Prospective analysis of gross and fine motor manifestations following STN- DBS and their correlation with electrode position.

Abstract

BACKGROUND\nDeep brain stimulation (DBS) has been proven to be a safe, reversible, cost effective procedure for treatment of Parkinson s disease. Final electrode position remains a significant factor determining the outcomes of Subthalamic nucleus deep brain stimulation (STN-DBS). This study aims to analyze the final lead position in three-dimensional plane and its effect on gross and fine motor outcomes in cases of advanced Parkinson s disease operated for STN-DBS.\n\n\nMETHODS\nPatients who underwent bilateral STN DBS were prospectively followed for improvement in gross motor outcomes at 6 months. Improvement in dysgraphia was analyzed by Fahn-Tolosa-Marin Tremor Rating Scale Part B score. Postoperative outcomes were correlated with final electrode position.\n\n\nRESULTS\nA total of 64 Patients (128 leads) were analyzed. Patients who were less than 65 years of age at time of surgery had more significant reduction in UPDRS III(p = 0.02). Cases with deviation of left x less than 3 mm had significant reduction in UPDRS III (p = 0.05) and speech sub-scores (p = 0.05). Deviation less than 2 mm in left x was associated with reduction in gait sub-scores (p = 0.04). Optimal placement of right y electrode was associated with reduction in UPDRS III (p = 0.02). Significant reduction in Fahn-Tolosa-Marin Tremor Rating Scale Part B score was noted after DBS(p =0.001).\n\n\nCONCLUSIONS\nSubthalamic nucleus deep brain stimulation thus results in significantly improved functional outcome particularly in patients with age less than 65 years. Accurate final electrode position is associated with maximum clinical benefit and improvement in dysgraphia.