Verhagen Rens, Bour Lo J, Odekerken Vincent J J, van den Munckhof Pepijn, Schuurman P Richard, de Bie Rob M A
Department of Neurology and Clinical Neurophysiology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Department of Neurosurgery, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Brain Sci. 2019 Mar 1;9(3):51. doi: 10.3390/brainsci9030051.
Motor improvement after deep brain stimulation (DBS) in the subthalamic nucleus (STN) may vary substantially between Parkinson's disease (PD) patients. Research into the relation between improvement and active contact location requires a correction for anatomical variation. We studied the relation between active contact location relative to the neurophysiological STN, estimated by the intraoperative microelectrode recordings (MER-based STN), and contralateral motor improvement after one year. A generic STN shape was transformed to fit onto the stereotactically defined MER sites. The location of 43 electrodes (26 patients), derived from MRI-fused CT images, was expressed relative to this patient-specific MER-based STN. Using regression analyses, the relation between contact location and motor improvement was studied. The regression model that predicts motor improvement based on levodopa effect alone was significantly improved by adding the one-year active contact coordinates (R² change = 0.176, = 0.014). In the combined prediction model (adjusted R² = 0.389, < 0.001), the largest contribution was made by the mediolateral location of the active contact (standardized beta = 0.490, = 0.002). With the MER-based STN as a reference, we were able to find a significant relation between active contact location and motor improvement. MER-based STN modeling can be used to complement imaging-based STN models in the application of DBS.
帕金森病（PD）患者接受丘脑底核（STN）深部脑刺激（DBS）后的运动改善情况可能存在很大差异。对改善情况与有效触点位置之间关系的研究需要校正解剖学变异。我们研究了相对于神经生理学定义的STN（通过术中微电极记录估算，即基于MER的STN）的有效触点位置与一年后对侧运动改善之间的关系。将一个通用的STN形状进行变换，以使其与立体定向定义的MER位点相匹配。从MRI融合CT图像得出的43个电极（26例患者）的位置相对于该特定患者基于MER的STN来表示。使用回归分析研究触点位置与运动改善之间的关系。通过添加一年期有效触点坐标，仅基于左旋多巴效应预测运动改善的回归模型得到了显著改善（R²变化 = 0.176，P = 0.014）。在组合预测模型中（调整后R² = 0.389，P < 0.001），有效触点的中外侧位置贡献最大（标准化β = 0.490，P = 0.002）。以基于MER的STN作为参考，我们能够发现有效触点位置与运动改善之间存在显著关系。基于MER的STN建模可用于在DBS应用中补充基于成像的STN模型。
