Abstract Details

Title Dorsal and Ventral Subthalamic Nucleus Stimulation Improve the Symptoms of Parkinson Disease

Topic Movement Disorders

Presentation(s) IN11 - (-)

Poster/Presentation
Number 004

Objective

Background Deep brain stimulation of the subthalamic nucleus (STN DBS) provides dramatic improvement for the motor signs of PD. Previous anatomical studies have demonstrated differential functions of STN subdivision; dorsal for motor control and ventral for cognitive control. Cognitive function has been shown to be impaired by ventral STN DBS.

Design/Methods 52 patients with STN DBS for PD who withheld anti-parkinsonian medication overnight were studied. A validated contact localization method was used to determine dorsal and ventral electrode contacts with no overlapping shells of stimulation. Total Unified Parkinson Disease Rating Scale subscale III (UPDRS III) scores, unilateral UPDRS hand rotation and arm rigidity scores as well as kinematic measures of bradykinesia (hand rotation velocity (HRV)) and rigidity (upper extremity impedance). All subjects were tested in three conditions; STN DBS off (OFF), unilateral dorsal (D-STN) or ventral (V-STN) STN DBS on in random order. Stimulation parameters were chosen such that the stimulation shells did not overlap.

Results In all subjects dorsal and ventral contacts were defined. D-STN and V-STN improved total UPDRS (19.9% and 19.1% respectively, p < 0.001), hand rotation score (18.8%, 22.1%, p<0.001), arm rigidity score (55.0%, 58.2% ), HRV (71.2%, 75.1%, p< 0.001) and impedance (26.7%, 31.2%, P<0.001). D-STN and V-STN were not different from each other for any measure.

Conclusions Subjective rating scales and objective kinematic data demonstrate that D-STN and V-STN DBS produce similar improvements in the motor signs of PD. However, further investigation may reveal that different mechanism and networks are involved in the improvement of PD motor signs by either dorsal or ventral STN DBS. Targeting of STN stimulation should address cognitive side effects.

Authors/Disclosures
Mwiza Ushe, MD (Washington University School of Medicine Department of Neurology) PRESENTER	No disclosure on file
	No disclosure on file
Meghan C. Campbell, PhD (Washington University in St. Louis)	The institution of Meghan C. Campbell has received research support from NIH. The institution of Meghan C. Campbell has received research support from NIH. The institution of Meghan C. Campbell has received research support from McDonnell Center for Systems Neuroscience. The institution of Meghan C. Campbell has received research support from WUSM Radiology Department. The institution of Meghan C. Campbell has received research support from NIH. Meghan C. Campbell has received personal compensation in the range of $0-$499 for serving as a Grant Reviewer with Parkinson Foundation. Meghan C. Campbell has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Department of Defense.
Fernando Dangond, MD, FAAN	Dr. Dangond has received personal compensation in the range of $1,000,000+ for serving as a Head, Global Clinical Development (employee for 12 years) with EMD Serono.
	No disclosure on file
Samer D. Tabbal, MD, FAAN (Baptist Health Medical Group Physicians)	No disclosure on file
Morvarid Karimi, MD (Washington University School of Medicine)	No disclosure on file
	No disclosure on file
Joel S. Perlmutter, MD, FAAN (Washington University in St. Louis)	Dr. Perlmutter has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for CHDI. Dr. Perlmutter has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Parkinson Study Group. Dr. Perlmutter has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Wood, Cooper and Peterson, LLC . Dr. Perlmutter has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Simmons and Simmons LLP . The institution of Dr. Perlmutter has received research support from NIH. The institution of Dr. Perlmutter has received research support from American Parkinson Disease Association (Advanced Research Center at Washington University). The institution of Dr. Perlmutter has received research support from CHDI. The institution of Dr. Perlmutter has received research support from Huntington Disease Society of America. The institution of Dr. Perlmutter has received research support from University of Western Toronto. The institution of Dr. Perlmutter has received research support from Barnes-Jewish Hospital Foundation. The institution of Dr. Perlmutter has received research support from Michael J Fox Foundation. The institution of Dr. Perlmutter has received research support from UCSD. The institution of Dr. Perlmutter has received research support from Paula & Rodger Riney FUnd. The institution of Dr. Perlmutter has received research support from Jo Oertli Fund. The institution of Dr. Perlmutter has received research support from Murphy FUnd. The institution of Dr. Perlmutter has received research support from Fixel Fund. The institution of Dr. Perlmutter has received research support from N Grant WIlliams Fund. The institution of Dr. Perlmutter has received research support from Pohlman Fund. Dr. Perlmutter has received personal compensation in the range of $500-$4,999 for serving as a lecturer with Boston University. Dr. Perlmutter has received personal compensation in the range of $500-$4,999 for serving as a external advisor with Stanford University. Dr. Perlmutter has received personal compensation in the range of $500-$4,999 for serving as a visiting professor with Beth Israel Hospital. Dr. Perlmutter has received personal compensation in the range of $500-$4,999 for serving as a visiting professor with U Pennsylvania.

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