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

• DOI: 10.1093/brain/awl127
• Publication Date: 2006-05-24T03:45:02Z
• Authors: P. Plaha
• Keywords: Zona incerta; Subthalamic Nucleus

Deep brain stimulation (DBS) has an increasing role in the treatment of idiopathic Parkinson's disease. Although, subthalamic nucleus (STN) is commonly chosen target, a number groups have reported that most effective contact lies dorsal/dorsomedial to STN (region pallidofugal fibres and rostral zona incerta) or at junction between dorsal border latter. We analysed our outcome data from disease patients treated with DBS April 2002 June 2004. During this period we moved target region dorsomedial/medial it subsequently targeted caudal part incerta (cZI). present comparison motor outcomes these three optimal contacts within (group 1), 2) cZI 3). Thirty-five underwent MRI directed implantation 64 leads into (17), (20) (27). The primary measure was contralateral Unified Disease Rating Scale (UPDRS) score (off medication/off versus off medication/on stimulation) measured follow-up (median time 6 months). secondary measures were UPDRS III subscores tremor, bradykinesia rigidity. Dyskinesia score, L-dopa medication reduction parameters also recorded. mean adjusted 3.1 (76% reduction) compared 4.9 (61% group 2 5.7 (55% (P-value for trend <0.001). There 93% improvement tremor 86% 61% 1 = 0.01). Adjusted 'off–on' rigidity scores 1.0 reduction), 2.0 (52% 2.1 (50% 0.002). Bradykinesia more markedly improved (65%) (56%) (59%) 0.17). no statistically significant differences dyskinesia scores, groups. Stimulation related complications seen some patients. High frequency results greater than STN. discuss implications finding potential played by ZI