Thesis defense Saman Vinke (Donders series 579)

20 January 2023

Promotors: prof. dr. R. Bartels

Co-promotors: dr. R. Essink, dr. P. Kubben (MUMC)

Paradigm Shifts in the Surgical Treatment of Parkinson's Disease

Bilateral Deep Brain Stimulation of the subthalamic nucleus has become a cornerstone in the treatment of advanced Parkinson’s disease. Most centers adopt a traditional operative approach under local anaesthesia with the patient awake and in the OFF-medication state, to allow for microelectrode recording (MER) and intraoperative clinical testing (ICT). With advancements in magnetic resonance imaging (MRI) techniques, some centers started to adopt an asleep MRI-guided operative approach, without MER and ICT. Final electrode position is then verified by checking the anatomical location of the lead on immediate postoperative imaging. The studies in this thesis show that 1) MER and ICT have no added value in determining final lead position in awake MER-guided and CT-verified DBS surgery and that these results changed our daily clinical practice to an asleep MRI-guided and CT-verified approach. 2) MRI-guided and MRI-verified DBS-surgery is safe, accurate and precise. 3) That female patients are more likely to undergo bilateral STN-DBS surgery is performed asleep. Furthermore, we propose a protocol of a multicenter comparative effectiveness trial to compare both methods. The findings of the studies in this thesis will have direct impact on daily clinical practice of DBS-surgery across the world.