Session Information
Date: Monday, June 20, 2016
Session Title: Surgical therapy: Parkinson's disease
Session Time: 12:30pm-2:00pm
Location: Exhibit Hall located in Hall B, Level 2
Objective: To evaluate whether stimulation-induced therapeutic and side effects of the permanent electrode are predictable by intraoperative test stimulation with clinical examination.
Background: Intraoperative test stimulation is established to optimize target localization in STN DBS, but requires a time-consuming awake surgery in off-medication state. The effects of intra- and postoperative stimulation vary heavily in some patients.
Methods: 59 PD-patients receiving bilateral STN-DBS were clinically examined with stepwise increasing monopolar stimulation during surgery and DBS programming at matched stimulation depths. Thresholds of therapeutic effects on rigidity, tremor, akinesia as well as threshold and categories of side effects as dysarthria, paraesthesia, oculomotor dysfunction, autonomic and capsular effects were obtained retrospectively from standardized examination protocols.
Results: The central trajectory was chosen in 48.3% for the implantation of the permanent electrode. Postoperative stimulation via the permanent electrode caused any side effect at a significantly lower threshold than predicted during intraoperative test stimulation (p<0,001), whereas sufficient therapeutic effects were achieved at significantly higher thresholds. The category of side effects differed frequently, only 33.5% of intraoperative side effects were reproducible in their category with permanent stimulation.
Conclusions: Stimulation-induced therapeutic and side effects do not seem to be reliably predictable by intraoperative test stimulation concerning their thresholds and even their categories. Furthermore intraoperative testing may lead to an overestimation of the therapeutic window. Thereby our data may stimulate the controversy about awake DBS surgery.
Part of this data had been presented at XXI World Congress on Parkinson’s disease and Related Disorders, 6-9 December 2015 in Milan.
To cite this abstract in AMA style:
J. Blume, J. Schlaier, F. Zeman, E. Rothenfußer, A. Brawanski, U. Bogdahn, M. Lange. Can intraoperative clinical testing really predict the effects of deep brain stimulation in the subthalamic nucleus? [abstract]. Mov Disord. 2016; 31 (suppl 2). https://www.mdsabstracts.org/abstract/can-intraoperative-clinical-testing-really-predict-the-effects-of-deep-brain-stimulation-in-the-subthalamic-nucleus/. Accessed May 18, 2025.« Back to 2016 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/can-intraoperative-clinical-testing-really-predict-the-effects-of-deep-brain-stimulation-in-the-subthalamic-nucleus/