Subthalamic deep brain stimulation for primary dystonia: defining an optimal location using the medial subthalamic nucleus border as anatomical reference

Introduction Although the subthalamic nucleus (STN) has proven to be a safe and effective target for deep brain stimulation (DBS) in treatment of primary dystonia, rates individual improvement vary considerably. On premise selecting appropriate patients, location contacts dorsolateral sensorimotor area STN may an important factor affecting therapeutic effects, but optimal remains unclear. This study aimed define using medial border as anatomical reference explore influence active on outcomes programming strategies series patients with dystonia. Methods Data from 18 who underwent bilateral STN-DBS were retrospectively acquired analyzed. Patients assessed preoperatively postoperatively (1 month, 3 months, 6 1 year, 2 years, last follow-up after neurostimulator initiation) Toronto Western Spasmodic Torticollis Rating Scale (for cervical dystonia) Burke–Fahn–Marsden Dystonia other types). Optimal parameters contact locations determined during clinical follow-up. The position relative was postoperative stereotactic MRI. Results showed significant negative correlation y-axis (anterior–posterior; A+, P−). more posterior electrode positioned STN, better effects. Cluster analysis delineated sub-optimal groups. coordinates group 2.56 mm lateral, 0.15 anterior, 1.34 superior border. Conclusion dependent location. Bilateral located behind or adjacent Bejjani’s line most likely produce ideal These findings help guide preoperative planning, programming, prognosis efficacy