Objective: To evaluate influence of microelectrode recording (MER) on clinical outcome of subthalamic deep brain stimulation (DBS STN) in patients with Parkinson’s disease (PD).

Background: For optimal outcome of DBS STN in PD, precise stereotactic placement of intracerebral electrodes is crucial. Intraoperative MER allows to register specific patterns of basal ganglia neuronal activity and to determine electrophysiological boundaries of STN. There is still no agreement between leading centers weather MER is obligatory for DBS-surgery since its impact on long-term results is not clear.

Methods: We included 70 patients with advanced PD (age at surgery 55.1±9.2years, disease duration 12.3±4.0years, Hoehn&Yahr stage 3-4). 33 patients underwent stereotactic implantation of STN-electrodes without MER (MER– group). In 37 patients, MER was additionally performed (MER+). Groups were comparable in basic demographic and clinical parameters. Neurological evaluation and postoperative management were standardized. In each patient, implantation strategy and complications/side effects were analyzed. Clinical outcome was assessed using UPDRS, PDQ-39, Schwab&England, levodopa equivalent daily dose scoring, and neuropsychological tests from 6th month through 3rd year postoperatively.

Results: In MER– group, MRI-calculated trajectory was used for implantation in 94% of electrodes; depth adjustments performed in 9%. In 4 patients, postoperative electrode correction was needed. In MER+ group, image-based trajectory corresponded to optimal electrophysiological track only in 63.5%. Main final correction was performed in medial direction avoiding proximity to internal capsule. Depth adjustments according to neurophysiological findings were performed in 73%. Following DBS STN, both groups experienced amelioration of PD-symptoms and improvement in life quality. In off-medication state at 3-year follow-up, UPDRS-3 remained improved by 49.5% in MER– vs 61.9% in MER+ group (p˂0.01). In MER+ group, motor on-state was better (p<0.05), and occurrence of stimulation-induced dysarthria was lower. LEDD remained reduced by 57.4% in MER+ vs 36.4% in MER– (p˂0.01). Improvement in off-state UPDRS-2 was significantly better in MER+ patients till the 2nd year.

Conclusions: Thus, MER serves choosing optimal electrode position in subthalamic surgery. Moreover, it might optimize overall motor and functional outcome of DBS STN in advanced PD patients, and decrease occurrence of stimulation-dependent side effects.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/microelectrode-recording-for-optimization-of-the-long-term-outcome-in-subthalamic-deep-brain-stimulation-for-parkinsons-disease/