Atlas-Independent, Electrophysiological Mapping of the Optimal Locus of Subthalamic Deep Brain Stimulation for the Motor Symptoms of Parkinson Disease

Stereotact Funct Neurosurg. 2018;96(2):91-99. doi: 10.1159/000486643. Epub 2018 May 23.


Background/aims: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms of Parkinson disease (PD). However, motor outcomes can be variable, perhaps due to inconsistent positioning of the active contact relative to an unknown optimal locus of stimulation. Here, we determine the optimal locus of STN stimulation in a geometrically unconstrained, mathematically precise, and atlas-independent manner, using Unified Parkinson Disease Rating Scale (UPDRS) motor outcomes and an electrophysiological neuronal stimulation model.

Methods: In 20 patients with PD, we mapped motor improvement to active electrode location, relative to the individual, directly MRI-visualized STN. Our analysis included a novel, unconstrained and computational electrical-field model of neuronal activation to estimate the optimal locus of DBS.

Results: We mapped the optimal locus to a tightly defined ovoid region 0.49 mm lateral, 0.88 mm posterior, and 2.63 mm dorsal to the anatomical midpoint of the STN. On average, this locus is 11.75 lateral, 1.84 mm posterior, and 1.08 mm ventral to the mid-commissural point.

Conclusion: Our novel, atlas-independent method reveals a single, ovoid optimal locus of stimulation in STN DBS for PD. The methodology, here applied to UPDRS and PD, is generalizable to atlas-independent mapping of other motor and non-motor effects of DBS.

Keywords: Deep brain stimulation; Electrical field; Magnetic resonance imaging; Model; Parkinson disease; Subthalamic nucleus.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atlases as Topic
  • Brain Mapping / methods*
  • Deep Brain Stimulation / methods*
  • Female
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Motor Skills Disorders / diagnostic imaging
  • Motor Skills Disorders / physiopathology
  • Motor Skills Disorders / therapy
  • Parkinson Disease / diagnostic imaging*
  • Parkinson Disease / physiopathology
  • Parkinson Disease / therapy*
  • Subthalamic Nucleus / anatomy & histology
  • Subthalamic Nucleus / diagnostic imaging*
  • Subthalamic Nucleus / physiology*
  • Treatment Outcome