University of Oulu

Lahtinen, M.J., Haapaniemi, T.H., Kauppinen, M.T. et al. A comparison of indirect and direct targeted STN DBS in the treatment of Parkinson’s disease—surgical method and clinical outcome over 15-year timespan. Acta Neurochir 162, 1067–1076 (2020).

A comparison of indirect and direct targeted STN DBS in the treatment of Parkinson’s disease : surgical method and clinical outcome over 15-year timespan

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Author: Lahtinen, Maija1,2,3; Haapaniemi, Tarja3,4; Kauppinen, Mikko1,3;
Organizations: 1Department of Neurosurgery, Oulu University Hospital, Kajaanintie 50, FI-90220, Oulu, Finland
2Oulu Research Group of Advanced Surgical Technologies and Physics, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
3Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
4Department of Neurology, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: Springer Nature, 2020
Publish Date: 2020-06-09


Background: Deep brain stimulation (DBS) in the subthalamic nucleus (STN) is used in advanced Parkinson’s disease (PD) for reducing motor fluctuations and the side effects of antiparkinsonian medication (APM). The development of neuroimaging has enabled the direct targeting of the STN. The aim of this study is to evaluate the outcome in patients with PD using STN DBS when changing from atlas-based indirect targeting method (iTM) to direct MRI-based targeting (dTM) assuming dTM is superior.

Methods: Twenty-five consecutive PD patients underwent dTM STN DBS surgery from 2014 to 2017 with follow-up for 1 year. The neuroimaging, surgical method, outcome in Unified Parkinson’s Disease Rating Scale (UPDRS) scores, and reduction of APM are described and compared with the results of an earlier iTM STN DBS study.

Results: Twelve months after a dTM STN DBS, significant improvement (p < 0.001) was seen in six out of seven parameters of UPDRS when patients had medication (medON) and stimulation (stimON). The activities of daily living (UPDRSII) and motor scores (UPDRSIII) improved by 41% and 62%, respectively. Dyskinesias and fluctuations were both reduced by 81%. In dTM STN DBS group, the levodopa equivalent dose (LED) and the total daily levodopa equivalent dose (LEDD) were significantly decreased by 62% and 55%, respectively, compared with the baseline (p < 0.001). Five patients (20%) were without levodopa medication 12 months after the operation.

Conclusions: The development of surgical technique based on advanced neuroimaging has improved the outcome of PD STN DBS.

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Series: Acta neurochirurgica
ISSN: 0001-6268
ISSN-E: 0942-0940
ISSN-L: 0001-6268
Volume: 162
Issue: 5
Pages: 1067 - 1076
DOI: 10.1007/s00701-020-04269-x
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3124 Neurology and psychiatry
3112 Neurosciences
Funding: Open Access funding provided by University of Oulu including Oulu University Hospital. The EVO/VTR funding was provided by Oulu University Hospital, Oulu, Finland. The Finnish Parkinson’s Association and The Association of Scientific Medical Research in Oulu, Finland, have provided financial support for this scientific work. The sponsor had no role in the design or conduct of this research.
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