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NEUROLOGY 2005;64:1598-1604
© 2005 American Academy of Neurology

Parkinson disease, brain volumes, and subthalamic nucleus stimulation

F. Bonneville, MD*, M. L. Welter, MD*, C. Elie, MD, S. Tezenas du Montcel, MD, PhD, D. Hasboun, MD, PhD, C. Menuel, MSc, J. L. Houeto, MD, A. M. Bonnet, MD, V. Mesnage, MD, B. Pidoux, MD, PhD, S. Navarro, MD, P. Cornu, MD, PhD, Y. Agid, MD, PhD and D. Dormont, MD

From the Service de Neuroradiologie (Drs. Bonneville, Hasboun, and Dormont), UPR 640 CNRS LENA (Drs. Bonneville, Menuel, and Dormont), Centre d’Investigation Clinique and INSERM U 289 (Drs. Welter, Houeto, Bonnet, Mesnage, and Agid), Service de Biostatistique (Drs. Elie and Tezenas du Montcel), Service d’Explorations Fonctionnelles Neurologiques (Dr. Pidoux), and Service de Neurochirurgie (Drs. Navarro and Cornu), Hôpital de la Salpêtrière, Assistance-Publique-Hôpitaux de Paris, France.

Address correspondence and reprint requests to Dr. D. Dormont, Service de Neuroradiologie, Hôpital de la Salpêtrière, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France; e-mail: didier.dormont{at}psl.ap-hop-paris.fr

Background: High-frequency stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson disease (PD). The clinical and preoperative predictive factors of the best postoperative outcome have been identified. Radiologic predictive factors were investigated.

Methods: Forty patients with PD underwent surgery for bilateral STN stimulation. MRI was performed in stereotactic conditions before surgery. Brain parenchyma, caudate nucleus, putamen, pallidum, and red nucleus volumes and the surface of the mesencephalon were measured and normalized as percentages of the intracranial volume. Clinical evaluation was performed 1 month before and 6 months after surgery.

Results: The normalized brain parenchyma volume was lower in patients who were older and had a longer disease duration or a lower frontal score and was not predictive of the postoperative outcome. The residual scores for activities of daily living and parkinsonian motor disability were higher in patients with a smaller normalized mesencephalon. The normalized caudate nucleus volume was predictive of the pre- and postoperative levodopa-equivalent dosage.

Conclusions: Brain atrophy is not an exclusion criterion for neurosurgery, indicating that patients’ neurologic, psychiatric, and neuropsychological characteristics are the best predictive factors for neurosurgery. The fact that a smaller normalized mesencephalon surface was associated with a lower beneficial effect of the subthalamic nucleus stimulation on the parkinsonian motor disability suggests that the normalized mesencephalon surface is a predictive factor of the postoperative outcome.

*These authors contributed equally to this work.

Supported by INSERM, Assistance Publique–Hôpitaux de Paris, and the National Parkinson Foundation–Miami.

Received July 14, 2004. Accepted in final form January 18, 2005.






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