medical Center, Richmond, Virginia.
  • Holloway KL; 7Department of Neurosurgery, Southern Arizona VA Health Care System, Tucson, Arizona; and.
J Neurosurg ; : 1-11, 2024 Jul 05.
Article en En | MEDLINE | ID: mdl-38968618
ABSTRACT

OBJECTIVE:

Deep brain stimulation (DBS) targeting the globus pallidus interna (GPi) has been shown to significantly improve motor symptoms for the treatment of medication-refractory Parkinson's disease. Yet, heterogeneity in clinical outcomes persists, possibly due to suboptimal target identification within the GPi. By leveraging robust sampling of the GPi and 6-month postsurgical outcomes, this study aims to determine optimal symptom-specific GPi DBS targets.

METHODS:

In this study, the authors analyzed the anatomical lead location and 6-month postsurgical, double-blinded outcome measures of 86 patients who underwent bilateral GPi DBS. These patients were selected from the multicenter Veterans Affairs (VA)/National Institutes of Neurological Disorders and Stroke (NINDS) Cooperative Studies Program (CSP) 468 study to identify the optimal target zones ("sweet spots") for the control of overall motor (United Parkinson's Disease Rating Scale [UPDRS]-III), axial, tremor, rigidity, and bradykinesia symptoms. Lead coordinates were normalized to Montreal Neurological Institute space and the optimal target zones were identified and validated using a leave-one-patient-out approach.

RESULTS:

The authors' findings revealed statistically significant optimal target zones for UPDRS-III (R = 0.37, p < 0.001), axial (R = 0.22, p = 0.042), rigidity (R = 0.20, p = 0.021), and bradykinesia (R = 0.23, p = 0.004) symptoms. These zones were localized within the primary motor and premotor subdivisions of the GPi. Interestingly, these zones extended beyond the GPi lateral border into the GPi-globus pallidus externa (GPe) lamina and into the GPe, but they did not reach the GPi ventral border, challenging traditional surgical approaches based on pallidotomies.

CONCLUSIONS:

Drawing upon a robust dataset, this research effectively delineates specific optimal target zones for not only overall motor improvement but also symptom subscores. These insights hold the potential to enhance the precision of targeting in subsequent bilateral GPi DBS surgical procedures.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Neurosurg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Neurosurg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos