Comparing differences in clinical outcomes between microelectrode & image-led lead placement verification in Parkinson's Disease patients treated with deep brain stimulation of the subthalamic nucleus – a systematic review.
| Abstract: |
- Objective: To review the published literature in order to compare the published results of the clinical outcomes of the two main methods of deep-brain stimulation (DBS) lead placement verification within the subthalamic nucleus (STN) – that using microelectrode recording (MER) versus a complete stereotactic approach without the need for electrophysiological recording.
- Methods: A search of EMBASE and MEDLINE databases using the key words subthalamic, Deep brain stimulation, Parkinson’s Disease and UPDRS. This yielded 681 papers published between January 2000 and September 2013.
- Results: 31 papers were included in the final data analysis – 27 in the MER guided verification group and 4 in the stereotactic guided verification group. Statistically significant improvement in UPDRS III from baseline to 3, 6 and 12 months post-surgery was present in both groups. The baseline UPDRS III off medication was very similar (median of 45.13 for MER group versus 46.79 for image-guided group) with no statistically significant difference between groups, p=0.38. A statistically significant difference in UPDRS III improvement from baseline off medication to post-operative on stimulation off medication was present in the Image-guided lead verification arm (Mean=25.3, SD=8.8, 54% improvement) when compared to the MER-guided lead verification at 12 months (Mean=22.3, SD=8.9, 49% score), a mean difference of 2.9 in UPDRS III score between groups with a 95% CI of 0.8-5.1 which was statistically significant (p=0.002). The improvement in median LED scores between groups from baseline to 12 months post-operatively (MER -511.95, Image-led verification- 584.03), was not significantly different, p = 0.145.
- Conclusion: Although DBS has traditionally been performed using MER for lead placement verification as opposed to intraoperative stereotactic imaging, review of the published literature demonstrates that there is no inferiority in clinical outcome of the latter as compared to the former technique. Further evaluation and research through formal clinical trials comparing the two methods would be suggested.
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| Imaging keywords: |
- Magnetic resonance imaging (MRI)
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| Application / disease keywords: |
- Deep-brain stimulation (DBS)
- Microelectrode recording (MER)
- Parkinson’s disease
- Subthalamic nucleus (STN)
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