Front. Neurol., 19 March 2014 | doi: 10.3389/fneur.2014.00025

Methods for surgical targeting of the STN in early-stage Parkinson’s disease

imageCorrie R. Camalier1, imagePeter E. Konrad1, imageChandler E. Gill2, imageChris Kao1, imageMichael R. Remple1, imageHana M. Nasr1, imageThomas L. Davis3, imagePeter Hedera3, imageFenna T. Phibbs3, imageAnna L. Molinari3, imageJoseph S. Neimat1 and imageDavid Charles3*
  • 1Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
  • 2Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
  • 3Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

Patients with Parkinson’s disease (PD) experience progressive neurological decline, and future interventional therapies are thought to show most promise in early stages of the disease. There is much interest in therapies that target the subthalamic nucleus (STN) with surgical access. While locating STN in advanced disease patients (Hoehn–Yahr Stage III or IV) is well understood and routinely performed at many centers in the context of deep brain stimulation surgery, the ability to identify this nucleus in early-stage patients has not previously been explored in a sizeable cohort. We report surgical methods used to target the STN in 15 patients with early PD (Hoehn–Yahr Stage II), using a combination of image guided surgery, microelectrode recordings, and clinical responses to macrostimulation of the region surrounding the STN. Measures of electrophysiology (firing rates and root mean squared activity) have previously been found to be lower than in later-stage patients, however, the patterns of electrophysiology seen and dopamimetic macrostimulation effects are qualitatively similar to those seen in advanced stages. Our experience with surgical implantation of Parkinson’s patients with minimal motor symptoms suggest that it remains possible to accurately target the STN in early-stage PD using traditional methods.

Keywords: Parkinson’s disease, subthalamic nucleus, surgical targeting, early stage, neurosurgery

Citation: Camalier CR, Konrad PE, Gill CE, Kao C, Remple MR, Nasr HM, Davis TL, Hedera P, Phibbs FT, Molinari AL, Neimat JS and Charles D (2014) Methods for surgical targeting of the STN in early-stage Parkinson’s disease. Front. Neurol. 5:25. doi: 10.3389/fneur.2014.00025

Received: 16 September 2013; Paper pending published: 12 November 2013;
Accepted: 21 February 2014; Published online: 19 March 2014.

Edited by:

Ryuji Kaji, Tokushima University Hospital, Japan

Reviewed by:

Davide Martino, Queen Mary University of London, UK
Fredy J. Revilla, University of Cincinnati College of Medicine, USA

Copyright: © 2014 Camalier, Konrad, Gill, Kao, Remple, Nasr, Davis, Hedera, Phibbs, Molinari, Neimat and Charles. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: David Charles, Department of Neurology, Vanderbilt University Medical Center, Suite A-1106 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA e-mail:

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