Clinical outcome of the patients with Subthalmic nucleus Deep Brain Stimulation - with calculated and visual targets in Parkinsonism.

Ajaydeep Singh; Arvinpreet Kour; Dinesh Choudhary

Volume : VIII, Issue : XI, November - 2018

Clinical outcome of the patients with Subthalmic nucleus Deep Brain Stimulation - with calculated and visual targets in Parkinsonism.

Ajaydeep Singh, Arvinpreet Kour, Dinesh Choudhary

Abstract :

Objectives: The purpose of this study was to evaluate the efficacy of Deep Brain Stimulation (DBS) at subthalmic nucleus in patients of Parkinsonism.

Patients and Methods: Total 30 patients down with idiopathic Parkinson’s disease with excellent motor ‘On’ state after levodopa challenge response with disability were studied. The target(STN) was localised using 3 tesla MRI[Visual target] and calculated target on the basis of the AC and PC .The final targets achieved were finalized with MER with inomed software. Patients were informed about the study and benefits. Confidentiality of the participants was maintained at all the levels.

Results: Percent improvements in parameters like tremors, rigidity and dyskinesia was carried out preoperatively and post–operatively in both the target groups. The comparison of the effects of the stimulation on the different contacts at calculated group and the visual group showed that , in the visual target group the improvement was 88%, 75% and 58 % respectively in tremors, rigidity and dyskinesia in on state and in the calculated target group 62%, 46% and 58% improvement respectively in tremors, rigidity and dyskinesia in on state. There was statically significantly more improvement in visual target group in tremors (p=0.040) and rigidity (p = 0.032) than calculated group and insignificant (p = 0.265) improvement of dyskinesia between the 2 groups. The improvement in rigidity, tremor and the dyskinesia due to subthalamic nuclei stimulation correlated well with the improvement of the other sensory and motor parkinsonian symptoms.

Conclusion: Our results clearly suggested that the visual target with MER gave better clinical results than calculated targets with MER and the outcome of the patients showed significant improvement with least need of the medications.