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The Role of the Cortico-subthalamic Hyperdirect Pathway in Deep Brain Stimulation for the Treatment of Parkinson’s Disease: A Diffusion Tensor Imaging Study.

The Role of the Cortico-subthalamic Hyperdirect Pathway in Deep Brain Stimulation for the Treatment of Parkinson’s Disease: A Diffusion Tensor Imaging Study.
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Chen Y, Ge S, Li Y, Li N, Wang J, Wang X, Li J, Jing J, Su M, Zheng Z, Luo T, Qiu C, Wang X,


Chen Y, Ge S, Li Y, Li N, Wang J, Wang X, Li J, Jing J, Su M, Zheng Z, Luo T, Qiu C, Wang X, (click to view)

Chen Y, Ge S, Li Y, Li N, Wang J, Wang X, Li J, Jing J, Su M, Zheng Z, Luo T, Qiu C, Wang X,

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World neurosurgery 2018 03 29() pii S1878-8750(18)30631-4
Abstract
OBJECTIVE
The aim of our study was to evaluate the clinical effect of the position of stimulation contacts relative to the hyperdirect pathway (HDP) on the alleviation of motor symptoms in patients with Parkinson’s disease (PD).

METHODS
A group of 11 patients diagnosed with idiopathic PD were included in this study, and all selected targets were in the subthalamic nucleus (STN). One patient was implanted with a single side electrode due to unilateral symptoms, and all others were implanted with bilateral electrodes containing 4 discrete contacts. We excluded 9 contacts due to adverse reactions caused by stimulation. The sum total of 75 active contacts was evaluated using the same stimulus parameters. Fiber tractography was individually processed using StealthViz software before all data underwent statistical analysis.

RESULTS
Under the same stimulus parameters, the shortest distance of each contact to the HDP in Group I (n=45, >50% improvement rate) was less than in Group II (n=30, ≤50% improvement rate) (1.18±0.86 mm vs 2.14±1.20 mm, t=3.78, p<0.05) and the shortest distance had a negative correlation with the improvement of motor symptoms (r=-0.48, p<0.05). CONCLUSION
Stimulation of the HDP coincided with the improvement of motor symptoms in patients with PD. We propose an improvement of the direct visualization method based on DTI fiber tractography of the HDP to select the motor part of STN. In the future, we need further rigorous clinical trials to verify the value of applying this method in order to achieve precise target location and individualized treatment.

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