Dorsal and Ventral Subthalamic Nucleus Stimulation Improve the Symptoms of Parkinson Disease (P04.181)

OBJECTIVE: To determine the differential improvement in motor signs of idiopathic Parkinson disease (PD) patients with unilateral dorsal and ventral STN DBS. 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 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. Supported by: The American Academy of Neurology and American Brain Foundation - Clinical Research Training Fellowship; NIH (TR000448, 5T32NS00720530, NS41509, NS057105 and NS075321); Murphy Fund; American Parkinson Disease Association (APDA) Center for Advanced PD Research at Washington University; Greater St. Louis Chapter of the APDA; McDonnell Center for Higher Brain Function; Barnes-Jewish Hospital Foundation. Disclosure: Dr. Ushe has nothing to disclose. Dr. Hill has nothing to disclose. Dr. Campbell has recieved research support from Synosia Therapeutics. Dr. Hershey has nothing to disclose. Dr. Tabbal has nothing to disclose. Dr. Karimi has nothing to disclose. Dr. Hartlein has nothing to disclose. Dr. Perlmutter has received personal compensation for activities with The University of Louisville, Toronto Western University Hospital, University of Maryland, Rhode Island General Hospital, Medical University of South Carolina, and the Bachmann-Strauss Foundation as a speaker. Dr. Perlmutter has received personal compensation in an editorial capacity from the Parkinson Study Group. Dr. Perlmutter has received research support from Express Scripts, NIH (NINDS, ORDR, NCRR), American Parkinson Disease Association (APDA), Greater St. Louis Chaper of the APDA, HDSA, CHDI, Michael J. Fox Foundation, Barnes Jewish Hospital Foundation, McDonnell Center for Higher Brain Function, and Bander Foundation for Medical Business Ethnics.