Deep brain stimulation using simultaneous stereotactic electrode placement. An alternative to conventional functional stereotaxy?

Deep brain stimulation (DBS) has become a reliable method in the treatment of movement disorders, e.g. idiopathic Parkinson's disease (IPD) and is technically based on stereotaxy. The StarfixA (R) platform is a new type of stereotactic frame that allows an individualized and patient-optimized therapeutic regimen in IPD. The aim of this study was to retrospectively compare the outcomes of IPD patients who underwent surgery with the use of conventional stereotactic frames (31 patients) to those who underwent implantation of DBS with the use of StarfixA (R) frames (29 patients). Surgery time, the unified Parkinson's disease rating scale III (UPDRS/III) score, L-dopa and L-dopa equivalent doses (LED) were compared prior to surgery as well as 4 weeks, 12 weeks, 6 months and 1 year postoperatively. The IPD-related symptoms improved significantly in both groups with respect to the UPDRS III score (conventional 69.6 % vs. 72.4 % StarfixA (R)). After surgery significant reductions of L-dopa and LED were seen in both groups. Inherent advantages of the StarfixA (R) platform included simultaneous positioning of the stimulating electrodes and a significant reduction in surgical time. In summary, both stereotactic procedures are reliable and safe procedures for the placement of stimulating electrodes as well as the stimulation effect achieved. The logistical uncoupling of presurgical planning from surgical therapy emphasizes the benefits of the individualized stereotactic procedure.