1. Deep Brain Stimulation of Caudal Zona Incerta for Parkinson's Disease : One-Year Follow-Up and Electric Field Simulations
- Author
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Karin Wårdell, Patric Blomstedt, Teresa Nordin, Lars Forsgren, Gun-Marie Hariz, Marwan Hariz, and Rasmus Stenmark Persson
- Subjects
medicine.medical_specialty ,Deep brain stimulation ,Parkinson's disease ,Neurologi ,zona incerta ,Deep Brain Stimulation ,medicine.medical_treatment ,Stimulation ,Physical medicine and rehabilitation ,Quality of life ,Rating scale ,Activities of Daily Living ,Tremor ,medicine ,Humans ,Zona Incerta ,improvement maps ,Lead (electronics) ,medicine.diagnostic_test ,business.industry ,Parkinson Disease ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,electric field simulation ,Parkinsons disease ,quality of life ,Treatment Outcome ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Neurology ,Quality of Life ,Zona incerta ,Neurology (clinical) ,business ,Follow-Up Studies - Abstract
Objective To evaluate the effects of bilateral caudal zona incerta (cZi) deep brain stimulation (DBS) for Parkinsons disease (PD) one year after surgery and to create anatomical improvement maps based on patient-specific simulation of the electric field. Materials and Methods We report the one-year results of bilateral cZi-DBS in 15 patients with PD. Patients were evaluated on/off medication and stimulation using the Unified Parkinsons Disease Rating Scale (UPDRS). Main outcomes were changes in motor symptoms (UPDRS-III) and quality of life according to Parkinsons Disease Questionnaire-39 (PDQ-39). Secondary outcomes included efficacy profile according to sub-items of UPDRS-III, and simulation of the electric field distribution around the DBS lead using the finite element method. Simulations from all patients were transformed to one common magnetic resonance imaging template space for creation of improvement maps and anatomical evaluation. Results Median UPDRS-III score off medication improved from 40 at baseline to 21 on stimulation at one-year follow-up (48%, p < 0.0005). PDQ-39 summary index did not change but the subdomains activities of daily living (ADL) and stigma improved (25%, p < 0.03 and 75%, p < 0.01), whereas communication worsened (p < 0.03). For UPDRS-III sub-items, stimulation alone reduced median tremor score by 9 points, akinesia by 3, and rigidity by 2 points at one-year follow-up in comparison to baseline (90%, 25%, and 29% respectively, p < 0.01). Visual analysis of the anatomical improvement maps based on simulated electrical fields showed no evident relation with the degree of symptom improvement and neither did statistical analysis show any significant correlation. Conclusions Bilateral cZi-DBS alleviates motor symptoms, especially tremor, and improves ADL and stigma in PD patients one year after surgery. Improvement maps may be a useful tool for visualizing the spread of the electric field. However, there was no clear-cut relation between anatomical location of the electric field and the degree of symptom relief. Funding Agencies|Umea Universitet Funding Source: Medline; Umea University Hospital [Spjutspetsmedel] Funding Source: Medline; Parkinsonfonden Funding Source: Medline; Stiftelsen for Strategisk Forskning [SSF BD150032] Funding Source: Medline; Vetenskapsradet [VR 2016-03564] Funding Source: Medline
- Published
- 2022