Clinical Outcomes Of Deep Brain Stimulation Placement Using Intraoperative MRI for Parkinson Disease (P3.359)

OBJECTIVE: To assess motor outcome in patients with Parkinson disease (PD) who underwent deep brain stimulation (DBS) placement using intraoperative MRI (ClearPoint®, MRI Interventions). BACKGROUND: DBS lead placement using intraoperative MRI (iMRI) is an alternative surgical technique utilizing real-time intraoperative neuroimaging to guide electrode placement. Unlike the traditional awake procedure, iMRI DBS is done under general anesthesia without microelectrode recording (MER) and electrical stimulation. The procedure is beneficial in patients who cannot tolerate or prefer not to undergo an awake procedure. However, there is limited literature on clinical outcomes. METHODS: Forty-one patients with PD who underwent iMRI DBS placement were identified. Of these, patients who also had placement using MER (revision = 1, additional lead = 4) and those with pre-DBS OFF-medication UPDRS part III scores <=15 (n=3) were excluded. Pre- and post- DBS UPDRS Part III scores were obtained at 6 and 12 months. RESULTS: The mean age of patients (M=23, F=10) was 63.8 years. Out of 33 patients, 26 had bilateral (GPi=23, STN=3) and 7 had unilateral (GPi=6, STN=1) implants. Before DBS, the mean improvement in UPDRS Part III score ON-medication was 59.6[percnt] (95[percnt] CI: 53.5-65.8[percnt]) for bilateral cases and 55.5[percnt] (95[percnt] CI: 46.1-65 [percnt]) for unilateral cases. After DBS, UPDRS part III ON-stimulation/OFF-medication score in bilateral cases had a mean improvement of 53.2[percnt] (95[percnt] CI: 45.2-61.2[percnt], p<0.01) at 6 months and 53.3[percnt] (95[percnt] CI: 43.8-62.8[percnt], p<0.01) at 12 months. In unilateral cases, mean improvement in UPDRS part III ON-stimulation/OFF-medication score at 6 months was 23.7[percnt] (95[percnt] CI: 2.6- 44.9[percnt], p=0.03). Three patients had small asymptomatic subdural hemorrhages detected on post-operative imaging and 1 patient had hardware-related infection. CONCLUSIONS: iMRI-guided DBS in PD patients showed improvement in clinical outcomes as measured by their motor UPDRS scores comparable to previously reported results using awake MER-guided DBS placement. Disclosure: Dr. Sharma has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Buetefisch has nothing to disclose. Dr. Triche has nothing to disclose. Dr. Willie has nothing to disclose. Dr. Boulis received a royalty payment from Neuralstem Inc. Dr. Factor has received personal compensation for activities with Lundbeck, Chelsea Therapeutics, Auspex, Neurocrin, Up-To-Date, and UCB Pharma. Dr. Factor has received personal compensation in an editorial capacity for Neurotherapeutics. Dr. Factor has r Dr. Gross has received research support from Visualase Inc. Dr. DeLong has received personal compensation for activities with Medtronic Corporation, Boston Scientific and Effron Laboratories as a consultant.