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Mana J, Bezdicek O, Růžička F, Lasica A, Šmídová A, Klempířová O, Nikolai T, Uhrová T, Růžička E, Urgošík D, Jech R. Preoperative cognitive profile predictive of cognitive decline after subthalamic deep brain stimulation in Parkinson's disease. Eur J Neurosci 2024. [PMID: 39212074 DOI: 10.1111/ejn.16521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 08/07/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
Cognitive decline represents a severe non-motor symptom of Parkinson's disease (PD) that can significantly reduce the benefits of subthalamic deep brain stimulation (STN DBS). Here, we aimed to describe post-surgery cognitive decline and identify pre-surgery cognitive profile associated with faster decline in STN DBS-treated PD patients. A retrospective observational study of 126 PD patients treated by STN DBS combined with oral dopaminergic therapy followed for 3.54 years on average (SD = 2.32) with repeated assessments of cognition was conducted. Pre-surgery cognitive profile was obtained via a comprehensive neuropsychological examination and data analysed using exploratory factor analysis and Bayesian generalized linear mixed models. On the whole, we observed a mild annual cognitive decline of 0.90 points from a total of 144 points in the Mattis Dementia Rating Scale (95% posterior probability interval [-1.19, -0.62]) with high inter-individual variability. However, true score changes did not reach previously reported reliable change cut-offs. Executive deficit was the only pre-surgery cognitive variable to reliably predict the rate of post-surgery cognitive decline. On the other hand, exploratory analysis of electrode localization did not yield any statistically clear results. Overall, our data and models imply mild gradual average annual post-surgery cognitive decline with high inter-individual variability in STN DBS-treated PD patients. Nonetheless, patients with worse long-term cognitive prognosis can be reliably identified via pre-surgery examination of executive functions. To further increase the utility of our results, we demonstrate how our models can help with disentangling true score changes from measurement error in future studies of post-surgery cognitive changes.
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Affiliation(s)
- Josef Mana
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Filip Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Andrej Lasica
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Anna Šmídová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Olga Klempířová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Tomáš Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Tereza Uhrová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Dušan Urgošík
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
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Bulut E, Johansen PM, Elbualy A, Kalman C, Mayer R, Kato N, Salmeron de Toledo Aguiar R, Pilitsis JG. How Long Does Deep Brain Stimulation Give Patients Benefit? Neuromodulation 2024:S1094-7159(24)00128-4. [PMID: 39001725 DOI: 10.1016/j.neurom.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION One of the most common questions patients ask when they are contemplating deep brain stimulation (DBS) is how long it will last. To guide physicians in answering this query, we performed a scoping review to assess the current state of the literature and to identify the gaps that need to be addressed. MATERIALS AND METHODS The authors performed a MEDLINE search inclusive of articles from January 1987 (advent of DBS literature) to June 2023 including human and modeling studies written in English. For longevity of therapy data, only studies with a mean follow-up of ≥three years were included. Using the Rayyan platform, two reviewers (JP and RM) performed a title screen. Of the 734 articles, 205 were selected by title screen and 109 from abstract review. Ultimately, a total of 122 articles were reviewed. The research questions we explored were 1) how long can the different components of the DBS system maintain functionality? and 2) how long can DBS remain efficacious in treating Parkinson's disease (PD), essential tremor (ET), dystonia, and other disorders? RESULTS We showed that patients with PD, ET, and dystonia maintain a considerable long-term benefit in motor scores seven to ten years after implant, although the percentage improvement decreases over time. Stimulation off scores in PD and ET show worsening, consistent with disease progression. Battery life varies by the disease treated and the programming settings used. There remains a paucity of literature after ten years, and the impact of new device technology has not been classified to date. CONCLUSION We reviewed existing data on DBS longevity. Overall, outcomes data after ten years of therapy are substantially limited in the current literature. We recommend that physicians who have data for patients with DBS exceeding this duration publish their results.
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Affiliation(s)
- Esin Bulut
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - P Mitchell Johansen
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Alya Elbualy
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Cheyenne Kalman
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ryan Mayer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Nicholas Kato
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Julie G Pilitsis
- Department of Neurosurgery, University of Arizona, Tucson, AZ, USA.
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Cavallieri F, Mulroy E, Moro E. The history of deep brain stimulation. Parkinsonism Relat Disord 2024; 121:105980. [PMID: 38161106 DOI: 10.1016/j.parkreldis.2023.105980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Deep brain stimulation (DBS) surgery is an established and effective treatment for several movement disorders (tremor, Parkinson's disease, and dystonia), and is under investigation in numerous other neurological and psychiatric disorders. However, the origins and development of this neurofunctional technique are not always well understood and recognized. In this mini-review, we review the history of DBS, highlighting important milestones and the most remarkable protagonists (neurosurgeons, neurologists, and neurophysiologists) who pioneered and fostered this therapy throughout the 20th and early 21st century. Alongside DBS historical markers, we also briefly discuss newer developments in the field, and the future challenges which accompany such progress.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France.
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Pereira GM, Soares NM, Rieder CRDM, Alva TAP. Stereotatic radiosurgery for the treatment of motor symptoms in Parkinson's disease: A systematic review. J Med Imaging Radiat Sci 2024; 55:146-157. [PMID: 38342737 DOI: 10.1016/j.jmir.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Stereotaxic Radiosurgery (SRS) is a non-invasive lesioning technique for movement disorders when patients cannot undergo DBS due to medical comorbidities. OBJECTIVE To describe and summarize the literature on SRS's application and physical parameters for Parkinson's disease (PD) motor symptoms. METHODS The MEDLINE/PUBMED and EMBASE databases were searched in July 2022 following the PRISMA guideline. Two independent reviewers screened data from 425 articles. The level of evidence followed the Oxford Centre for Evidence-Based Medicine. Pertinent details for each study regarding participants, physical parameters, and results were extracted. RESULTS Twelve studies reported that 454 PD patients underwent Gamma KnifeⓇ (GK). The mean improvement time of the treated symptoms was three months after GK. Tremor is the most common symptom investigated, with success rates ranging from 47.5% to 93.9%. Few studies were conducted for caudatotomy (GKC) and pallidotomy (GKP), which presented an improvement for dyskinesia and bradykinesia. Physical parameters were similar with doses ranging from 110 to 200 Gy, use of a 4-mm collimator with an advanced imaging locator system, and coordinates were obtained from available stereotactic atlases. CONCLUSIONS GK thalamotomy is a good alternative for treating tremor; however, its effects are delayed, and there are cases in which it can regress after years. The outcomes of GKC and GKP seem to be promising. The existing studies are more limited, and effects need to be better investigated.
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Affiliation(s)
- Gabriela Magalhães Pereira
- Exact and Applied Social Sciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil; Clinical research center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Nayron Medeiros Soares
- Exact and Applied Social Sciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil; Clinical research center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Roberto de Mello Rieder
- Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Thatiane Alves Pianoschi Alva
- Exact and Applied Social Sciences Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
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Jost ST, Aloui S, Evans J, Ashkan K, Sauerbier A, Rizos A, Petry-Schmelzer JN, Gronostay A, Fink GR, Visser-Vandewalle V, Antonini A, Silverdale M, Timmermann L, Martinez-Martin P, Chaudhuri KR, Dafsari HS. Neurostimulation for Advanced Parkinson Disease and Quality of Life at 5 Years: A Nonrandomized Controlled Trial. JAMA Netw Open 2024; 7:e2352177. [PMID: 38236600 PMCID: PMC10797423 DOI: 10.1001/jamanetworkopen.2023.52177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Deep brain stimulation of the subthalamic nucleus (STN-DBS) improves quality of life (QOL) in patients with advanced Parkinson disease (PD). However, controlled studies with more than 3 years of follow-up are lacking. Objective To investigate the long-term effects of STN-DBS on QOL compared with standard-of-care medication (MED). Design, Setting, and Participants In this prospective, observational, quasi-experimental, longitudinal nonrandomized controlled trial, 183 patients were screened for eligibility and 167 were enrolled from March 1, 2011, to May 31, 2017, at 3 European university centers. Propensity score matching for demographic and clinical characteristics was applied to 108 patients with PD (62 in the STN-DBS group and 46 in the MED group), resulting in a well-balanced, matched subcohort of 25 patients per group. Data analysis was performed from September 2022 to January 2023. Exposure Treatment for PD of STN-DBS or MED. Main Outcomes and Measures Assessments included Parkinson's Disease Questionnaire 8 (PDQ-8), Unified PD Rating Scale-motor examination, Scales for Outcomes in PD-activities of daily living (ADL) and motor complications, and levodopa-equivalent daily dose. Within-group longitudinal outcome changes, between-group differences, and correlations of change scores were analyzed. Results The study population in the analysis included 108 patients (mean [SD] age, 63.7 [8.3] years; 66 [61.1%] male). At 5-year follow-up, PDQ-8 and ADL worsened only in the MED group (PDQ-8 change, -10.9; 95% CI, -19.0 to -2.7; P = .01; ADL change: -2.0; 95% CI, -3.1 to -0.8; P = .002), whereas both outcomes remained stable in the STN-DBS group (PDQ-8 change, -4.3; 95% CI, -13.2 to 4.7; P = .34; ADL change, -0.8; 95% CI, -2.5 to 1.0; P = .38). Changes in PDQ-8 and ADL correlated moderately (rs = .40, P = .008). Furthermore, STN-DBS outcomes were favorable for motor complications (median difference in change scores between STN-DBS and MED, -2.0; 95% CI, -4.0 to -1.0; P = .003), mobility (-1.0; 95% CI, -2.0 to 0; P = .03), and levodopa-equivalent daily dose reduction (-821.4; 95% CI, -1111.9 to -530.8; P < .001). Conclusions and Relevance This study provides evidence of differences in QOL outcomes at 5-year follow-up between STN-DBS (stable) and MED (worsened), mainly driven by the favorable effect of STN-DBS on mobility (class IIb evidence). The association between changes in QOL and ADL, but not motor impairment or complications, highlights the relative importance of ADL outcomes for long-term DBS assessments. Trial Registration German ClinicalTrials Registry: DRKS00006735.
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Affiliation(s)
- Stefanie T. Jost
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Salima Aloui
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Anna Sauerbier
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Alexandra Gronostay
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Gereon R. Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - K. Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King’s College Hospital, London, UK
- Academic Health Science Centre, University of Manchester, Greater Manchester, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR Mental Health Biomedical Research Centre and Dementia Biomedical Research Unit, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Haidar S. Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
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Pal G, Corcos DM, Metman LV, Israel Z, Bergman H, Arkadir D. Cognitive Effects of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease with GBA1 Pathogenic Variants. Mov Disord 2023; 38:2155-2162. [PMID: 37916476 PMCID: PMC10990226 DOI: 10.1002/mds.29647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023] Open
Abstract
Genetic subtyping of patients with Parkinson's disease (PD) may assist in predicting the cognitive and motor outcomes of subthalamic deep brain stimulation (STN-DBS). Practical questions were recently raised with the emergence of new data regarding suboptimal cognitive outcomes after STN-DBS in individuals with PD associated with pathogenic variants in glucocerebrosidase gene (GBA1-PD). However, a variety of gaps and controversies remain. (1) Does STN-DBS truly accelerate cognitive deterioration in GBA1-PD? If so, what is the clinical significance of this acceleration? (2) How should the overall risk-to-benefit ratio of STN-DBS in GBA1-PD be established? (3) If STN-DBS has a negative effect on cognition in GBA1-PD, how can this effect be minimized? (4) Should PD patients be genetically tested before STN-DBS? (5) How should GBA1-PD patients considering STN-DBS be counseled? We aim to summarize the currently available relevant data and detail the gaps and controversies that exist pertaining to these questions. In the absence of evidence-based data, all authors strongly agree that clinicians should not categorically deny DBS to PD patients based solely on genotype (GBA1 status). We suggest that PD patients considering DBS may be offered genetic testing for GBA1, where available and feasible, so the potential risks and benefits of STN-DBS can be properly weighed by both the patient and clinician. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gian Pal
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
| | - Leo Verhagen Metman
- Parkinson’s Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zvi Israel
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel–Canada (IMRIC), The Hebrew University–Hadassah Medical School, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - David Arkadir
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
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Polat S, Erdem M, Çekinmez M. Comparison of Apathy and Cognitive Symptoms in Pre- and Postoperative Period in Deep Brain Stimulation Surgery. PSYCHIAT CLIN PSYCH 2023; 33:238-245. [PMID: 38765847 PMCID: PMC11037465 DOI: 10.5152/pcp.2023.23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/29/2023] [Indexed: 05/22/2024] Open
Abstract
Background The aim of the study was to investigatie apathy and cognitive functions in Parkinson's disease patients who underwent deep brain stimulation surgery on bilateral subthalamic nuclei. Methods This study included 18 patients with Parkinson's disease who were accommodated in the Parkinson's and Movement Disorders Center of Adana City Training and Research Hospital for treatment in 2022. Patients were evaluated by psychiatry, neurology and neurosurgery specialists with a multidisciplinary approach and found to be surgically appropriate. Standardized Mini-Mental Test and Montreal Cognitive Assessment Scale, Apathy Evaluation Scale, and Hamilton Anxiety and Depression Scale were administered to each patient before the operation and at 6 months after effective stimulation parameters were reached. Results The mean apathy score at the preoperative zeroth month was 47.77 ± 15.83 in patients having deep brain stimulation surgery and 30.83 ± 13.59 in the postoperative sixth month. Statistically that reduction was significant (P = .003) and showed clinical development. The average Hamilton Anxiety Scale scores at the preoperative zeroth month was 11.50 ± 5.14 and 10.22 ± 5.57 at the postoperative sixth month, with no clinical significance (P = .280). The determined value for the Unified Parkinson's Disease Rating Scale, on treatment, was 22.55 ± 7.53 in the preoperative zeroth month and 14.50 ± 6.99 in the postoperative sixth month, with statistical significance (P < .001). The Unified Parkinson's Disease Rating Scale, off treatment, score was revealed to be significant in the preoperative zeroth month (37.44 ± 9.85) in comparison to that of the postoperative sixth month (23.44 ± 7.86; P < .001). Conclusion This study showed that bilateral subthalamic stimulation improves nonmotor and motor symptoms in patients having Parkinson's disease. The mechanism is complex, and we believe that future studies focusing on pharmacological and nonpharmacological treatments involving more patient groups will be useful for clinicians.
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Affiliation(s)
- Selim Polat
- Department of Mental Health and Diseases, Adana City Training and Research Hospital, Adana, Turkey
| | - Miray Erdem
- Department of Neurology, Adana City Training and Research Hospital, Adana, Turkey
| | - Melih Çekinmez
- Department of Neurosurgery, Adana City Training and Research Hospital, Adana, Turkey
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Lee JM, Pak K. Comparison of UPDRS III score between young and late onset Parkinson disease after deep brain stimulation: A meta-analysis. Medicine (Baltimore) 2023; 102:e35861. [PMID: 37933060 PMCID: PMC10627674 DOI: 10.1097/md.0000000000035861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Parkinson disease (PD) is a common age-related neurodegenerative disease. Subthalamic nucleus deep brain stimulation (DBS) is a safe and effective surgical treatment for medically resistant advanced PD. However, the relationship between the age at PD onset and the efficacy of subthalamic nucleus DBS surgery remains unclear. Thus, we conducted a meta-analysis to compare motor symptom improvements after DBS for the treatment of young-onset and late-onset PD. METHODS We systematically searched the Medline and Embase databases (from inception to March 2023) for English publications. All published studies comparing the outcomes (Unified Parkinson's Disease Rating Scale part III [UPDRS III] scores) of DBS between the young-onset Parkinson disease (YOPD) and late-onset Parkinson disease (LOPD) groups were identified. The effect size was defined as the standardized mean difference (Hedge g) with 95% confidence intervals. The standardized mean difference was calculated by dividing the difference in UPDRS III scores between old and young patients by the pooled and weighted standard deviations. The meta-analysis was performed using R Statistical Software version 4.2.2 (The R Foundation for Statistical Computing). RESULTS Six studies were eligible for inclusion. The standardized mean difference of UPDRS III score between young and old patients ranged from -0.54 to 1.43 with a pooled difference of 0.0932 (95% confidence intervals: - 0.4666 to 0.6530, I2 = 86.77%). Subgroup analyses were performed with a cutoff age of 65 years and did not show a significant difference in UPDRS III scores between patients with YOPD and LOPD (0.1877, -0.6663 to 1.0417). CONCLUSIONS The efficacy of DBS in patients with YOPD and LOPD showed similar improvements in the UPDRS score; hence, DBS should be considered, if necessary, regardless of the onset age of PD.
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Affiliation(s)
- Jae Meen Lee
- Department of Neurosurgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
- School of Medicine, Pusan National University, Busan, Republic of Korea
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Dharnipragada R, Denduluri LS, Naik A, Bertogliat M, Awad M, Ikramuddin S, Park MC. Frequency settings of subthalamic nucleus DBS for Parkinson's disease: A systematic review and network meta-analysis. Parkinsonism Relat Disord 2023; 116:105809. [PMID: 37604755 DOI: 10.1016/j.parkreldis.2023.105809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Deep Brain Stimulation (DBS) is an effective treatment for the motor symptoms of Parkinson's Disease. The targeted physiological structure for lead location is commonly the subthalamic nucleus (STN). The efficacy of DBS for improving motor symptoms is assessed via the Unified Parkinson's Disease Rating III Scale (UPDRS-III). In this study, we sought to compare the efficacy of frequency settings utilized for STN-DBS. METHODS Following PRISMA Guidelines, a search on PUBMED and MEDLINE was performed to include full-length randomized controlled trials evaluating STN-DBS. The frequency stimulation parameters and Unified Parkinson's Disease Rating Scale (UPDRS-III) outcomes were extracted in the search. High-frequency stimulation (HFS) was defined as ≥100 Hz and low-frequency stimulation (LFS) was defined as <100 Hz. A frequentist network meta-analysis was performed with odds ratios (OR) and pooling performed using the Mantel-Haenszel method. Statistics are presented as OR [95% CI]. RESULTS 15 studies consisting of 298 patients were included for analysis. Bilateral HFS -0.68 [-0.89; -0.46] was associated with better UPDRS-III scores compared to bilateral LFS. On the other hand, bilateral LFS with medications (MEDS) was favored over HFS with MEDS (-0.28 [-0.63; 0.07]). Bilateral LFS and MEDS, HFS and MEDS, stimulation (STIM) OFF MEDS ON, HFS, LFS, STIM OFF MEDS OFF UPDRS outcomes were ranked from best to worst outcomes. DISCUSSION The outcomes of this study suggest that bilateral HFS has better utility for those with no response to medication, while LFS has additive benefits to medication by improving unique symptoms via different neurophysiological mechanisms.
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Affiliation(s)
- Rajiv Dharnipragada
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA.
| | - Lalitha S Denduluri
- College of Liberal Arts, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL, 61801, USA
| | - Mario Bertogliat
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Matthew Awad
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Salman Ikramuddin
- Department of Neurology, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Michael C Park
- Department of Neurology, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA; Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
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Dams J, Zapp JJ, König HH. Modelling the Cost Effectiveness of Treatments for Parkinson's Disease: An Updated Methodological Review. PHARMACOECONOMICS 2023; 41:1205-1228. [PMID: 37344724 PMCID: PMC10492764 DOI: 10.1007/s40273-023-01289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This article systematically reviewed the methodological quality of modelling approaches for economic evaluations of the treatment of motor symptoms in Parkinson's disease in studies published after 2010. METHODS A systematic literature search was undertaken using PubMed, EconLit, the Cochrane Database of Systematic Reviews, National Health Service Economic Evaluation Database and Health Technology Assessment databases of the UK National Health Service Centre for Review and Dissemination (March 2010 to July 2022). Quality was assessed using a checklist from the German Scientific Working Group. RESULTS A total of 20 studies were evaluated, with the majority based on Markov models (n = 18). Studies assessed the cost effectiveness of medical (n = 12) or surgical (n = 8) treatment, and included costs from a payer or healthcare provider's perspective (n = 17). Furthermore, all studies included quality-adjusted life-years as an effect measure. In the quality assessment of the literature, a mean score of 42.1 points (out of 56 points) on the checklist of the German Scientific Working Group was achieved. Seventeen studies concluded the intervention under study was (likely) cost effective. No intervention was classified as cost ineffective. CONCLUSIONS The quality of economic evaluation models in Parkinson's disease has improved in terms of calculating cost and transition parameters, as well as carrying out probabilistic sensitivity analyses, compared with the published literature of previous systematic reviews up to 2010. However, there is still potential for further development in terms of the integration of non-motor complications and treatment changes, the transparent presentation of parameter estimates, as well as conducting sensitivity analyses and validations to support the interpretation of results.
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany.
| | - Johann-Jacob Zapp
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistraße 52, 20246, Hamburg, Germany
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11
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Dharnipragada R, Denduluri LS, Naik A, Bertogliat M, Awad M, Ikramuddin S, Park MC. WITHDRAWN: Laterality and frequency settings of subthalamic nucleus DBS for Parkinson's disease: A systematic review and network meta-analysis. Parkinsonism Relat Disord 2023:105455. [PMID: 37321937 DOI: 10.1016/j.parkreldis.2023.105455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Rajiv Dharnipragada
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA.
| | - Lalitha S Denduluri
- College of Liberal Arts, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL, 61801, USA
| | - Mario Bertogliat
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Matthew Awad
- University of Minnesota Medical School, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Salman Ikramuddin
- Department of Neurology, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
| | - Michael C Park
- Department of Neurology, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA; Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN, 55455, USA
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12
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Park HR, Im HJ, Park J, Yoon BW, Lim YH, Song EJ, Kim KR, Lee JM, Park K, Park KH, Park HJ, Shin JH, Woo KA, Lee JY, Park S, Kim HJ, Jeon B, Paek SH. Long-Term Outcomes of Bilateral Subthalamic Nucleus Deep Brain Stimulation for Patients With Parkinson's Disease: 10 Years and Beyond. Neurosurgery 2022; 91:726-733. [PMID: 36084204 DOI: 10.1227/neu.0000000000002117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) represents an effective treatment for severe Parkinson's disease (PD), but little is known about the long-term benefit. OBJECTIVE To investigate the survival rate and long-term outcome of DBS. METHODS We investigated all 81 patients including 37 males and 44 females who underwent bilateral STN DBS from March 2005 to March 2008 at a single institution. The current survival status of the patients was investigated. Preoperative and postoperative follow-up assessments were analyzed. RESULTS The mean age at the time of surgery was 62 (range 27-82) years, and the median clinical follow-up duration was 145 months. Thirty-five patients (43%) died during the follow-up period. The mean duration from DBS surgery to death was 110.46 ± 40.8 (range 0-155) months. The cumulative survival rate is as follows: 98.8 ± 1.2% (1 year), 95.1 ± 2.4% (5 years), and 79.0 ± 4.5% (10 years). Of the 81 patients, 33 (40%) were ambulatory up to more than 11 years. The Unified Parkinson's Disease Rating Scale (UPDRS) score was significantly improved until 5 years after surgery although it showed a tendency to increase again after 10 years. The patient group with both electrodes located within the STN showed a higher rate of survival and maintained ambulation. CONCLUSION STN DBS is a safe and effective treatment for patients with advanced PD. This study based on the long-term follow-up of large patient populations can be used to elucidate the long-term fate of patients who underwent bilateral STN DBS for PD.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyung-Jun Im
- Department of Applied Bioengineering, Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jeongbin Park
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Byung Woo Yoon
- Department of Internal Medicine, School of Medicine, Chung-Ang University, Seoul, Korea
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Eun Jin Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung Ran Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang Hyon Park
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Hyun Joo Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jung-Hwan Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Seoul, Korea.,Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.,Hypoxia/Ischemia Disease Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Advanced Institutes of Convergence Technology, Suwon-si, Gyeonggi-do, Korea
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13
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Hayashi Y, Mishima T, Fujioka S, Morishita T, Inoue T, Nagamachi S, Tsuboi Y. Unilateral GPi-DBS Improves Ipsilateral and Axial Motor Symptoms in Parkinson’s Disease as Evidenced by a Brain Perfusion Single Photon Emission Computed Tomography Study. Front Hum Neurosci 2022; 16:888701. [PMID: 35634204 PMCID: PMC9130959 DOI: 10.3389/fnhum.2022.888701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Deep brain stimulation (DBS) is an effective treatment for advanced Parkinson’s disease (PD) with the targeting bilateral subthalamic nucleus or globus pallidus internus (STN or GPi-DBS). So far, detailed studies on the efficacy of unilateral STN-DBS for motor symptoms have been reported, but few studies have been conducted on unilateral GPi-DBS. Materials and Methods Seventeen patients with Parkinson’s disease (PwPD) who underwent unilateral GPi-DBS were selected. We conducted comparison analyses between scores obtained 6–42 months pre- and postoperatively using the following measurement tools: the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part III, the Hoehn and Yahr stage, the presence/absence of dyskinesia, Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), Geriatric Depression Scale (GDS), levodopa equivalent dose (LED), and cerebral blood flow by single photon emission computed tomography (SPECT). Patient backgrounds were compared between four cohorts with favorable (good responders, ≥50% improvement) and unfavorable (poor responders, <50% improvement) postoperative outcome. Results Significant improvement was observed postoperatively in the following: total MDS-UPDRS Part III scores during the off period, contralateral scores, ipsilateral scores, and axial scores. Similarly, the Hoehn and Yahr stages during the off period, and GDS also showed significant decrease. In contrast, LED, MMSE, and FAB remained unchanged while the number of patients who scored positive for dyskinesia decreased by 40%. Abnormal cerebral blood flow preoperatively seen in the cerebral cortex had normalized in the total score-based good responder cohort. In the ipsilateral score-based good responder cohort, cerebral blood flow increased in the contralateral frontal lobe including in the premotor cortex, contralateral to the DBS. Compared to the poor responders, postoperative good responders demonstrated significantly higher preoperative MMSE scores. Discussion Unilateral GPi-DBS therapy was effective in improving contralateral, ipsilateral, and axial motor symptoms of patients with advanced PD; in particular, it was found to be especially beneficial in PwPD whose cognitive function was unimpaired; the treatment efficacy rivaled that of bilateral counterparts up till at least 6 months postoperatively. Finally, normalization of preoperative abnormalities in cerebral blood flow and increased cerebral blood flow in the contralateral frontal lobe indicated the beneficial potential of this therapy on ipsilateral motor symptoms.
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Affiliation(s)
- Yuka Hayashi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takayasu Mishima
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- *Correspondence: Takayasu Mishima,
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shigeki Nagamachi
- Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Yoshio Tsuboi,
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Erdman HB, Kornilov E, Kahana E, Zarchi O, Reiner J, Socher A, Strauss I, Firman S, Israel Z, Bergman H, Tamir I. Asleep DBS under ketamine sedation: Proof of concept. Neurobiol Dis 2022; 170:105747. [PMID: 35550159 DOI: 10.1016/j.nbd.2022.105747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/28/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to optimize brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS borders and subdomains based on electrophysiological properties like firing rates and patterns, intra-operative evaluation of therapeutic window, and improvement of lead placement accuracy. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties and interference with clinical testing, resulting in potential impact on surgical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. OBJECTIVE This open-label study investigates the use of low-dose ketamine for conscious sedation during microelectrode recordings and lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. METHODS Three anesthetic regimens were retrospectively compared in 38 surgeries (74 MER trajectories, 5962 recording sites) across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). RESULTS All anesthesia regimens achieved satisfactory MER. Detection of STN borders and subdomains by expert electrophysiologist was similar between the groups. Electrophysiological signature of the STN under ketamine was not inferior to either control group. All patients completed stimulation testing. CONCLUSIONS This study supports a low-dose ketamine anesthesia regimen for DBS which allows microelectrode recordings and stimulation testing that are not inferior to those conducted under awake and propofol-awake regimens and may optimize patient experience. A prospective double-blind study that would also compare patients' satisfaction level and clinical outcome should be performed to confirm these findings.
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Affiliation(s)
- Halen Baker Erdman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel.
| | - Evgeniya Kornilov
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel; Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Eilat Kahana
- Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Omer Zarchi
- Intraoperative Neurophysiology Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Johnathan Reiner
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel
| | - Achinoam Socher
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shimon Firman
- Department of Anesthesiology, Critical Care Medicine, and Pain Management, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Zvi Israel
- Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel; Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel; The Edmond and Lily Safra Center for Brain Sciences, Hebrew University, Jerusalem, Israel
| | - Idit Tamir
- Department of Neurosurgery, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
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15
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Silverio AA, Silverio LAA. Developments in Deep Brain Stimulators for Successful Aging Towards Smart Devices—An Overview. FRONTIERS IN AGING 2022; 3:848219. [PMID: 35821845 PMCID: PMC9261350 DOI: 10.3389/fragi.2022.848219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 12/02/2022]
Abstract
This work provides an overview of the present state-of-the-art in the development of deep brain Deep Brain Stimulation (DBS) and how such devices alleviate motor and cognitive disorders for a successful aging. This work reviews chronic diseases that are addressable via DBS, reporting also the treatment efficacies. The underlying mechanism for DBS is also reported. A discussion on hardware developments focusing on DBS control paradigms is included specifically the open- and closed-loop “smart” control implementations. Furthermore, developments towards a “smart” DBS, while considering the design challenges, current state of the art, and constraints, are also presented. This work also showcased different methods, using ambient energy scavenging, that offer alternative solutions to prolong the battery life of the DBS device. These are geared towards a low maintenance, semi-autonomous, and less disruptive device to be used by the elderly patient suffering from motor and cognitive disorders.
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Affiliation(s)
- Angelito A. Silverio
- Department of Electronics Engineering, University of Santo Tomas, Manila, Philippines
- Research Center for the Natural and Applied Sciences, University of Santo Tomas, Manila, Philippines
- *Correspondence: Angelito A. Silverio,
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16
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Fernández-García C, Monje MH, Gómez-Mayordomo V, Foffani G, Herranz R, Catalán MJ, González-Hidalgo M, Matias-Guiu J, Alonso-Frech F. Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming. Brain Stimul 2022; 15:727-736. [DOI: 10.1016/j.brs.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 01/16/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022] Open
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17
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Steinhardt J, Hanssen H, Heldmann M, Neumann A, Münchau A, Schramm P, Rasche D, Saryyeva A, Büntjen L, Voges J, Tronnier V, Krauss JK, Münte TF, Brüggemann N. Sweets for my sweet: modulation of the limbic system drives salience for sweet foods after deep brain stimulation in Parkinson's disease. J Neurol Neurosurg Psychiatry 2022; 93:324-331. [PMID: 34911783 DOI: 10.1136/jnnp-2021-326280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND An increase in body weight is observed in the majority of patients with Parkinson's disease (PD) who undergo deep brain stimulation (DBS) of the subthalamic nucleus (STN) although the mechanisms are unclear. OBJECTIVES To identify the stimulation-dependent effects on reward-associated and attention-associated neural networks and to determine whether these alterations in functional connectivity are associated with the local impact of DBS on different STN parcellations. METHODS We acquired functional task-related MRI data from 21 patients with PD during active and inactive STN DBS and 19 controls while performing a food viewing paradigm. Electrode placement in the STN was localised using a state-of-the-art approach. Based on the 3D model, the local impact of STN DBS was estimated. RESULTS STN DBS resulted in a mean improvement of motor function of 22.6%±15.5% (on medication) and an increase of body weight of ~4 kg within 2 years of stimulation. DBS of the limbic proportion of the STN was associated with body weight gain and an increased functional connectivity within the salience network and at the same time with a decreased activity within the reward-related network in the context of sweet food images. CONCLUSIONS Our findings indicate increased selective attention for high-caloric foods and a sweet food seeking-like behaviour after DBS particularly when the limbic proportion of the STN was stimulated.
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Affiliation(s)
- Julia Steinhardt
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Henrike Hanssen
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | | | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Peter Schramm
- Institute of Neuroradiology, University of Lübeck, Lübeck, Germany
| | - Dirk Rasche
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Hannover Medical School, Hanover, Niedersachsen, Germany
| | - Lars Büntjen
- Department of Neurology and Stereotactic Neurosurgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jürgen Voges
- Department of Neurology and Stereotactic Neurosurgery, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Leibniz Institute of Neurobiology, Magdeburg, Germany
| | - Volker Tronnier
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hanover, Niedersachsen, Germany
| | - Thomas F Münte
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany .,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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18
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Wagner JR, Schaper M, Hamel W, Westphal M, Gerloff C, Engel AK, Moll CKE, Gulberti A, Pötter-Nerger M. Combined Subthalamic and Nigral Stimulation Modulates Temporal Gait Coordination and Cortical Gait-Network Activity in Parkinson's Disease. Front Hum Neurosci 2022; 16:812954. [PMID: 35295883 PMCID: PMC8919031 DOI: 10.3389/fnhum.2022.812954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/27/2022] [Indexed: 01/10/2023] Open
Abstract
Background Freezing of gait (FoG) is a disabling burden for Parkinson's disease (PD) patients with poor response to conventional therapies. Combined deep brain stimulation of the subthalamic nucleus and substantia nigra (STN+SN DBS) moved into focus as a potential therapeutic option to treat the parkinsonian gait disorder and refractory FoG. The mechanisms of action of DBS within the cortical-subcortical-basal ganglia network on gait, particularly at the cortical level, remain unclear. Methods Twelve patients with idiopathic PD and chronically-implanted DBS electrodes were assessed on their regular dopaminergic medication in a standardized stepping in place paradigm. Patients executed the task with DBS switched off (STIM OFF), conventional STN DBS and combined STN+SN DBS and were compared to healthy matched controls. Simultaneous high-density EEG and kinematic measurements were recorded during resting-state, effective stepping, and freezing episodes. Results Clinically, STN+SN DBS was superior to conventional STN DBS in improving temporal stepping variability of the more affected leg. During resting-state and effective stepping, the cortical activity of PD patients in STIM OFF was characterized by excessive over-synchronization in the theta (4-8 Hz), alpha (9-13 Hz), and high-beta (21-30 Hz) band compared to healthy controls. Both active DBS settings similarly decreased resting-state alpha power and reduced pathologically enhanced high-beta activity during resting-state and effective stepping compared to STIM OFF. Freezing episodes during STN DBS and STN+SN DBS showed spectrally and spatially distinct cortical activity patterns when compared to effective stepping. During STN DBS, FoG was associated with an increase in cortical alpha and low-beta activity over central cortical areas, while with STN+SN DBS, an increase in high-beta was prominent over more frontal areas. Conclusions STN+SN DBS improved temporal aspects of parkinsonian gait impairment compared to conventional STN DBS and differentially affected cortical oscillatory patterns during regular locomotion and freezing suggesting a potential modulatory effect on dysfunctional cortical-subcortical communication in PD.
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Affiliation(s)
- Jonas R. Wagner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas K. Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K. E. Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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19
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Jahanshahi M, Leimbach F, Rawji V. Short and Long-Term Cognitive Effects of Subthalamic Deep Brain Stimulation in Parkinson's Disease and Identification of Relevant Factors. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2191-2209. [PMID: 36155529 DOI: 10.3233/jpd-223446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) successfully controls the motor symptoms of Parkinson's disease (PD) but has associated cognitive side-effects. OBJECTIVE Establish the short- and long-term cognitive effects of STN-DBS in PD. METHODS Both the short-term and long-term effects of STN-DBS on cognition were examined through evaluation of the controlled studies that compared patients with STN-DBS to unoperated PD patients, thus controlling for illness progression. We also reviewed the literature to identify the factors that influence cognitive outcome of STN-DBS in PD. RESULTS The meta-analysis of the short-term cognitive effects of STN-DBS revealed moderate effect sizes for semantic and phonemic verbal fluency and small effect sizes for psychomotor speed and language, indicating greater decline in the STN-DBS operated than the unoperated patients in these cognitive domains. The longer-term STN-DBS results from controlled studies indicated rates of cognitive decline/dementia up to 32%; which are no different from the rates from the natural progression of PD. Greater executive dysfunction and poorer memory pre-operatively, older age, higher pre-operative doses of levodopa, and greater axial involvement are some of the factors associated with worse cognition after STN-DBS in PD. CONCLUSION This evidence can be used to inform patients and their families about the short-term and long-term risks of cognitive decline following STN-DBS surgery and aid the team in selection of suitable candidates for surgery.
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Affiliation(s)
- Marjan Jahanshahi
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, The National Hospital for Neurology & Neurosurgery, London, UK
| | - Friederike Leimbach
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, The National Hospital for Neurology & Neurosurgery, London, UK
| | - Vishal Rawji
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, The National Hospital for Neurology & Neurosurgery, London, UK
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20
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Lin Z, Zhang C, Li D, Sun B. Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2021; 9:140-155. [PMID: 35146054 DOI: 10.1002/mdc3.13379] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Research Center for Brain Science and Brain‐Inspired Intelligence Shanghai China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
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21
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Amoozegar S, Pooyan M, Roghani M. Identification of effective features of LFP signal for making closed-loop deep brain stimulation in parkinsonian rats. Med Biol Eng Comput 2021; 60:135-149. [PMID: 34775553 DOI: 10.1007/s11517-021-02470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/06/2021] [Indexed: 02/01/2023]
Abstract
Traditional deep brain stimulation (DBS) is one of the acceptable methods to relieve the clinical symptoms of Parkinson's disease in its advanced stages. Today, the use of closed-loop DBS to increase stimulation efficiency and patient satisfaction is one of the most important issues under investigation. The present study was aimed to find local field potential (LFP) features of parkinsonian rats, which can determine the timing of stimulation with high accuracy. The LFP signals from rats were recorded in three groups of parkinsonian rat models receiving stimulation (stimulation), without getting stimulation (off-stimulation), and sham-controlled group. The frequency domain and chaotic features of signals were extracted for classifying three classes by support vector machine (SVM) and neural networks. The best combination of features was selected using the genetic algorithm (GA). Finally, the effective features were introduced to determine the on/off stimulation time, and the optimal stimulation parameters were identified. It was found that a combination of frequency domain and chaotic features with an accuracy of about 99% was able to determine the time the DBS must switch on. In about 80.67% of the 1861 different stimulation parameters, the brain was able to maintain its state for about 3 min after stimulation discontinuation.
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Affiliation(s)
- Sana Amoozegar
- Department of Biomedical Engineering, Faculty of Engineering, Shahed University, Tehran, Iran
| | - Mohammad Pooyan
- Department of Biomedical Engineering, Faculty of Engineering, Shahed University, Tehran, Iran.
| | - Mehrdad Roghani
- Neurophysiology Research Center, Shahed University, Tehran, Iran
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22
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Brozova H, Barnaure I, Ruzicka E, Stochl J, Alterman R, Tagliati M. Short- and Long-Term Effects of DBS on Gait in Parkinson's Disease. Front Neurol 2021; 12:688760. [PMID: 34690908 PMCID: PMC8531078 DOI: 10.3389/fneur.2021.688760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022] Open
Abstract
The aim was to compare the short and long-term effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on gait dysfunction and other cardinal symptoms of Parkinson's disease (PD). Two groups of patients were studied. The first group (short-term DBS, n = 8) included patients recently implanted with STN DBS (mean time since DBS 15.8 months, mean age 58.8 years, PD duration 13 years); the second group (long-term DBS, n = 10) included patients with at least 5 years of DBS therapy (mean time since DBS 67.6 months, mean age 61.7 years, PD duration 17.1 years). Both groups were examined using the Unified Parkinson's Disease Rating Scale (UPDRS) and Gait and Balance scale (GABS) during four stimulation/medication states (ON/OFF; OFF/OFF; OFF/ON; ON/ON). Data were analyzed using repeated measures ANOVA with time since implantation (years) between groups and medication or DBS effect (ON, OFF) within groups. In the short-term DBS group, stimulation improved all UPDRS subscores similar to dopaminergic medications. In particular, average gait improvement was over 40% (p = 0.01), as measured by the UPDRS item 29 and GABS II. In the long-term DBS group, stimulation consistently improved all clinical subscores with the exception of gait and postural instability. In these patients, the effect of levodopa on gait was partially preserved. Short-term improvement of gait abnormalities appears to significantly decline after 5 years of STN DBS in PD patients, while effectiveness for other symptoms remains stable. Progressive non-dopaminergic (non-DBS responsive) mechanisms or deleterious effects of high frequency STN stimulation on gait function may play a role.
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Affiliation(s)
- Hana Brozova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Isabelle Barnaure
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Evzen Ruzicka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jan Stochl
- Department of Kinanthropology, Charles University in Prague, Prague, Czechia.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Ron Alterman
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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23
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Anderson RW, Wilkins KB, Parker JE, Petrucci MN, Kehnemouyi Y, Neuville RS, Cassini D, Trager MH, Koop MM, Velisar A, Blumenfeld Z, Quinn EJ, Henderson J, Bronte-Stewart HM. Lack of progression of beta dynamics after long-term subthalamic neurostimulation. Ann Clin Transl Neurol 2021; 8:2110-2120. [PMID: 34636182 PMCID: PMC8607445 DOI: 10.1002/acn3.51463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/15/2021] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To investigate the progression of neural and motor features of Parkinson's disease in a longitudinal study, after washout of medication and bilateral subthalamic nucleus deep brain stimulation (STN DBS). METHODS Participants with clinically established Parkinson's disease underwent bilateral implantation of DBS leads (18 participants, 13 male) within the STN using standard functional frameless stereotactic technique and multi-pass microelectrode recording. Both DBS leads were connected to an implanted investigative sensing neurostimulator (Activa™ PC + S, Medtronic, PLC). Resting state STN local field potentials (LFPs) were recorded and motor disability, (the Movement Disorder Society-Unified Parkinson's Disease Rating Scale - motor subscale, MDS-UPDRS III) was assessed off therapy at initial programming, and after 6 months, 1 year, and yearly out to 5 years of treatment. The primary endpoint was measured at 3 years. At each visit, medication had been held for over 12/24 h and DBS was turned off for at least 60 min, by which time LFP spectra reached a steady state. RESULTS After 3 years of chronic DBS, there were no increases in STN beta band dynamics (p = 0.98) but there were increases in alpha band dynamics (p = 0.0027, 25 STNs). Similar results were observed in a smaller cohort out to 5 years. There was no increase in the MDS-UPDRS III score. INTERPRETATION These findings provide evidence that the beta oscillopathy does not substantially progress following combined STN DBS plus medication in moderate to advanced Parkinson's disease.
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Affiliation(s)
- Ross W Anderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Department of Neurosurgery, Kaiser Permanente, Redwood City, California, USA
| | - Kevin B Wilkins
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jordan E Parker
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Department of Psychology, The University of California, Los Angeles, California, USA
| | - Matthew N Petrucci
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Yasmine Kehnemouyi
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Department of Bioengineering, Stanford Schools of Engineering & Medicine, Stanford, California, USA
| | - Raumin S Neuville
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,The University of California School of Medicine, Irvine, California, USA
| | - Declan Cassini
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Megan H Trager
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Columbia University College of Physicians and Surgeons, New York City, New York, USA
| | - Mandy M Koop
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Cleveland Clinic, Cleveland, Ohio, USA
| | - Anca Velisar
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,The Smith-Kettlewell Eye Research Institute, San Francisco, California, USA
| | - Zack Blumenfeld
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,California Institute of Technology, Pasadena, California, USA
| | - Emma J Quinn
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Credit Karma, San Francisco, California, USA
| | - Jaimie Henderson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Helen M Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
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24
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Golfrè Andreasi N, Romito LM, Telese R, Cilia R, Elia AE, Novelli A, Tringali G, Messina G, Levi V, Devigili G, Rinaldo S, Franzini AA, Eleopra R. Short- and long-term motor outcome of STN-DBS in Parkinson's Disease: focus on sex differences. Neurol Sci 2021; 43:1769-1781. [PMID: 34499244 DOI: 10.1007/s10072-021-05564-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for patients with Parkinson's disease (PD) with motor complications; the contribution of sex in determining the outcome is still not understood. METHODS We included 107 patients (71 males) with PD consecutively implanted with STN-DBS at our center. We reviewed patient charts from our database and retrospectively collected demographical and clinical data at baseline and at three follow-up visits (1, 5 and 10 years). RESULTS We found a long-lasting effect of DBS on motor complications, despite a progressive worsening of motor performances in the ON medication condition. Bradykinesia and non-dopaminergic features seem to be the major determinant of this progression. Conversely to males, females showed a trend towards worsening in bradykinesia already at 1-year follow-up and poorer scores in non-dopaminergic features at 10-year follow-up. Levodopa Equivalent Daily Dose (LEDD) was significantly reduced after surgery compared to baseline values; however, while in males LEDD remained significantly lower than baseline even 10 years after surgery, in females LEDD returned at baseline values. Males showed a sustained effect on dyskinesias, but this benefit was less clear in females; the total electrical energy delivered was consistently lower in females compared to males. The profile of adverse events did not appear to be influenced by sex. CONCLUSION Our data suggest that there are no major differences on the motor effect of STN-DBS between males and females. However, there may be some slight differences that should be specifically investigated in the future and that may influence therapeutic decisions in the chronic follow-up.
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Affiliation(s)
- Nico Golfrè Andreasi
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy.
| | - Luigi Michele Romito
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Roberta Telese
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Roberto Cilia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Antonio Emanuele Elia
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Alessio Novelli
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Giovanni Tringali
- Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Giuseppe Messina
- Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Vincenzo Levi
- Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Grazia Devigili
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Sara Rinaldo
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Angelo Amato Franzini
- Neurosurgery Department, Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
| | - Roberto Eleopra
- Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, via G. Celoria 11, 20133, Milano, Italy
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25
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Lachenmayer ML, Mürset M, Antih N, Debove I, Muellner J, Bompart M, Schlaeppi JA, Nowacki A, You H, Michelis JP, Dransart A, Pollo C, Deuschl G, Krack P. Subthalamic and pallidal deep brain stimulation for Parkinson's disease-meta-analysis of outcomes. NPJ PARKINSONS DISEASE 2021; 7:77. [PMID: 34489472 PMCID: PMC8421387 DOI: 10.1038/s41531-021-00223-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 08/12/2021] [Indexed: 12/26/2022]
Abstract
Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) and the subthalamic nucleus (STN) has become an established treatment for Parkinson’s disease (PD), a recent meta-analysis of outcomes is lacking. To address this gap, we performed a meta-analysis of bilateral STN- and GPi-DBS studies published from 1990-08/2019. Studies with ≥10 subjects reporting Unified Parkinson’s Disease Rating Scale (UPDRS) III motor scores at baseline and 6–12 months follow-up were included. Several outcome variables were analyzed and adverse events (AE) were summarized. 39 STN studies (2035 subjects) and 5 GPi studies (292 subjects) were eligible. UPDRS-II score after surgery in the stimulation-ON/medication-OFF state compared to preoperative medication-OFF state improved by 47% with STN-DBS and 18.5% with GPi-DBS. UPDRS-III score improved by 50.5% with STN-DBS and 29.8% with GPi-DBS. STN-DBS improved dyskinesia by 64%, daily OFF time by 69.1%, and quality of life measured by PDQ-39 by 22.2%, while Levodopa Equivalent Daily Dose (LEDD) was reduced by 50.0%. For GPi-DBS information regarding dyskinesia, OFF time, PDQ-39 and LEDD was insufficient for further analysis. Correlation analysis showed that preoperative L-dopa responsiveness was highly predictive of the STN-DBS motor outcome across all studies. Most common surgery-related AE were infection (5.1%) and intracranial hemorrhage (3.1%). Despite a series of technological advances, outcomes of modern surgery are still comparable with those of the early days of DBS. Recent changes in target selection with a preference of GPi in elderly patients with cognitive deficits and more psychiatric comorbidities require more published data for validation.
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Affiliation(s)
- M Lenard Lachenmayer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Melina Mürset
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Ines Debove
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia Muellner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Janine-Ai Schlaeppi
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hana You
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joan P Michelis
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Claudio Pollo
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Guenther Deuschl
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Paul Krack
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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26
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Bove F, Mulas D, Cavallieri F, Castrioto A, Chabardès S, Meoni S, Schmitt E, Bichon A, Di Stasio E, Kistner A, Pélissier P, Chevrier E, Seigneuret E, Krack P, Fraix V, Moro E. Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease. Neurology 2021; 97:e254-e262. [PMID: 34078713 DOI: 10.1212/wnl.0000000000012246] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) on motor complications in patients with Parkinson disease (PD) beyond 15 years after surgery. METHODS Data on motor complications, quality of life (QoL), activities of daily living, Unified Parkinson's Disease Rating Scale motor scores, dopaminergic treatment, stimulation measures, and side effects of STN-DBS were retrospectively retrieved and compared before surgery, at 1 year, and beyond 15 years after bilateral STN-DBS. RESULTS Fifty-one patients with 17.06 ± 2.18 years STN-DBS follow-up were recruited. Compared to baseline, the time spent with dyskinesia and the time spent in the "off" state were reduced by 75% (p < 0.001) and by 58.7% (p < 0.001), respectively. Moreover, dopaminergic drugs were reduced by 50.6% (p < 0.001). Parkinson's Disease Quality of Life Questionnaire total score and the emotional function and social function domains improved 13.8% (p = 0.005), 13.6% (p = 0.01), and 29.9% (p < 0.001), respectively. Few and mostly manageable device-related adverse events were observed during the follow-up. CONCLUSIONS STN-DBS is effective beyond 15 years from the intervention, notably with significant improvement in motor complications and stable reduction of dopaminergic drugs. Furthermore, despite the natural continuous progression of PD with worsening of levodopa-resistant motor and nonmotor symptoms over the years, patients undergoing STN-DBS could maintain an improvement in QoL. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that, for patients with PD, STN-DBS remains effective at treating motor complications 15 years after surgery.
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Affiliation(s)
- Francesco Bove
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Delia Mulas
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Francesco Cavallieri
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Anna Castrioto
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Stephan Chabardès
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Sara Meoni
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Emmanuelle Schmitt
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Amélie Bichon
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Enrico Di Stasio
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Andrea Kistner
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Pierre Pélissier
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Eric Chevrier
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Eric Seigneuret
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Paul Krack
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Valerie Fraix
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Elena Moro
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland.
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Grassi G, Albani G, Terenzi F, Razzolini L, Ramat S. New pharmacological and neuromodulation approaches for impulsive-compulsive behaviors in Parkinson's disease. Neurol Sci 2021; 42:2673-2682. [PMID: 33852081 DOI: 10.1007/s10072-021-05237-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A significant proportion of patients with Parkinson's disease (PD) display a set of impulsive-compulsive behaviors at some point during the course of illness. These behaviors range from the so-called behavioral addictions to dopamine dysregulation syndrome, punding and hoarding disorders. These behaviors have been consistently linked to the use of dopaminergic medications used to treat PD motor symptoms (dopamine agonists, levodopa, and other agents) and less consistently to neuromodulation techniques such as deep brain stimulation (DBS). Since there are still no approved treatments for these conditions, their pharmacological management is still a big challenge for clinicians. METHODS We conducted an extensive review of current pharmacological and neuromodulation literature for the management of impulsive-compulsive disorders in PD patients. RESULTS Pharmacological treatment approaches for impulsive-compulsive behaviors and DDS in PD patients include reduction of levodopa (LD), reduction/cessation of dopamine agonist (DA), and initiation of infusion therapies (apomorphine infusion and duodopa). Also, atomoxetine, a noradrenergic agent approved for the treatment of attention deficit hyperactivity disorder, showed some interesting preliminary results but there is still a lack of controlled longitudinal studies. Finally, while DBS effects on impulsive-compulsive disorders are still controversial, non-invasive techniques (such as transcranial magnetic stimulation and transcranial direct current stimulation) could have a potential positive effect but, again, there is still a lack of controlled trials. CONCLUSION Managing impulsivity and compulsivity in PD patients is still a non-evidence-based challenge for clinicians. Controlled trials on promising approaches such as atomoxetine and non-invasive neuromodulation techniques are needed.
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Affiliation(s)
- Giacomo Grassi
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.
| | | | | | - Lorenzo Razzolini
- Brain Center Firenze, Viale Belfiore 36, 5014, Florence, Italy.,University of Florence, Florence, Italy
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Krishnan S, Shetty K, Puthanveedu DK, Kesavapisharady K, Thulaseedharan JV, Sarma G, Kishore A. Apraxia of Lid Opening in Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease-Frequency, Risk Factors and Response to Treatment. Mov Disord Clin Pract 2021; 8:587-593. [PMID: 33981792 DOI: 10.1002/mdc3.13206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 11/06/2022] Open
Abstract
Background New-onset apraxia of lid opening (ALO) is reported to occur in Parkinson's disease (PD) patients following Deep Brain Stimulation (DBS). There are only few systematic studies on this uncommon disorder of eyelid movements. Objectives We aimed to examine the frequency, temporal evolution, predisposing factors and response to treatment, of new-onset ALO in PD patients who underwent bilateral subthalamic nucleus (STN) DBS. Methods We retrospectively reviewed the data of patients who underwent STN DBS at our centre between 1999 and 2017, with a minimum of 2 years of follow up after surgery. Results New-onset ALO was seen in 17 (9.1%) of the 187 patients after an average of 16.9 months (Range - 6-36 months). Comparison of the groups with and without ALO revealed that ALO occurred more often in older patients, both at the onset of PD symptoms and at surgery and in those with non-tremor dominant subtypes of PD and freezing of gait at baseline. The extent of levodopa dose reduction after surgery and the pre-operative severity of motor symptoms were not risk factors. Response to adjustments of dopaminergic medications and stimulation parameters was ill-sustained or nil. Botulinum toxin therapy resulted in satisfactory improvement in the majority. Conclusions New-onset ALO is an uncommon phenomenon that manifests months after STN DBS. Development of ALO is likely to be due to the effects of chronic stimulation of basal ganglia-thalamo-cortical or brain stem circuits controlling lid movements in susceptible patients. Botulinum toxin therapy offers relatively better relief of symptoms than other strategies.
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Affiliation(s)
- Syam Krishnan
- Comprehensive Care Centre for Movement Disorders Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram Kerala India
| | - Kuldeep Shetty
- Comprehensive Care Centre for Movement Disorders Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram Kerala India
| | - Divya Kalikavil Puthanveedu
- Comprehensive Care Centre for Movement Disorders Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram Kerala India
| | - Krishnakumar Kesavapisharady
- Department of Neurosurgery Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram Kerala India
| | - Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram Kerala India
| | - Gangadhara Sarma
- Comprehensive Care Centre for Movement Disorders Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram Kerala India
| | - Asha Kishore
- Comprehensive Care Centre for Movement Disorders Sree Chitra Tirunal Institute for Medical Sciences and Technology Thiruvananthapuram Kerala India
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Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: A Meta-Analysis of Mood Effects. Neuropsychol Rev 2021; 31:385-401. [PMID: 33606174 DOI: 10.1007/s11065-020-09467-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/22/2020] [Indexed: 12/15/2022]
Abstract
This meta-analysis examines mood changes after bilateral subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). Deep brain stimulation improves motor outcomes in Parkinson's disease but there appears to be conflicting reports as to subsequent mood outcomes. Pubmed, PsychINFO and SCOPUS were searched for studies assessing mood outcomes in PD patients who had undergone STN-DBS published between January 2003 and the end of January 2019. Random effects meta-analyses were conducted for all outcome groups with at least two studies homogenous in design and measure. Forty-eight studies, providing data on negative moods (such as depression, anxiety, apathy, and anger) and positive moods (pleasure and euphoria) were assessed. Results of the meta-analysis suggest that post-DBS, depression and anxiety symptoms improve and there is a reduction in negative affect, an increase in apathy, and in energy level. Although there have been reported cases of mania post-DBS surgery, the meta-analysis suggested no significant changes in symptoms of mania in the broader DBS population. Considerable heterogeneity was found and partially addressed through meta-regression and qualitative assessment of the included STN-DBS controlled studies. The major strengths of this meta-analysis, include attention to outcome validity, heterogeneity, independence of samples, and clinical utility, with the potential to improve post-operative safety through comprehensive consideration of mood and psychological adjustment. It appears that STN-DBS is a relatively safe and, in the case of mood symptomatology, an advantageous treatment of Parkinson's disease.
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Kim MS, Ryu HS, Park KW, Choi N, You S, Kim MJ, Kim YJ, Kim J, Kim K, Chung SJ. Age-dependent efficacy of subthalamic nucleus deep brain stimulation in young- and late-onset Parkinson's disease based on a 10 year follow-up. J Neurol Sci 2020; 416:117004. [PMID: 32622084 DOI: 10.1016/j.jns.2020.117004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Long-term efficacy and safety of subthalamic nucleus deep brain stimulation (STN DBS) in patients with young-onset Parkinson's disease (YOPD) and late-onset PD (LOPD) (i.e. motor symptom initial appearance at ages ≤40 and > 40 years, respectively) was compared to identify relationships between PD onset age and the efficacy of DBS. METHODS Statistical analyses compared specific motor and non-motor features among 13 patients with YOPD and 11 with LOPD. Medication reduction patterns and dyskinesia severity scores at baseline and after 1, 3, 5, and 10 years of follow-up were also analyzed using a repeated measures ANOVA tests. Lastly, a correlation analysis identified relationships between the impact of DBS settings (volume of activated tissue) and levodopa equivalent daily dose (LED), dyskinesia severity scores, Unified Parkinson's Disease Rating Scale (UPDRS) part III, and UPDRS part II (disability) scores. RESULTS Ten years after DBS surgery, the reduction of LED from baseline (85.9 ± 592.6 mg versus 623.2 ± 464.9 mg; p = .023) and levodopa-induced dyskinesia (LID) scores (Unified Dyskinesia Rating Scale [UDysRS] parts III items 16-22; 1.6 ± 2.8 versus 5.5 ± 4.1; p = .013) were significantly lower in YOPD patients than LOPD patients. There were no significant differences between the two groups regarding UPDRS part III score improvement in response to levodopa, psychosis occurrence, or adverse effects. CONCLUSION Ten years after STN DBS surgery, LOPD patients showed greater LED reduction, and YOPD patients showed greater LID improvement, although the general long-term outcomes were similar between YOPD and LOPD patients.
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Affiliation(s)
- Mi Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Ho-Sung Ryu
- Department of Neurology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, South Korea
| | - Kye Won Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Nari Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Sooyeoun You
- Department of Neurology, Dongsan Medical Center, Keimyung University, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, South Korea
| | - Mi-Jung Kim
- Department of Neurology, Bobath Memorial Hospital, 155-7 Daewangpangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13552, South Korea
| | - Young Jin Kim
- Department of Neurology, Bestheals Hospital, 17, Seonjinan-gil, Sangnok-gu, Ansan-si, Gyeonggi-do, South Korea
| | - Juyeon Kim
- Department of Neurology, Raonheal Hospital, 13, Yanghyeon-ro 405beon-gil, Jungwon-gu, Seongnam-si, Gyeonggi-do 13439, South Korea
| | - Kiju Kim
- Department of Neurology, Good Light Hospital, Gwangju, 119, Gyeongchung-daero 1926beon-gil, Gwangju-si, Gyeonggi-do, South Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
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Weiss D, Schoellmann A, Fox MD, Bohnen NI, Factor SA, Nieuwboer A, Hallett M, Lewis SJG. Freezing of gait: understanding the complexity of an enigmatic phenomenon. Brain 2020; 143:14-30. [PMID: 31647540 DOI: 10.1093/brain/awz314] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022] Open
Abstract
Diverse but complementary methodologies are required to uncover the complex determinants and pathophysiology of freezing of gait. To develop future therapeutic avenues, we need a deeper understanding of the disseminated functional-anatomic network and its temporally associated dynamic processes. In this targeted review, we will summarize the latest advances across multiple methodological domains including clinical phenomenology, neurogenetics, multimodal neuroimaging, neurophysiology, and neuromodulation. We found that (i) locomotor network vulnerability is established by structural damage, e.g. from neurodegeneration possibly as result from genetic variability, or to variable degree from brain lesions. This leads to an enhanced network susceptibility, where (ii) modulators can both increase or decrease the threshold to express freezing of gait. Consequent to a threshold decrease, (iii) neuronal integration failure of a multilevel brain network will occur and affect one or numerous nodes and projections of the multilevel network. Finally, (iv) an ultimate pathway might encounter failure of effective motor output and give rise to freezing of gait as clinical endpoint. In conclusion, we derive key questions from this review that challenge this pathophysiological view. We suggest that future research on these questions should lead to improved pathophysiological insight and enhanced therapeutic strategies.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Anna Schoellmann
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Michael D Fox
- Berenson-Allen Center, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, Ann Arbor, MI, USA; Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA; Morris K. Udall Center of Excellence for Parkinson's Disease Research, University of Michigan, Ann Arbor, MI, USA
| | - Stewart A Factor
- Department of Neurology, Emory School of Medicine, Atlanta, GA, USA
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Simon J G Lewis
- Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Australia
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Eisinger RS, Scott BM, Le A, Ponce EMT, Lanese J, Hundley C, Nelson B, Ravy T, Lopes J, Thompson S, Sathish S, O'Connell RL, Okun MS, Bowers D, Gunduz A. Pavlovian bias in Parkinson's disease: an objective marker of impulsivity that modulates with deep brain stimulation. Sci Rep 2020; 10:13448. [PMID: 32778775 PMCID: PMC7417529 DOI: 10.1038/s41598-020-69760-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Impulsivity is a common symptom in Parkinson's disease (PD). Adaptive behavior is influenced by prepotent action-reward and inaction-avoid loss Pavlovian biases. We aimed to assess the hypothesis that impulsivity in PD is associated with Pavlovian bias, and to assess whether dopaminergic medications and deep brain stimulation (DBS) influence Pavlovian bias. A PD DBS cohort (N = 37) completed a reward-based Go/No-Go task and bias measures were calculated. This DBS cohort completed the task under three conditions: on-med/pre-DBS, off-med/off-DBS, and on-med/on-DBS. Participants also completed self-reported measures of impulsivity. Dopaminergic medication was associated with lower action-reward bias while DBS was associated with higher action-reward bias. Impulsivity was associated with higher action-reward bias but not inaction-avoid loss bias. We furthermore replicated this association in an independent, non-DBS PD cohort (N = 88). Overall we establish an objective behavioral marker of impulsivity and show that DBS affects impulsivity by amplifying automated responding. Our results point to the importance of reward rather than punishment avoidance in driving impulsive behaviors. This work provides insight into the pathophysiological underpinnings of impulsivity and especially medication and DBS-associated impulsivity in PD.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA.
| | - Bonnie M Scott
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Anh Le
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Elena M Torres Ponce
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Joseph Lanese
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Christopher Hundley
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Brawn Nelson
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Tasmeah Ravy
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Janine Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Sable Thompson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sneha Sathish
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rebecca L O'Connell
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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Orcutt T, Vitek J, Patriat R, Harel N, Matsumoto J. Apraxia of Eyelid Opening Improved by Pallidal Stimulation in Progressive Supranuclear Palsy. Mov Disord Clin Pract 2020; 7:698-700. [PMID: 32775519 DOI: 10.1002/mdc3.13001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/27/2020] [Accepted: 05/27/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tseganesh Orcutt
- Department of Neurology University of Minnesota Minneapolis Minnesota USA
| | - Jerrold Vitek
- Department of Neurology University of Minnesota Minneapolis Minnesota USA
| | - Rémi Patriat
- Department of Radiology Center for Magnetic Resonance Research, University of Minnesota Minneapolis Minnesota USA
| | - Noam Harel
- Department of Radiology Center for Magnetic Resonance Research, University of Minnesota Minneapolis Minnesota USA
| | - Joseph Matsumoto
- Department of Neurology University of Minnesota Minneapolis Minnesota USA
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Shin HW, Kim MS, Kim SR, Jeon SR, Chung SJ. Long-term Effects of Bilateral Subthalamic Deep Brain Stimulation on Postural Instability and Gait Difficulty in Patients with Parkinson's Disease. J Mov Disord 2020; 13:127-132. [PMID: 32498496 PMCID: PMC7280933 DOI: 10.14802/jmd.19081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective The long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on postural instability and gait difficulty (PIGD) in patients with Parkinson’s disease (PD) remain unclear. In this study, we aimed to evaluate the longterm effects of STN-DBS surgery on PIGD symptoms in patients with advanced-stage PD. Methods This study included 49 consecutively included patients with PD who underwent bilateral STN-DBS. The Unified Parkinson’s Disease Rating Scale (UPDRS) scores and subscores for PIGD were assessed at baseline and at 1, 3, and 5 years postoperatively. The PIGD subscore was divided into PIGD-motor and PIGD-activities of daily living (ADL) scores according to parts III and II of the UPDRS, respectively. Results The PIGD-motor and PIGD-ADL scores at the “medication-off” state improved at 3 and 5 years, respectively. Overall, the UPDRS III and II scores at “medication-off” improved at 5 years. The UPDRS IV score also significantly improved and the levodopa equivalent daily dosage decreased at all follow-ups. Finally, the PIGD-motor score at baseline was able to predict long-term improvement in the PIGD-motor score at the 5-year follow-up. Conclusion The STN-DBS has both short- and long-term effects on PIGD, as well as overall motor function, in patients with advanced PD. The degree of PIGD at the preoperative evaluation can be used to predict long-term outcomes after STN-DBS surgery.
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Affiliation(s)
- Hae-Won Shin
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mi Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Grabie M, Gabriels J, Xiang K, Elayi CS, Makaryus JN, Catanzaro JN. Feasibility of radiofrequency catheter ablation in a patient with deep brain stimulators. HeartRhythm Case Rep 2020; 6:253-255. [PMID: 32461888 PMCID: PMC7244632 DOI: 10.1016/j.hrcr.2020.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mordechai Grabie
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - James Gabriels
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Kun Xiang
- Department of Electrophysiology, University of Florida, Jacksonville, Florida
| | - Claude S Elayi
- Department of Electrophysiology, University of Florida, Jacksonville, Florida
| | - John N Makaryus
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York.,The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - John N Catanzaro
- Department of Electrophysiology, University of Florida, Jacksonville, Florida
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Ng JH, See AAQ, Xu Z, King NKK. Longitudinal medication profile and cost savings in Parkinson's disease patients after bilateral subthalamic nucleus deep brain stimulation. J Neurol 2020; 267:2443-2454. [PMID: 32367298 DOI: 10.1007/s00415-020-09741-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Deep brain stimulation of the subthalamic nucleus (STN DBS) has been shown to reduce antiparkinsonian medication in Parkinson's disease. We aimed to investigate the changes in long-term medication profile with STN DBS. METHODS Antiparkinsonian medication data for 56 patients were collected from as early as 3 years before STN DBS up to 10 years after. Cost spending on medication changes was analyzed. Mean levodopa equivalent daily dose (LEDD) was projected 10 years into the future based on preoperative data to create a comparator group wherein the patients did not undergo STN DBS. Use of neuroleptics and antidepressants was also recorded. RESULTS LEDD requirement was significantly reduced by a mean of 31 ± 2% over 10 years after DBS, from 1049 ± 381 mg at pre-DBS baseline, to 713 ± 392 mg at 1 year post-DBS, and 712 ± 385 mg at 10 years post-DBS. This was associated with a mean reduction of 35 ± 3% in medicine cost. Modeled LEDD requirements for not having STN DBS were in the range of 1489 mg to 2721 mg at 10 years post-DBS (109-282% higher than the observed mean LEDD in DBS cohort). The proportion of patients increased from 5% before STN DBS to 14% at 10 year post-DBS for neuroleptics, and 11-23% for antidepressants. CONCLUSION STN DBS led to LEDD reduction and antiparkinsonian medication cost savings in our South-East Asian cohort. Medication reduction with STN DBS in our cohort over the 10-year period was comparable to those reported in Western populations.
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Affiliation(s)
- Jing Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Zheyu Xu
- Department of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Nicolas Kon Kam King
- Department of Neurosurgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Baertschi M, Favez N, Flores Alves Dos Santos J, Radomska M, Herrmann F, Burkhard PR, Canuto A, Weber K, Ghisletta P. Illness Representations and Coping Strategies in Patients Treated with Deep Brain Stimulation for Parkinson's Disease. J Clin Med 2020; 9:E1186. [PMID: 32326245 PMCID: PMC7230846 DOI: 10.3390/jcm9041186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 12/26/2022] Open
Abstract
There is a debate on possible alterations of self-identity following deep brain stimulation for neurological disorders including Parkinson's disease. Among the psychological variables likely to undergo changes throughout such a medical procedure, illness representations and coping strategies have not been the target of much research to this day. In order to remedy this, we investigated the dynamics of illness representations and coping strategies in an 18-month longitudinal study involving 45 patients undergoing deep brain stimulation for idiopathic Parkinson's disease. Two research hypotheses were formulated and investigated through repeated measures of ANOVAs and structural equation modelling with full information maximum likelihood and Bayesian estimations. Representations of Parkinson's disease as a cyclical condition and perception of control over the disease diminished after surgery. Use of instrumental coping strategies was not modified after deep brain stimulation. These changes were identified by SEM but not ANOVAs; their magnitude was nevertheless relatively small, implying general stability in representations. These findings suggest that psychological variables do not undergo major changes after deep brain stimulation for Parkinson's disease.
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Affiliation(s)
- Marc Baertschi
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
- Nant Foundation, Service of General Psychiatry and Psychotherapy, Avenue des Alpes 66, 1820 Montreux, Switzerland
| | - Nicolas Favez
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
| | - João Flores Alves Dos Santos
- Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Michalina Radomska
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
| | - François Herrmann
- Division of Geriatrics, Geneva University Hospitals, Chemin du Pont-Bochet 3, 1226 Thônex, Switzerland;
| | - Pierre R. Burkhard
- Service of Neurology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland;
| | - Alessandra Canuto
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland; (A.C.); (K.W.)
| | - Kerstin Weber
- Faculty of Medicine, University of Geneva, Rue Michel Servet 1, 1206 Geneva, Switzerland; (A.C.); (K.W.)
| | - Paolo Ghisletta
- Faculty of Psychology and Educational Sciences, University of Geneva, Boulevard du Pont-d’Arve 40, 1205 Geneva, Switzerland; (N.F.); (M.R.); (P.G.)
- Swiss Distance Learning University, Überlandstrasse 12, 3900 Brig, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, Universities of Lausanne and of Geneva, CH-1015 Lausanne, Switzerland
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38
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Abstract
Deep brain stimulation (DBS) has become an established therapeutic tool for treating patients with Parkinson's disease (PD) who have troublesome motor fluctuations and dyskinesias refractory to best medical therapy. In addition to its proven efficacy in patients with late PD, the EARLYSTIM trial not only demonstrated the efficacy of DBS in patients with early motor complications but also showed that it did not lose its therapeutic efficacy as the years passed by. However, like all other therapies for PD, DBS is not offered to patients either as a cure for this disease nor is it expected to stop the progression of the neurodegenerative process underlying PD; these important issues need to be highlighted to patients who are considering this therapy. This article aims to provide an introduction to residents or trainees starting a career in movement disorders of the technical aspects of this therapy and the evidence base for its use. For the latter objective, PUBMED was searched from 1946 to 2017 combining the search terms "deep brain stimulation" and "Parkinson's disease" looking for studies demonstrating the efficacy of this therapy in PD. Inclusion criteria included studies that involved more than 20 patients with a physician confirmed diagnosis of PD and a follow-up of greater than or equal to at least 12 months. The findings from those studies on motor symptoms, medication requirements, quality of life, and independence in activities of daily living in PD patients are summarized and presented in tabulated form in this paper at the end.
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Affiliation(s)
- Naveed Malek
- Department of Neurology, Ipswich Hospital NHS Trust, United Kingdom
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Steinhardt J, Münte TF, Schmid SM, Wilms B, Brüggemann N. A systematic review of body mass gain after deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease. Obes Rev 2020; 21:e12955. [PMID: 31823457 DOI: 10.1111/obr.12955] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
This systematic review investigated the effects of deep brain stimulation of the subthalamic nucleus on extent and time course of body mass changes in patients with Parkinson's disease. A computerized search identified relevant articles using a priori defined inclusion and exclusion criteria. A descriptive analysis was calculated for the main outcome parameters body mass and BMI. Thirty-eight out of 206 studies fulfilled the inclusion criteria (979 patients aged 59.0±7.5 years). Considering the longest follow-up time for each study, body mass and BMI showed a mean increase across studies of +5.71kg (p < .0001; d = 0.64) and +1.8kg/m2 (p < .0001; d = 1.61). The time course of body mass gain revealed a continuous increase ranging from +3.25kg (d = 0.69) at 3 months, +3.88kg (d = 0.21) at 6 months, +6.35kg (d = 0.72) at 12 months, and +6.11kg (d = 1.02) greater than 12 months. Changes in BMI were associated with changes in disease severity (r = 0.502, p = .010) and pharmacological treatment (r = 0.440, p = .0231). Data suggest that body mass gain is one of the most common side effects of deep brain stimulation going beyond normalization of preoperative weight loss. Considering the negative health implications of overweight, we recommend the development of tailored therapies to prevent overweight and associated metabolic disorders following this treatment.
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Affiliation(s)
- Julia Steinhardt
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Sebastian M Schmid
- Institute of Psychology II, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Britta Wilms
- Institute of Psychology II, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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40
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The potential neuromodulatory impact of subthalamic nucleus deep brain stimulation on Parkinson's disease progression. J Clin Neurosci 2020; 73:150-154. [PMID: 32001113 DOI: 10.1016/j.jocn.2019.12.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/30/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION STN-DBS has been claimed to change progressionsymptomsin animal models of PD, but information is lacking about the possible neuromodulatory role of STN-DBS in humans. The aim of this prospective controlled study was to evaluate the long-term impact of STN-DBS on motor disabilities and cognitive impairment in PD patients in comparison to Best-Medical-Therapy (BMT) and Long-term-Post-Operative (POP) groups. MATERIAL AND METHODS Patients were divided into 3 groups: the BMT-group consisted of 20 patients treated only with pharmacotherapy, the DBS-group consisted of 20 PD patients who underwent bilateral STN-DBS (examined pre- and postoperatively) and the POP-group consisted of 14 long-term postoperative patients in median 30 month-time after DBS. UPDRS III scale was measured during 3 visits in 9 ± 2 months periods (V1, V2, V3) in total-OFF phase. Cognitive assessment was performed during each visit in total-ON phase. RESULTS The comparable UPDRS III OFF gain was observed in both BMT-group and POP-group evaluations (p < 0.05). UPDRS III OFF results in DBS-group revealed significant UPDRS III OFF increase in ΔV2-V1 assessment (p < 0.05) with no significant UPDRS III OFF alteration in ΔV3-V2 DBS-group evaluation (p > 0.05). Cognitive assessment revealed significant alterations between DBS-group and BMT-group in working memory, executive functions and learning abilities (p < 0.05). CONCLUSIONS The impact of STN-DBS on UPDRS III OFF score and cognitive alterations suggest its neuromodulatory role, mainly during the first 9-18 months after surgery.
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Limousin P, Foltynie T. Long-term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol 2020; 15:234-242. [PMID: 30778210 DOI: 10.1038/s41582-019-0145-9] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The efficacy of deep brain stimulation (DBS) for Parkinson disease (PD) is well established for up to 1 or 2 years, but long-term outcome data are still limited. In this Review, we critically discuss the evidence on the long-term outcomes of DBS and consider the clinical implications. Although many patients are lost to follow-up, the evidence indicates that subthalamic nucleus DBS improves motor function for up to 10 years, although the magnitude of improvement tends to decline over time. Functional scores recorded during on-medication periods worsen more quickly than those recorded in off periods, consistent with the degeneration of non-dopaminergic pathways. Dyskinesia, motor fluctuations and activities of daily living in off periods remain improved at 5 years, but quality-of-life scores have usually fallen below preoperative levels. The incidence and severity of dementia among patients receiving DBS are comparable to those among patients who receive medical treatment. Severe adverse events are rare, but adverse events such as dysarthria are common and probably under-reported. Long-term data on the outcomes of globus pallidus interna DBS are limited and mostly confirm the efficacy for dyskinesia. A trend towards offering DBS in the earlier stages of PD creates a need to identify factors that predict long-term outcomes and to discuss realistic expectations with patients preoperatively.
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Affiliation(s)
- Patricia Limousin
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK. .,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Vachez Y, Carcenac C, Magnard R, Kerkerian‐Le Goff L, Salin P, Savasta M, Carnicella S, Boulet S. Subthalamic Nucleus Stimulation Impairs Motivation: Implication for Apathy in Parkinson's Disease. Mov Disord 2020; 35:616-628. [DOI: 10.1002/mds.27953] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/13/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yvan Vachez
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Carole Carcenac
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Robin Magnard
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | | | | | - Marc Savasta
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Sebastien Carnicella
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
| | - Sabrina Boulet
- Inserm U1216 Grenoble France
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN Grenoble France
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Yang C, Qiu Y, Wang J, Wu Y, Hu X, Wu X. Intracranial hemorrhage risk factors of deep brain stimulation for Parkinson's disease: a 2-year follow-up study. J Int Med Res 2019; 48:300060519856747. [PMID: 31885350 PMCID: PMC7251548 DOI: 10.1177/0300060519856747] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to analyze the risk factors of intracranial hemorrhage (ICH) after deep brain stimulation (DBS) for idiopathic Parkinson’s disease (PD). Methods Patients who received DBS from March 2014 to December 2016 were retrospectively analyzed. The hemorrhage index was derived by combining the hemorrhagic volume and clinical manifestations of ICH. All patients with IHC were followed up for 2 years. Results Computed tomography showed 13 events of ICH in 11 patients (nine cases in the subthalamic nucleus), including eight cases with symptomatic hemorrhage (seven cases in the subthalamic nucleus). Hemorrhage was characterized by intracranial hematoma in the electrode puncture tract. Male sex and hypertension were significant risk factors for ICH. Hemorrhage in the preferred puncture side was significantly higher than that in the non-preferred puncture side. The mean hemorrhage index was 2.23 ± 0.83 in 11 patients, and no permanent neurological impairment was found during the 2-year follow-up. The effect of DBS on motor symptoms was similar in patients with and without ICH. Conclusion Male sex and hypertension are risk factors of ICH after DBS in PD. The risk of hemorrhage on the first puncture site is significantly higher than that on the second puncture site.
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Affiliation(s)
- Chunhui Yang
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Yiqing Qiu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Jiali Wang
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Yina Wu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Xiaowu Hu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
| | - Xi Wu
- Department of Neurosurgery, Changhai Hospital, Shanghai, China
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Brandmeir NJ, Murray A, Cheyuo C, Ferari C, Rezai AR. Deep Brain Stimulation for Multiple Sclerosis Tremor: A Meta-Analysis. Neuromodulation 2019; 23:463-468. [PMID: 31755637 DOI: 10.1111/ner.13063] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the effect of deep brain stimulation (DBS) on multiple sclerosis (MS)-tremor, as measured by a normalized scale of tremor severity, with a meta-analysis of the published literature. METHODS Medline and EBSCO Host (January, 1998 to June, 2018) were systematically reviewed with librarian guidance, using the keywords "Deep brain stimulation" and "multiple sclerosis." Bibliographies and experts in the field were also consulted to identify missed articles. All therapeutic studies on DBS for MS-tremor, reported in the English language, within the study period were included. Papers that reported outcomes without a measure of central tendency and/or distribution were excluded. The papers were read in their entirety and graded for risk of bias according to the American Academy of Neurology (AAN) standards. To maximize statistical power, papers using different stimulation targets were grouped together. Outcomes were reported with the Fahn-Tolosa-Marin scale (FTM), the Bain-Finchley scale (CRS) and 3- and 4-point tremor severity scales and normalized with a Hedges g. RESULTS The search produced 13 studies suitable for meta-analysis. The random-effects meta-analysis showed that DBS improved the Hedges standardized mean tremor score by 2.86 (95%CI 2.03-3.70, p < .00001). Heterogeneity was high, with an I2 of 84%, suggesting that random effects model is more appropriate. Adverse event rates varied from 8% to 50%. CONCLUSIONS This meta-analysis provides level III evidence that DBS may improve MS-related tremor as measured by standardized tremor severity scales.
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Affiliation(s)
- Nicholas J Brandmeir
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Ann Murray
- Department of Neurology, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Cletus Cheyuo
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
| | - Christopher Ferari
- West Virginia School of Medicine, West Virginia University, Morgantown, West Virginia
| | - Ali R Rezai
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia.,Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia
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Long-term impact of subthalamic stimulation on cognitive function in patients with advanced Parkinson's disease. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Acera M, Molano A, Tijero B, Bilbao G, Lambarri I, Villoria R, Somme J, Ruiz de Gopegui E, Gabilondo I, Gomez-Esteban J. Impacto de la estimulación subtalámica a largo plazo sobre la situación cognitiva de los pacientes con enfermedad de Parkinson avanzada. Neurologia 2019; 34:573-581. [DOI: 10.1016/j.nrl.2017.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/28/2022] Open
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Fernandez-Garcia C, Alonso-Frech F, Monje MHG, Matias-Guiu J. Role of deep brain stimulation therapy in the magnetic resonance-guided high-frequency focused ultrasound era: current situation and future prospects. Expert Rev Neurother 2019; 20:7-21. [PMID: 31623494 DOI: 10.1080/14737175.2020.1677465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Deep brain stimulation (DBS) is a well-established treatment of movement disorders; but recently there has been an increasing trend toward the ablative procedure magnetic resonance-guided focused ultrasound (MRgFU). DBS is an efficient neuromodulatory technique but associated with surgical complications. MRIgFUS is an incision-free method that allows thermal lesioning, with fewer surgical complications but irreversible effects.Areas covered: We look at current and prospective aspects of both techniques. In DBS, appropriate patient selection, improvement in surgical expertise, target accuracy (preoperative and intraoperative imaging), neurophysiological recordings, and novel segmented leads need to be considered. However, increased number of older patients with higher comorbidities and risk of DBS complications (mainly intracranial hemorrhage, but also infections, hardware complications) make them not eligible for surgery. With MRgFUS, hemorrhage risks are virtually nonexistent, infection or hardware malfunction are eliminated, while irreversible side effects can appear.Expert commentary: Comparison of the efficacy and risks associated with these techniques, in combination with a growing aged population in developed countries with higher comorbidities and a preference for less invasive treatments, necessitates a review of the indications for movement disorders and the most appropriate treatment modalities.
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Affiliation(s)
- C Fernandez-Garcia
- Department of Neurosurgery, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Madrid, Spain.,Medicine Department, Universidad Complutense, Madrid, Spain
| | - F Alonso-Frech
- Department of Neurology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Universidad Complutense, Madrid, Spain.,HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, Móstoles, Madrid, Spain
| | - M H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, Móstoles, Madrid, Spain
| | - J Matias-Guiu
- Medicine Department, Universidad Complutense, Madrid, Spain.,Department of Neurology, Hospital Clínico San Carlos, San Carlos Research Health Institute (IdISSC), Universidad Complutense, Madrid, Spain
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Impact of subthalamic nucleus stimulation did not differ on young-onset and older-onset Parkinson's disease: A three-year follow up. Neurosci Lett 2019; 705:99-105. [PMID: 31028845 DOI: 10.1016/j.neulet.2019.04.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/13/2019] [Accepted: 04/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the role of onset age in the results of bilateral subthalamic nucleus deep brain stimulation (STN-DBS), we carried out a retrospective study of two groups of patients regarding age at disease onset. METHODS We compared, up to 3 years after surgery, the clinical effects, quality of life and the levodopa equivalent daily dose (LEDD) in patients with young-onset Parkinson's disease (onset age <50 years, YOPD) vs patients with older-onset Parkinson's disease (onset age ≥50 years, OOPD). RESULTS A dramatic improvement in motor symptoms was equally observed in both groups of patients after DBS. The improvements of the Unified Parkinson's Disease Rating Scale part III motor scale (UPDRS-III) score, axial sub-score and non-axial sub-score from baseline gradually decreased over time. The benefit of STN-DBS for the axial symptoms decreased most rapidly, which directly resulted in a progressive decline in stimulation efficacy in both groups. Nevertheless, the improvement in non-axial symptoms after DBS was remarkable and long-lasting. The quality of life in both groups were also improved after DBS but were slightly decreased in the following years. The reduced LEDD were equivalent in both groups. CONCLUSIONS STN-DBS alleviates motor symptoms and improves quality of life equally in both YOPD and OOPD patients with similar LEDD. The initial therapeutic benefit of STN-DBS for PD gradually decreases over time, mainly due to the progression of PD and the rapid withdrawal of the benefit for axial symptoms.
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Jiang JL, Chen SY, Tsai ST. Quality of life in patients with Parkinson's disease after subthalamic stimulation: An observational cohort study for outcome prediction. Tzu Chi Med J 2019; 31:107-112. [PMID: 31007491 PMCID: PMC6450151 DOI: 10.4103/tcmj.tcmj_92_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: The objective of this study was to investigate the changes in health-related quality of life (HRQoL) and motor and depressive symptoms in patients with Parkinson's disease (PD) from baseline to 12 months following subthalamic nucleus deep brain stimulation (STN-DBS). Materials and Methods: The study utilized a prospective observational cohort design. Thirty-three PD patients with a good levodopa response but drug-related morbidity were included. PD Questionnaire-39 (PDQ-39) scores, unified PD rating scale (UPDRS) scores, Hoehn and Yahr stages, Beck Depression Inventory-II scores, and levodopa equivalent daily doses (LEDD) were obtained at baseline and 1 year after surgery. Results: The enrolled patients showed a significant HRQoL improvement of 21.43% at 12 months after STN-DBS as assessed by the PDQ-39 total score. There was a 34.92% improvement in UPDRS scores after STN-DBS at 1 year follow-up. Subitem analysis revealed significant improvement in UPDRS part II, III, and IV scores. The LEDD was significantly reduced by up to 27.36% 12 months after surgery. The preoperative PDQ-39 total score and LEDD predicted postoperative HRQoL in PD following STN-DBS. Conclusions: The current study demonstrated that STN-DBS surgery significantly improved HRQoL and motor outcomes of patients with PD. The preoperative PDQ-39 score and LEDD were predictors of the efficacy of postoperative HRQoL following surgery.
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Affiliation(s)
| | - Shin-Yuan Chen
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Tzung Tsai
- Department of Neurosurgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Tucker HR, Mahoney E, Chhetri A, Unger K, Mamone G, Kim G, Audil A, Moolick B, Molho ES, Pilitsis JG, Shin DS. Deep brain stimulation of the ventroanterior and ventrolateral thalamus improves motor function in a rat model of Parkinson's disease. Exp Neurol 2019; 317:155-167. [PMID: 30890329 DOI: 10.1016/j.expneurol.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 12/21/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease with affected individuals exhibiting motor symptoms of bradykinesia, muscle rigidity, tremor, postural instability and gait dysfunction. The current gold standard treatment is pharmacotherapy with levodopa, but long-term use is associated with motor response fluctuations and can cause abnormal movements called dyskinesias. An alternative treatment option is deep brain stimulation (DBS) with the two FDA-approved brain targets for PD situated in the basal ganglia; specifically, in the subthalamic nucleus (STN) and globus pallidus pars interna (GPi). Both improve quality of life and motor scores by ~50-70% in well-selected patients but can also elicit adverse effects on cognition and other non-motor symptoms. Therefore, identifying a novel DBS target that is efficacious for patients not optimally responsive to current DBS targets with fewer side-effects has clear clinical merit. Here, we investigate whether the ventroanterior (VA) and ventrolateral (VL) motor nuclei of the thalamus can serve as novel and effective DBS targets for PD. In the limb-use asymmetry test (LAT), hemiparkinsonian rats showcased left forelimb akinesia and touched only 6.5 ± 1.3% with that paw. However, these animals touched equally with both forepaws with DBS at 10 Hz, 100 μsec pulse width and 100 uA cathodic stimulation in the VA (n = 7), VL (n = 8) or at the interface between the two thalamic nuclei which we refer to as the VA|VL (n = 12). With whole-cell patch-clamp recordings, we noted that VA|VL stimulation in vitro increased the number of induced action potentials in proximal neurons in both areas albeit VL neurons transitioned from bursting to non-bursting action potentials (APs) with large excitatory postsynaptic potentials time-locked to stimulation. In contrast, VA neurons were excited with VA|VL electrical stimulation but with little change in spiking phenotype. Overall, our findings show that DBS in the VA, VL or VA|VL improved motor function in a rat model of PD; plausibly via increased excitation of residing neurons.
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Affiliation(s)
- Heidi R Tucker
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Emily Mahoney
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Ashok Chhetri
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Kristen Unger
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Gianna Mamone
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Gabrielle Kim
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Aliyah Audil
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Benjamin Moolick
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America
| | - Eric S Molho
- Department of Neurology, Albany Medical Center, Albany, NY, United States of America
| | - Julie G Pilitsis
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America; Department of Neurosurgery, Albany Medical Center, Albany, NY, United States of America
| | - Damian S Shin
- Department of Neuroscience & Experimental Therapeutics, Albany Medical College, Albany, NY, United States of America; Department of Neurology, Albany Medical Center, Albany, NY, United States of America.
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