BACKGROUND: In this study we evaluated the impact of location of deep brain stimulation electrode active contact in different parts of the subthalamic nucleus on improvement of non-motor symptoms in patients with Parkinson's disease. METHODS: The subthalamic nucleus was divided into two (dorsolateral/ventromedial) and three (dorsolateral, medial, ventromedial) parts. 37 deep brain stimulation electrodes were divided according to their active contact location. Correlation between change in non-motor symptoms before and one and four months after deep brain stimulation electrode implantation and the location of active contact was made. RESULTS: In dividing the subthalamic nucleus into three parts, no electrode active contact was placed ventromedially, 28 active contacts were located in the medial part and 9 contacts were placed dorsolaterally. After one and four months, no significant difference was found between medial and dorsolateral positions. In the division of the subthalamic nucleus into two parts, 13 contacts were located in the ventromedial part and 24 contacts were placed in the dorsolateral part. After one month, significantly greater improvement in the Non-motor Symptoms Scale for Parkinson's disease (P=0.045) was found on dorsolateral left-sided stimulation, but no significant differences between the ventromedial and dorsolateral positions were found on the right side. CONCLUSION: This study demonstrated the relationship between improvement of non-motor symptoms and the side (hemisphere, left/right) of the deep brain stimulation electrode active contact, rather than its precise location within specific parts of the subthalamic nucleus in patients treated for advanced Parkinson's disease.

Department of Biomedical Engineering University Hospital Olomouc Czech Republic

Department of Medical Biophysics Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Department of Neurology Jessenius Faculty of Medicine in Martin Comenius University in Bratislava and University Hospital Martin Martin Slovak Republic

Department of Neurology University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

Department of Neurosurgery University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic

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Lukins TR, Tisch S, Jonker B.The latest evidence on target selection in deep brain stimulation for Parkinson's disease. J Clin Neurosci 2014;21(1):22-7. doi: 10.1016/j.jocn.2013.05.011 PubMed DOI

Honey CR, Hamani C, Kalia SK, Sankar T, Picillo M, Munhoz RP, Fasano A, Panisset M. Deep Brain Stimulation Target Selection for Parkinson's Disease. Can J Neurol Sci 2017;44(1):3-8. doi: 10.1017/cjn.2016.22 PubMed DOI

Mao Z, Ling Z, Pan L, Xu X, Cui Z, Liang S, Yu X. Comparison of Efficacy of Deep Brain Stimulation of Different Targets in Parkinson's Disease: A Network Meta-Analysis. Front Aging Neurosci 2019;11:23. doi: 10.3389/fnagi.2019.00023 PubMed DOI

Mallet L, Schüpbach M, N'Diaye K, Remy P, Bardinet E, Czernecki V, Welter ML, Pelissolo A, Ruberg M, Agid Y, Yelnik J. Stimulation of subterritories of the subthalamic nucleus reveals its role in the integration of the emotional and motor aspects of behaviour. PNAS 2007;104(25):10661-6. doi: 10.1073/pnas.0610849104 PubMed DOI

Nambu A. Somatotopic organization of the primate Basal Ganglia. Front Neuroanat 2011;5:26. doi: 10.3389/fnana.2011.00026 PubMed DOI

Dafsari HS, Petry-Schmelzer JN, Ray-Chaudhuri K, Ashkan K, Weis L, Dembek TA, Samuel M, Rizos A, Silverdale M, Barbe MT, Fink GR, Evans J,Martinez-Martin P, Antonini A, Visser-Vandewalle V. Timmermanna L, EUROPARthe IPMDS Non Motor PD Study Group.Non-motor outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts.Brain Stimulation 2018;11(4):904-12. doi: https://doi.org/10.1016/j.brs.2018.03.009 PubMed DOI

Petry-Schmelzer JN, Krause M, Dembek TA, Horn A, Evans J, Ashkan K, Rizos A, Silverdale M, Schumacher W, Sack C, Loehrer PA, Fink GR, Fonoff ET, Martinez-Martin P,Antonini A, Barbe MT, Visser-Vandewalle V, Ray-Chaudhuri K,Timmermann L, Dafsari HS, EUROPAR and the IPMDS Non-Motor PD Study Group. Non-motor outcomes depend on location ofneurostimulation in Parkinson's disease. Brain 2019;142(11):3592-604. doi: 10.1093/brain/awz285 PubMed DOI

Kurcova S, Bardon J, Vastik M, Vecerkova M, Frolova M, Hvizdosova L, Nevrly M, Mensikova K, Otruba P, Krahulik D,Kurca E, Sivak S, Zapletalova J, Kanovsky P. Bilateral subthalamic deep brain stimulation initial impact on nonmotor and motor symptoms in Parkinson's disease. Medicine (Baltimore) 2018;97(5):e9750. doi: 10.1097/MD.0000000000009750 PubMed DOI

Akram H, Miller S, Lagrata S, Hariz M, Ashburner J, Behrens T, Matharu M, Zrinzo L. Optimal deep brain stimulation site and target connectivity for chronic cluster headache. Neurology 2017;89(20):2083-91. doi: 10.1212/WNL.0000000000004646 PubMed DOI

Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N, Movement Disorder Society UPDRS Revision Task Force. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008;23(15):2129-70. doi: 10.1002/mds.22340 PubMed DOI

Fahn S, Elton RL, UPDRS program members. Unified Parkinson´s Disease Rating Scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB, eds. Recent Developments in Parkinson´s disease.Vol 2. Florham Park; NJ: Macmilian Healthcare Information. 1987;153-63,293-304.

Chaudhuri KR, Martinez-Martin P, Brown RG, Sethi K, Stocchi F, Odin P,Ondo W, Abe K, MacPhee G, MacMahon D, Barone P, Rabey M, Forbes A, Breen K, Tluk S, Naidu Y, Olanow W, Williams AJ, Thomas S, Rye D, Tsuboi Y. The metric properties of a novel non-motor symptoms scale for Parkinson's disease: Results from an international pilot study. Mov Disord 2007;22(13):1901-11. doi: 10.1002/mds.21596 PubMed DOI

Peto V, Jenkinson C, Fitzpatrick R, Greenhall R. The development and validation of a short measure of functioning and well being for individuals with Parkinson's disease. Qual Life Res 1995;4(3):241-8. doi: 10.1007/BF02260863 PubMed DOI

Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N. The Parkinson's Disease Questionnaire (PDQ-39): development and validation of a Parkinson's disease summary index score. Age Ageing 1997;26(5):353-7. doi: 10.1093/ageing/26.5.353 PubMed DOI

Visser M, Marinus J, Stiggerlbout AM, van Hilten JJ. Assessment of autonomic dysfunctions in Parkinson's disease: the SCOPA-AUT. Mov Disord 2004;19(11):1306-12. dop: 10.1002/mds.20153 PubMed DOI

Chaudhuri KR, Pal S, DiMarco A, Whately-Smith C, Bridgman K, Mathew R,Pezzela FR, Forbes A, Högl B,Trenkwalder C. Parkinson's disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson's disease. J NeurolNeurosurg Psychiatry 2002;73(6):629-35. doi: 10.1136/jnnp.73.6.629 PubMed DOI

Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997;49(6):822-30.doi: 10.1016/s0090-4295(97)00238-0. PubMed DOI

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R Jr. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000;26(2):191-208. doi: 10.1080/009262300278597 PubMed DOI

Temel Y, Blokland A, Steinbusch HW, Visser-Vandewalle V. The functional role of the subthalamic nucleus in cognitive and limbic circuits. Prog Neurobiol 2005;76(6):393-413. doi: 10.1016/j.pneurobio.2005.09.005 PubMed DOI

Kurtis MM, Rajah T, Delgado LF, Dafsari HS. The effect of deep brain stimulation on the non-motor symptoms of Parkinson's disease: a critical review of the current evidence. NPJ Parkinson's Disease 2017;3:16024. doi: 10.1038/npjparkd.2016.24eCollection 2017. DOI

Dafsari HS, Ray-Chaudhuri K, Mahlstedt P, Sachse L, Steffen JK, Petry-Schmelzer JN, Dembek TA, Reker P, Barbe MT, Visser-Vandewalle V, Fink GR, Timmermann L. Beneficial effects of bilateral subthalamic stimulation on alexithymia in Parkinson's disease. Eur J Neurol 2019;26(2):222-e17. doi: 10.1111/ene.13773 PubMed DOI

Alkemane A, Forstman BU. Do we need to revise the tripartite subdivision hypothesis of the human subthalamic nucleus (STN)? Neuroimage 2014;95:326-9. doi: 10.1016/j.neuroimage.2014.03.010 PubMed DOI

Lambert C, Zrinzo L, Nagy Z, Lutti A, Hariz M, Foltynie T, Draganski B, Ashburner J, Frackowiak R. Do we need to revise the tripartite subdivision hypothesis of the human subthalamic nucleus (STN)? Response to Alkemade and Forstmann. Neuroimage 2015;110:1-2 doi: 10.1016/j.neuroimage.2015.01.038 PubMed DOI

Keuken MC, Uylings HB, Geyer S, Schäfer A, Turner R, Forstmann BU. Are there three subdivisions in the primate subthalamic nucleus? Front Neuroanat 2012;6(14). doi: 10.3389/fnana.2012.00014 PubMed DOI

McIntyre CC, Mori S, Sherman DL, Thakor NV, Vitek JL. Electric field and stimulating influence generated by deep brain stimulation of the subthalamic nucleus. Clin Neurophysiol 2004;115(3):589-95. doi: 10.1016/j.clinph.2003.10.033 PubMed DOI