Aug 26, 2016 0
Interventional magnetic resonance imaging‑guided subthalamic nucleus deep brain stimulation for Parkinson’s disease: Patient selection
Surg Neurol Int 02-Aug-2016;7:
Interventional magnetic resonance imaging (iMRI) guided deep brain stimulation (DBS) for Parkinson’s disease (PD) has been shown to be effective. The costs of a dedicated intraoperative MRI may be prohibitive. The procedure can also be performed in a diagnostic scanner, however this presents challenges for utilization of time when the scanner is used both as a diagnostic and an interventional unit. This report outlines our novel methodology for patient selection for implantation in a diagnostic MR scanner, as an attempt to streamline the use of resources. A retrospective review of our outcomes is also presented.
Methods: DBS candidacy evaluation included a PD questionnaire‑39. Anxiety, age, difficulties in communication and body habitus were factors that were assessed in selecting patients for this technique. Eleven patients underwent iMRI‑guided DBS implantation in the subthalamic nucleus. All patients were implanted bilaterally. Unified PD rating scale (UPDRS) part III and L‑dopa dose were compared pre‑ and post‑stimulation. A cohort of 11 DBS patients not selected for iMRI‑guided DBS were also reported for comparison.
Results: For the iMRI‑guided patients, mean “Off” UPDRS III score was 47.6 (standard deviation [SD] 8.26). Postoperative “On” medication, “On” stimulation UPDRS III was 13.6 (SD 5.23). Mean preoperative L‑dopa dose was 1060 mg (SD 474.3) and mean postoperative L‑dopa dose was 320 (SD 298.3).
Conclusion: iMRI‑guided DBS is a newly emerging technique for surgical treatment of patients with PD. We present a novel scoring system for patient selection assessing anxiety, age, ability to communicate, and body habitus to identify patients who will be benefited most from this technique.