Stimulation of the caudal zona incerta is superior to stimulation of the subthalamic nucleus in improving contralateral parkinsonism

• Published in: Brain (London, England : 1878) England : 1878), 2006-07, Vol.129 (7), p.1732-1747
• Main Authors: Plaha, Puneet, Ben-Shlomo, Y., Patel, Nikunj K., Gill, Steven S.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Brain Mapping - methods; caudal zona incerta stimulation; Deep Brain Stimulation - adverse effects; Deep Brain Stimulation - methods; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Diseases of the nervous system; Electrodes, Implanted; Female; Humans; Hypokinesia - therapy; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Muscle Rigidity - therapy; Neurology; Parkinson Disease - pathology; Parkinson Disease - therapy; Parkinson's disease; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Sensitivity and Specificity; Severity of Illness Index; Stereotaxic Techniques; Subthalamic Nucleus - pathology; Subthalamic Nucleus - physiopathology; Subthalamic Nucleus - surgery; Subthalamus - pathology; Subthalamus - physiopathology; Subthalamus - surgery; Treatment Outcome; Tremor - therapy
• ISSN: 0006-8950; 1460-2156
• DOI: 10.1093/brain/awl127

Deep brain stimulation (DBS) has an increasing role in the treatment of idiopathic Parkinson's disease. Although, the subthalamic nucleus (STN) is the commonly chosen target, a number of groups have reported that the most effective contact lies dorsal/dorsomedial to the STN (region of the pallidofugal fibres and the rostral zona incerta) or at the junction between the dorsal border of the STN and the latter. We analysed our outcome data from Parkinson's disease patients treated with DBS between April 2002 and June 2004. During this period we moved our target from the STN to the region dorsomedial/medial to it and subsequently targeted the caudal part of the zona incerta nucleus (cZI). We present a comparison of the motor outcomes between these three groups of patients with optimal contacts within the STN (group 1), dorsomedial/medial to the STN (group 2) and in the cZI nucleus (group 3). Thirty-five patients with Parkinson's disease underwent MRI directed implantation of 64 DBS leads into the STN (17), dorsomedial/medial to STN (20) and cZI (27). The primary outcome measure was the contralateral Unified Parkinson's Disease Rating Scale (UPDRS) motor score (off medication/off stimulation versus off medication/on stimulation) measured at follow-up (median time 6 months). The secondary outcome measures were the UPDRS III subscores of tremor, bradykinesia and rigidity. Dyskinesia score, L-dopa medication reduction and stimulation parameters were also recorded. The mean adjusted contralateral UPDRS III score with cZI stimulation was 3.1 (76% reduction) compared to 4.9 (61% reduction) in group 2 and 5.7 (55% reduction) in the STN (P-value for trend