Deep brain stimulation of the subthalamic nucleus: The role of intraoperative macrostimulation relating to preoperative planings and postoperative motoric / nonmotoric outcome

Deep brain stimulation (DBS) of subthalamic nucleus (STN) is effective to treat symptoms of Parkinson’s disease. Determining the optimal target point a specification based on microelectrode recording (MER) and macrostimulation has been established. As this requires the patients to be conscious during surgery the patients can be exposed to great psychological pressure. The present doctoral thesis evaluates the dispensability of intraoperative macrostimulation as part of DBS in patients with Parkinson’s disease. The study includes 94 deep brain stimulation lead placements in 47 patients. The patients were allocated to three groups according to intraoperative test results (group I: macrostimulation confirmed both STN predetermined by MER, group II: macrostimulation confirmed one STN, group III: macrostimulation confirmed none STN). The clinical outcome of the groups was compared by using indices of Parkinson’s disease (e.g. LEDD, UPDRS III, performance index). All groups benefited from DBS. After surgical procedure the motor activity improved and the overall medication could be reduced. However, there was no significant difference between the groups. To date macrostimulation as part of DBS is not dispensable. Further studies are needed to identify preoperative predictors to determine those patients in whom intraoperative macrostimulation provides no benefit.2016-07-2