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Intraoperative Predictive Factors

Jean-Luc Houeto, MD; Marie-Laure Welter, MD; Paul-Boulos Bejjani, MD; Sophie Tezenas du Montcel, MD; Anne-Marie Bonnet, MD; Valerie Mesnage, MD; Soledad Navarro, MD; Bernard Pidoux, MD, PhD; Didier Dormont, MD; Philippe Cornu, MD; Yves Agid, MD, PhD

Arch Neurol. 2003;60:690-694.

Background  High-frequency stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced forms of Parkinson disease. Postoperative improvement of motor parkinsonian disability is known to depend on patient selection and surgical targeting.

Objective  To determine which clinical and electrophysiological variables evaluated during the operation predict the postoperative clinical outcome of patients with Parkinson disease treated by bilateral high-frequency stimulation of the STN.

Methods  Intraoperative clinical and electrophysiological data obtained in 41 patients with Parkinson disease who underwent bilateral implantation of electrodes for STN stimulation were correlated with the improvement in parkinsonian disability assessed 6 months after the operation.

Results  The extent of STN neuronal activity recorded along the trajectory of the therapeutic electrode had no effect on the postoperative clinical outcome. The intraoperative improvement in segmental akinesia, but not rigidity, was predictive of the postoperative improvement in parkinsonian motor disability and reduction in daily levodopa-equivalent dosage. Parkinsonian motor disability scores assessed after surgery were lower in patients with intraoperative stimulation-induced dyskinesias than in those without stimulation-induced dyskinesias.

Conclusion  The improvement of segmental akinesia and the observation of dyskinesias provoked by stimulation during the operation predict the best postoperative effects of bilateral STN stimulation on parkinsonian motor disability.

From the Centre d'Investigation Clinique, Fédération de Neurologie, INSERM Unit 289 (Drs Houeto, Welter, Bonnet, Mesnage, and Agid), and Services de Biostatistique (Dr Tezenas du Montcel), Neuroradiologie (Dr Dormont), and Neurochirurgie (Drs Navarro and Cornu), and Fédération de Neurophysiologie Clinique (Dr Pidoux), Hôpital de la Salpêtrière, Paris, France; and Hospital Notre Dame des Secours, Byblos-Jbeil, Lebanon (Dr Bejjani).

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