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Christopher S. Lozano, Manish Ranjan, Alexandre Boutet, David S. Xu, Walter Kucharczyk, Alfonso Fasano, and Andres M. Lozano

S ubthalamic nucleus (STN) deep brain stimulation (DBS) surgery is commonly used to treat Parkinson’s disease (PD) throughout the world. With the passage of time, there have been a number of innovations in surgical technique. These include a shift away from electrophysiological confirmation of the STN target with microelectrode recordings (MERs) and a trend toward surgery with the patient awake or asleep, relying solely on MRI of the target for electrode placement in some centers. 2 , 3 , 6 , 8 The relative merits and limitations of the imaging-only methods are

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Katherine Leaver, Aaron Viser, Brian H. Kopell, Roberto A. Ortega, Joan Miravite, Michael S. Okun, Sonya Elango, Deborah Raymond, Susan B. Bressman, Rachel Saunders-Pullman, and Marta San Luciano

(STN) and the internal segment of the globus pallidus (GPi). Both targets have been shown to be safe and effective in IPD, 12 although there is a paucity of target-specific information, especially as it relates to genotype. 13 The objectives of the current study were to compare baseline clinical characteristics driving decisions to pursue DBS among G2019S LRRK2-PD. We also aimed to compare longitudinal motor and medication DBS outcomes between LRRK2-PD and IPD and to gather preliminary information about target-specific differences. Methods Participants

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Craig G. van Horne, Jorge E. Quintero, Julie A. Gurwell, Renee P. Wagner, John T. Slevin, and Greg A. Gerhardt

Kentucky institutional review board, and informed consent was obtained from all study participants. FIG. 1. Schematic time line of study design. MER = microelectrode recording; PC pulse generator = Activa PC pulse generator. Patient Selection Eight patients with a diagnosis of idiopathic PD, who had been selected and had provided consent for DBS of the subthalamic nucleus (STN), were subsequently informed about the study and then agreed to participate in the study and gave formal consent. Thus, agreeing to participate in the study had no influence on the

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Weiyuan Huang, Richard Ogbuji, Liangdong Zhou, Lingfei Guo, Yi Wang, and Brian H. Kopell

T he subthalamic nucleus (STN) is a glutamatergic nucleus situated in the diencephalon that is critical for the regulation of motor function through both the direct and indirect motor pathways connected to the basal ganglia and also plays a role in limbic and associative processing. 1 A hallmark of Parkinson’s disease (PD) is an increase in and abnormal synchronization of STN neuronal activity; thus, the STN is a primary target for deep brain stimulation (DBS) therapy. 2 , 3 DBS of the STN has been shown to provide significant benefit to patients

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Abuzer Güngör, Şevki Serhat Baydın, Vanessa M. Holanda, Erik H. Middlebrooks, Cihan Isler, Bekir Tugcu, Kelly Foote, and Necmettin Tanriover

C hronic deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a proven neurosurgical treatment to relieve refractory motor symptoms in Parkinson’s disease. 6 , 9 , 26 , 32 , 41 , 58–61 Preliminary results also suggest that STN stimulation may also be beneficial in cases of refractory obsessive-compulsive disorder and epilepsy. 11 , 13 , 15 , 28 , 56 , 60 , 61 Despite the extensive use of the STN as a DBS target, understanding of the 3D anatomy of the subthalamic region remains challenging due to the variable shape, oblique orientation, relatively

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Peter Novak, Slawomir Daniluk, Samuel A. Ellias, and Jules M. Nazzaro

H igh-frequency stimulation of the STN is an effective treatment for Parkinson disease. 1 Stimulating electrodes are inserted via established stereotactic approaches for which STN coordinates are obtained from anatomical atlases and imaging studies. The target is usually refined using MER because of targeting errors related to inherent anatomical variability, the limited accuracy of imaging, and brain shift associated with opening of the dura mater and implantation of stereotactic hardware. 1 , 2 , 8 , 13 , 17 , 18 Microelectrode recording can improve

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André Snellings, Oren Sagher, David J. Anderson, and J. Wayne Aldridge

O ver the last decade, DBS of the STN has become more prevalent and effective as a therapy for Parkinson disease symptoms. 2 , 6 The most challenging aspect of stimulator implantation is localizing the correct target for placement within the STN, as this structure is very small and obscured by fiber tracts, making imaging difficult. 20 Millimeter-level precision in targeting is vital to the procedure because incorrect placement leads both to reduced efficacy in symptom alleviation 12 and an increase in detrimental side effects. 22 Because of imaging

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Kendall H. Lee, Su-Youne Chang, David W. Roberts, and Uhnoh Kim

H igh -frequency stimulation of the STN through implanted electrodes has become an established treatment for PD. 13, 25 Nonetheless, the precise mechanism of DBS in the STN is unknown. Because the effects of HFS are usually similar to those of a lesion, it has been hypothesized that this type of DBS acts by silencing neurons within the stimulated structure. 6, 27 Beurrier, et al., 7 used the blind patch-clamp technique in a rat tissue slice preparation to demonstrate that HFS blocked action potential generation in STN neurons during the poststimulation

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Alexey V. Dimov, Ajay Gupta, Brian H. Kopell, and Yi Wang

T he subthalamic nucleus (STN) is a deep gray matter structure that is located in the midbrain and known to be involved in regulation of cognitive and motor functions. 19 , 22 Due to the latter, the STN has been a primary target in deep brain stimulation (DBS) to improve parkinsonian symptoms. 7 , 31 , 47 Success of DBS is critically dependent on accurate placement of the stimulation electrodes. 48 However, precise targeting of the STN is a challenging task due to its small size, oblique orientation, and variations in anatomical location. 16 , 21 , 28 , 35

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Kim Rijkers, Yasin Temel, Veerle Visser-Vandewalle, Linda Vanormelingen, Marjan Vandersteen, Peter Adriaensens, Jan Gelan, and Emile A. M. Beuls

H igh-Frequency stimulation of the STN is widely used to treat patients with advanced Parkinson disease. The STN (corpus Luysii) is a small, almond-shaped structure located in the upper part of the mesencephalon. Determination of the target coordinates is of critical importance in STN surgery, and several different imaging techniques are used during these stereotactic procedures. On ventriculography and computed tomography scanning, the target can only be determined indirectly in relation to the visible structures such as the AC and the PC. Because of the