51
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Dinter E, Saridaki T, Diederichs L, Reichmann H, Falkenburger BH. Parkinson's disease and translational research. Transl Neurodegener 2020; 9:43. [PMID: 33256849 PMCID: PMC7708097 DOI: 10.1186/s40035-020-00223-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
Parkinson’s disease (PD) is diagnosed when patients exhibit bradykinesia with tremor and/or rigidity, and when these symptoms respond to dopaminergic medications. Yet in the last years there was a greater recognition of additional aspects of the disease including non-motor symptoms and prodromal states with associated pathology in various regions of the nervous system. In this review we discuss current concepts of two major alterations found during the course of the disease: cytoplasmic aggregates of the protein α-synuclein and the degeneration of dopaminergic neurons. We provide an overview of new approaches in this field based on current concepts and latest literature. In many areas, translational research on PD has advanced the understanding of the disease but there is still a need for more effective therapeutic options based on the insights into the basic biological phenomena.
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Affiliation(s)
- Elisabeth Dinter
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Dresden, Germany
| | | | | | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Björn H Falkenburger
- Department of Neurology, Technische Universität Dresden, Dresden, Germany. .,Deutsches Zentrum für Neurodegenerative Erkrankungen, Dresden, Germany. .,Department of Neurology, RWTH University Aachen, Aachen, Germany.
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52
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Mosley PE, Robinson K, Coyne T, Silburn P, Barker MS, Breakspear M, Robinson GA, Perry A. Subthalamic deep brain stimulation identifies frontal networks supporting initiation, inhibition and strategy use in Parkinson's disease. Neuroimage 2020; 223:117352. [DOI: 10.1016/j.neuroimage.2020.117352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
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Abstract
Brain-machine interfaces (BMIs), which enable a two-way flow of signals, information, and directions between human neurons and computerized machines, offer spectacular opportunities for therapeutic and consumer applications, but they also present unique dangers to the safety, privacy, psychological health, and spiritual well-being of their users. The sale of these devices as commodities for profit exacerbates such issues and may subject the user to an unequal exchange with corporations. Catholic healthcare professionals and bioethicists should be especially concerned about the implications for the essential dignity of the persons using the new BMIs. Summary The commercial sale of brain-machine interfaces (BMIs) generates and exacerbates problems for end-users' safety, psychological health, and spiritual well-being.
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54
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Dietrich AD, Koeppen JA, Buhmann C, Pötter-Nerger M, Pinnschmidt HO, Oehlwein C, Oehlwein M, Mittmann K, Gerloff C, Engel AK, Westphal M, Schaper M, Hamel W, Moll CKE, Gulberti A. Sex Disparities in the Self-Evaluation of Subthalamic Deep Brain Stimulation Effects on Mood and Personality in Parkinson's Disease Patients. Front Neurol 2020; 11:776. [PMID: 32849228 PMCID: PMC7412792 DOI: 10.3389/fneur.2020.00776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
Changes in personality are one of the main concerns Parkinson's disease (PD) patients raise when facing the decision to undergo neurosurgery for deep brain stimulation (DBS) of the subthalamic nucleus (STN). While clinical instruments for monitoring functional changes following DBS surgery are well-established in the daily therapeutic routine, personality issues are far less systematically encompassed. Moreover, while sex disparities in the outcomes of STN-DBS therapy have been reported, little is known about the different effects that DBS treatment may have on mood and personality traits in female and male patients. To this aim, the effect of STN-DBS on personality traits was assessed in 46 PD patients (12 women and 34 men) by means of the Freiburg Personality Inventory. The Becks Depression Inventory (BDI-I) and the Parkinson's Disease Questionnaire were used to evaluate patients' level of depression and quality of life (QoL). Patients completed the questionnaires a few days before, within the first year, and 2 years after surgery. The 12 personality traits defined by the FPI-R questionnaire did not change significantly after STN-DBS surgery (p = 0.198). Women declared higher depression scores through all study stages (p = 0.009), but also showed a stronger QoL amelioration after surgery than male patients (p = 0.022). The BDI-I scores of female patients clearly correlated with their levodopa equivalent daily dose (LEDD; r = 0.621, p = 0.008). Remarkably, in both male and female patients, higher pre-operative LEDDs were related to worse post-operative QoL scores (p = 0.034). These results mitigate the concerns about systematic personality changes due to STN-DBS treatment in PD patients and encourage an early DBS approach, before severe levodopa-induced sequelae may irreparably compromise the patients' QoL. In the future, more focus should lie on sex-related effects, since female patients seem to profit more than male patients from STN-DBS, in terms of reduced depressive symptoms associated with a reduction of the LEDD and amelioration of QoL. These aspects may help to redress the sex imbalance in PD patients treated with DBS, given that women are still strongly under-represented.
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Affiliation(s)
- Amelie D Dietrich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes A Koeppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany
| | - Marita Oehlwein
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany
| | - Katrin Mittmann
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, 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
| | - Manfred Westphal
- Department of Neurosurgery, 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
| | - 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
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55
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Effects of Subthalamic Nucleus Deep Brain Stimulation on Facial Emotion Recognition in Parkinson's Disease: A Critical Literature Review. Behav Neurol 2020; 2020:4329297. [PMID: 32724481 PMCID: PMC7382738 DOI: 10.1155/2020/4329297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/12/2020] [Indexed: 01/04/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective therapy for Parkinson's disease (PD). Nevertheless, DBS has been associated with certain nonmotor, neuropsychiatric effects such as worsening of emotion recognition from facial expressions. In order to investigate facial emotion recognition (FER) after STN DBS, we conducted a literature search of the electronic databases MEDLINE and Web of science. In this review, we analyze studies assessing FER after STN DBS in PD patients and summarize the current knowledge of the effects of STN DBS on FER. The majority of studies, which had clinical and methodological heterogeneity, showed that FER is worsening after STN DBS in PD patients, particularly for negative emotions (sadness, fear, anger, and tendency for disgust). FER worsening after STN DBS can be attributed to the functional role of the STN in limbic circuits and the interference of STN stimulation with neural networks involved in FER, including the connections of the STN with the limbic part of the basal ganglia and pre- and frontal areas. These outcomes improve our understanding of the role of the STN in the integration of motor, cognitive, and emotional aspects of behaviour in the growing field of affective neuroscience. Further studies using standardized neuropsychological measures of FER assessment and including larger cohorts are needed, in order to draw definite conclusions about the effect of STN DBS on emotional recognition and its impact on patients' quality of life.
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56
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Wang J, Gong D, Zhang W, Zhang H, Wang S. Quantifying the influence of DBS surgery in patients with Parkinson's disease during perioperative period by wearable sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3311-3314. [PMID: 31946590 DOI: 10.1109/embc.2019.8856618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
It is a significant but ignored issue to quantify the influence of Deep Brain Stimulation (DBS) surgery in patients with Parkinson's disease during the whole perioperative period. In this paper, wearable sensors were utilized to record patients' motor changes in the time before surgery, after surgery with stimulation off and stimulation on. The results showed that the DBS surgery is effective and safe in the perioperative period.
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57
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Irmen F, Horn A, Mosley P, Perry A, Petry-Schmelzer JN, Dafsari HS, Barbe M, Visser-Vandewalle V, Schneider GH, Li N, Kübler D, Wenzel G, Kühn AA. Left Prefrontal Connectivity Links Subthalamic Stimulation with Depressive Symptoms. Ann Neurol 2020; 87:962-975. [PMID: 32239535 DOI: 10.1002/ana.25734] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) not only stimulates focal target structures but also affects distributed brain networks. The impact this network modulation has on non-motor DBS effects is not well-characterized. By focusing on the affective domain, we systematically investigate the impact of electrode placement and associated structural connectivity on changes in depressive symptoms following STN-DBS, which have been reported to improve, worsen, or remain unchanged. METHODS Depressive symptoms before and after STN-DBS surgery were documented in 116 patients with PD from 3 DBS centers (Berlin, Queensland, and Cologne). Based on individual electrode reconstructions, the volumes of tissue activated (VTAs) were estimated and combined with normative connectome data to identify structural connections passing through VTAs. Berlin and Queensland cohorts formed a training and cross-validation dataset used to identify structural connectivity explaining change in depressive symptoms. The Cologne data served as the test-set for which depressive symptom change was predicted. RESULTS Structural connectivity was linked to depressive symptom change under STN-DBS. An optimal connectivity map trained on the Berlin cohort could predict changes in depressive symptoms in Queensland patients and vice versa. Furthermore, the joint training-set map predicted changes in depressive symptoms in the independent test-set. Worsening of depressive symptoms was associated with left prefrontal connectivity. INTERPRETATION Fibers connecting the electrode with left prefrontal areas were associated with worsening of depressive symptoms. Our results suggest that for the left STN-DBS lead, placement impacting fibers to left prefrontal areas should be avoided to maximize improvement of depressive symptoms. ANN NEUROL 2020;87:962-975.
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Affiliation(s)
- Friederike Irmen
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Biological Psychology and Cognitive Neuroscience, Freie Universität Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philip Mosley
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Australia.,Queensland Brain Institute, University of Queensland, St. Lucia, Australia
| | - Alistair Perry
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Max Planck Institute for Human Development, Berlin, Germany.,Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Jan Niklas Petry-Schmelzer
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Haidar S Dafsari
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Michael Barbe
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ningfei Li
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dorothee Kübler
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gregor Wenzel
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
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58
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Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics. HANDBOOK OF CLINICAL NEUROLOGY 2020; 165:83-121. [PMID: 31727232 DOI: 10.1016/b978-0-444-64012-3.00007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.
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59
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Mole JA, Josephs L, Prangnell SJ. Impaired option generation underpins deficient reasoning in Parkinson’s disease patients with apathy. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:106-111. [DOI: 10.1080/23279095.2020.1712400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Joseph A. Mole
- Russell Cairns Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laurie Josephs
- Russell Cairns Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Simon J. Prangnell
- Russell Cairns Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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60
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Floden DP, Matias CM, Wathen CA, Ozinga GE, Hogue O, Machado AG. Contact Location and Neuropsychological Outcomes in Subthalamic Deep Brain Stimulation. Neurosurgery 2019; 83:666-674. [PMID: 29048606 DOI: 10.1093/neuros/nyx475] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 08/18/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A host of influences contribute to cognitive and behavioral changes following deep brain stimulation. The location of the active cathode is likely an important variable but it has received little attention. OBJECTIVE To determine whether active contact location relative to the subthalamic nucleus and other neighboring structures is related to nonmotor outcomes. METHODS We identified a retrospective, cross-sectional sample of 46 patients who underwent subthalamic nucleus deep brain stimulation for treatment of idiopathic Parkinson's disease. T-tests or nonparametric equivalents were used to detect baseline differences between unilateral left, unilateral right, and bilateral surgical groups. Correlation and partial correlational analyses identified relationships between contact location variables and alterations in cognitive, mood, quality of life, motor, and disease variables. RESULTS Medial contact locations within the left subthalamic nucleus were correlated with improvements in self-reported mood (r12 = -0.78, P = .001; 95% confidence interval [CI] = -0.43 to -0.93) but worsening semantic fluency (r26 = -0.38, P = .048; 95% CI = -0.01 to -0.66). Phonemic fluency worsened with more posterior left placement (r34 = 0.35, P = .036; 95% CI = 0.03 to 0.61). Memory outcome was related to right hemisphere stimulation voltage (r29 = -0.40, P = .022; 95% CI = -0.05 to -0.66), which is likely a proxy for variable electrode location. CONCLUSION Location of the active contact is related to nonmotor outcomes, even in electrodes that are adequately placed. This is relevant to clinical care as there appears to be a trade-off between mood and fluency abilities that should be considered during surgical planning according to preoperative patient characteristics.
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Affiliation(s)
- Darlene P Floden
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Caio M Matias
- Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - Connor A Wathen
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Grace E Ozinga
- Psychology Department, Cleveland State University, Cleveland, Ohio
| | - Olivia Hogue
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Andre G Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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61
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Quattrone A, Barbagallo G, Cerasa A, Stoessl AJ. Neurobiology of placebo effect in Parkinson's disease: What we have learned and where we are going. Mov Disord 2019; 33:1213-1227. [PMID: 30230624 DOI: 10.1002/mds.27438] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/19/2018] [Accepted: 04/24/2018] [Indexed: 12/29/2022] Open
Abstract
The placebo effect is a phenomenon produced when an inert substance administered like a regular treatment improves the clinical outcome. Parkinson's disease (PD) is one of the main clinical disorders for which the placebo response rates are high. The first evidence of the neurobiological mechanisms underlying the placebo effect in PD stems from 2001, when de la Fuente-Fernandez and colleagues demonstrated that a placebo injection led to the release of dopamine in the striatal nuclei of PD measured with positron emission tomography technology. Since then, several studies have been conducted to investigate the neurobiological underpinnings of placebo responses. This article presents a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Of an initial yield of 143 papers, 19 were included. The lessons learned from these studies are threefold: (i) motor improvement is dependent on the activation of the entire nigrostriatal pathway induced by dopamine release in the dorsal striatum; (ii) the magnitude of placebo-induced effects is modulated by an expectancy of improvement, which is in turn related to the release of dopamine within the ventral striatum; (iii) the functioning of the neural pathways underlying the placebo response can be tuned by prior exposure and learning strategies. In conclusion, although the neural network underlying the placebo effect in PD has been largely confirmed and accepted, what remains to be established is how, when, and where the expectation of reward (mediated by the ventral striatum) interacts with the primary motor system (mediated by the dorsal striatum) to induce clinical improvement in motor symptoms. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Aldo Quattrone
- Neuroscience Research Centre, University Magna Graecia, Catanzaro, Italy
- Neuroimaging Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | | | - Antonio Cerasa
- Neuroimaging Unit, Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
- Institute S. Anna-Research in Advanced Neurorehabilitation, Crotone, Italy
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre, Division of Neurology and Djavad Mowafaghian Centre for Brain Health, University of British Columbia and Vancouver Coastal Health, Vancouver, Canada
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62
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Zona incerta GABAergic neurons integrate prey-related sensory signals and induce an appetitive drive to promote hunting. Nat Neurosci 2019; 22:921-932. [DOI: 10.1038/s41593-019-0404-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/08/2019] [Indexed: 02/05/2023]
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63
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Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K. Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies. Front Neurol 2019; 10:410. [PMID: 31231293 PMCID: PMC6558426 DOI: 10.3389/fneur.2019.00410] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).
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Affiliation(s)
- Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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64
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Nickl RC, Reich MM, Pozzi NG, Fricke P, Lange F, Roothans J, Volkmann J, Matthies C. Rescuing Suboptimal Outcomes of Subthalamic Deep Brain Stimulation in Parkinson Disease by Surgical Lead Revision. Neurosurgery 2019; 85:E314-E321. [DOI: 10.1093/neuros/nyz018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Clinical trials have established subthalamic deep-brain-stimulation (STN-DBS) as a highly effective treatment for motor symptoms of Parkinson disease (PD), but in clinical practice outcomes are variable. Experienced centers are confronted with an increasing number of patients with partially “failed” STN-DBS, in whom motor benefit doesn’t meet expectations. These patients require a complex multidisciplinary and standardized workup to identify the likely cause.
OBJECTIVE
To describe outcomes in a series of PD patients undergoing lead revision for suboptimal motor benefit after STN-DBS surgery and characterize selection criteria for surgical revision.
METHODS
We investigated 9 PD patients with STN-DBS, who had unsatisfactory outcomes despite intensive neurological management. Surgical revision was considered if the ratio of DBS vs levodopa-induced improvement of UPDRS-III (DBS-rr) was below 75% and the electrodes were found outside the dorsolateral STN.
RESULTS
Fifteen electrodes were replaced via stereotactic revision surgery into the dorsolateral STN without any adverse effects. Median displacement distance was 4.1 mm (range 1.6-8.42 mm). Motor symptoms significantly improved (38.2 ± 6.6 to 15.5 ± 7.9 points, P < .001); DBS-rr increased from 64% to 190%.
CONCLUSION
Patients with persistent OFFmotor symptoms after STN-DBS should be screened for levodopa-responsiveness, which can serve as a benchmark for best achievable motor benefit. Even small horizontal deviations of the lead from the optimal position within the dorsolateral STN can cause stimulation responses, which are markedly inferior to the levodopa response. Patients with an image confirmed lead displacement and preserved levodopa response are candidates for lead revision and can expect significant motor improvement from appropriate lead replacement.
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Affiliation(s)
- Robert C Nickl
- Department of Neurosurgery, Julius-Maximilians-University Hospital, Wue-rzburg, Germany
| | - Martin M Reich
- Department of Neurology, Julius-Maximilians-University Hospital, Wuerzburg, Germany
| | | | - Patrick Fricke
- Department of Neurosurgery, Julius-Maximilians-University Hospital, Wue-rzburg, Germany
| | - Florian Lange
- Department of Neurosurgery, Julius-Maximilians-University Hospital, Wue-rzburg, Germany
| | - Jonas Roothans
- Department of Neurology, Julius-Maximilians-University Hospital, Wuerzburg, Germany
| | - Jens Volkmann
- Department of Neurology, Julius-Maximilians-University Hospital, Wuerzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, Julius-Maximilians-University Hospital, Wue-rzburg, Germany
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65
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Güngör A, Baydın ŞS, Holanda VM, Middlebrooks EH, Isler C, Tugcu B, Foote K, Tanriover N. Microsurgical anatomy of the subthalamic nucleus: correlating fiber dissection results with 3-T magnetic resonance imaging using neuronavigation. J Neurosurg 2019; 130:716-732. [PMID: 29726781 DOI: 10.3171/2017.10.jns171513] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/18/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Despite the extensive use of the subthalamic nucleus (STN) as a deep brain stimulation (DBS) target, unveiling the extensive functional connectivity of the nucleus, relating its structural connectivity to the stimulation-induced adverse effects, and thus optimizing the STN targeting still remain challenging. Mastering the 3D anatomy of the STN region should be the fundamental goal to achieve ideal surgical results, due to the deep-seated and obscure position of the nucleus, variable shape and relatively small size, oblique orientation, and extensive structural connectivity. In the present study, the authors aimed to delineate the 3D anatomy of the STN and unveil the complex relationship between the anatomical structures within the STN region using fiber dissection technique, 3D reconstructions of high-resolution MRI, and fiber tracking using diffusion tractography utilizing a generalized q-sampling imaging (GQI) model. METHODS Fiber dissection was performed in 20 hemispheres and 3 cadaveric heads using the Klingler method. Fiber dissections of the brain were performed from all orientations in a stepwise manner to reveal the 3D anatomy of the STN. In addition, 3 brains were cut into 5-mm coronal, axial, and sagittal slices to show the sectional anatomy. GQI data were also used to elucidate the connections among hubs within the STN region. RESULTS The study correlated the results of STN fiber dissection with those of 3D MRI reconstruction and tractography using neuronavigation. A 3D terrain model of the subthalamic area encircling the STN was built to clarify its anatomical relations with the putamen, globus pallidus internus, globus pallidus externus, internal capsule, caudate nucleus laterally, substantia nigra inferiorly, zona incerta superiorly, and red nucleus medially. The authors also describe the relationship of the medial lemniscus, oculomotor nerve fibers, and the medial forebrain bundle with the STN using tractography with a 3D STN model. CONCLUSIONS This study examines the complex 3D anatomy of the STN and peri-subthalamic area. In comparison with previous clinical data on STN targeting, the results of this study promise further understanding of the structural connections of the STN, the exact location of the fiber compositions within the region, and clinical applications such as stimulation-induced adverse effects during DBS targeting.
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Affiliation(s)
- Abuzer Güngör
- 1Department of Neurosurgery, Acıbadem University
- 2Department of Neurosurgery, Bakirkoy Research & Training Hospital for Psychiatry, Neurology, and Neurosurgery
| | - Şevki Serhat Baydın
- 3Department of Neurosurgery, Kanuni Sultan Süleyman Research & Training Hospital
| | - Vanessa M Holanda
- 4Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | | | - Cihan Isler
- 6Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Bekir Tugcu
- 2Department of Neurosurgery, Bakirkoy Research & Training Hospital for Psychiatry, Neurology, and Neurosurgery
| | - Kelly Foote
- 4Department of Neurosurgery, University of Florida, Gainesville, Florida; and
| | - Necmettin Tanriover
- 6Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Gruber D, Calmbach L, Kühn AA, Krause P, Kopp UA, Schneider GH, Kupsch A. Longterm outcome of cognition, affective state, and quality of life following subthalamic deep brain stimulation in Parkinson’s disease. J Neural Transm (Vienna) 2019; 126:309-318. [DOI: 10.1007/s00702-019-01972-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
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Senova S, Clair AH, Palfi S, Yelnik J, Domenech P, Mallet L. Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach. Front Psychiatry 2019; 10:905. [PMID: 31920754 PMCID: PMC6923766 DOI: 10.3389/fpsyt.2019.00905] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder featuring repetitive intrusive thoughts and behaviors associated with a significant handicap. Of patients, 20% are refractory to medication and cognitive behavioral therapy. Refractory OCD is associated with suicidal behavior and significant degradation of social and professional functioning, with high health costs. Deep brain stimulation (DBS) has been proposed as a reversible and controllable method to treat refractory patients, with meta-analyses showing 60% response rate following DBS, whatever the target: anterior limb of the internal capsule (ALIC), ventral capsule/ventral striatum (VC/VS), nucleus accumbens (NAcc), anteromedial subthalamic nucleus (amSTN), or inferior thalamic peduncle (ITP). But how do we choose the "best" target? Functional neuroimaging studies have shown that ALIC-DBS requires the modulation of the fiber tract within the ventral ALIC via the ventral striatum, bordering the bed nucleus of the stria terminalis and connecting the medial prefrontal cortex with the thalamus to be successful. VC/VS effective sites of stimulation were found within the VC and primarily connected to the medial orbitofrontal cortex (OFC) dorsomedial thalamus, amygdala, and the habenula. NAcc-DBS has been found to reduce OCD symptoms by decreasing excessive fronto-striatal connectivity between NAcc and the lateral and medial prefrontal cortex. The amSTN effective stimulation sites are located at the inferior medial border of the STN, primarily connected to lateral OFC, dorsal anterior cingulate, and dorsolateral prefrontal cortex. Finally, ITP-DBS recruits a bidirectional fiber pathway between the OFC and the thalamus. Thus, these functional connectivity studies show that the various DBS targets lie within the same diseased neural network. They share similar efficacy profiles on OCD symptoms as estimated on the Y-BOCS, the amSTN being the target supported by the strongest evidence in the literature. VC/VS-DBS, amSTN-DBS, and ALIC-DBS were also found to improve mood, behavioral adaptability and potentially both, respectively. Because OCD is such a heterogeneous disease with many different symptom dimensions, the ultimate aim should be to find the most appropriate DBS target for a given refractory patient. This quest will benefit from further investigation and understanding of the individual functional connectivity of OCD patients.
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Affiliation(s)
- Suhan Senova
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,IMRB UPEC/INSERM U 955 Team 14, Créteil, France
| | - Anne-Hélène Clair
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Stéphane Palfi
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,IMRB UPEC/INSERM U 955 Team 14, Créteil, France
| | - Jérôme Yelnik
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Philippe Domenech
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Luc Mallet
- AP-HP, Groupe Hospitalier Henri-Mondor, DHU PePsy, Neurosurgery, Psychiatry and Addictology departments, Créteil, France.,Université Paris Est Creteil, Faculté de Médecine, Créteil, France.,Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Institut du Cerveau et de la Moelle épinière, Paris, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
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Irmen F, Horn A, Meder D, Neumann WJ, Plettig P, Schneider GH, Siebner HR, Kühn AA. Sensorimotor subthalamic stimulation restores risk-reward trade-off in Parkinson's disease. Mov Disord 2018; 34:366-376. [PMID: 30485537 DOI: 10.1002/mds.27576] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/26/2018] [Accepted: 10/11/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND STN-DBS effectively treats motor symptoms of advanced PD. Nonmotor cognitive symptoms, such as impaired impulse control or decision making, may either improve or worsen with DBS. A potential mediating factor of DBS-induced modulation of cognition is the electrode position within the STN with regard to functional subareas of parallel motor, cognitive, and affective basal ganglia loops. However, to date, the volume of tissue activated and weighted stimulation of STN motor versus nonmotor territories are yet to be linked to differential DBS effects on cognition. OBJECTIVES We aim to investigate whether STN-DBS influences risk-reward trade-off decisions and analyze its dependency on electrode placement. METHODS Seventeen PD patients ON and OFF STN-DBS and 17 age-matched healthy controls conducted a sequential decision-making task with escalating risk and reward. We computed the effect of STN-DBS on risk-reward trade-off decisions, localized patients' bilateral electrodes, and analyzed the predictive value of volume of tissue activated in STN motor and nonmotor territories on behavioral change. RESULTS We found that STN-DBS not only improves PD motor symptoms, but also normalizes overly risk-averse decision behavior in PD. Intersubject variance in electrode location could explain this behavioral change. Specifically, if STN-DBS activated preferentially STN motor territory, patients' risk-reward trade-off decisions more resembled those of healthy controls. CONCLUSIONS Our findings support the notion of convergence of different functional circuits within the STN and imply a positive effect of well-placed STN-DBS on nonmotor cognitive functioning in PD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Friederike Irmen
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Biological Psychology and Cognitive Neuroscience, Freie Universität Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Wolf-Julian Neumann
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Philip Plettig
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
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Muthuraman M, Koirala N, Ciolac D, Pintea B, Glaser M, Groppa S, Tamás G, Groppa S. Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease. Front Neurol 2018; 9:711. [PMID: 30210436 PMCID: PMC6119713 DOI: 10.3389/fneur.2018.00711] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nabin Koirala
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stanislav Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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71
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Tröster AI. Some Clinically Useful Information that Neuropsychology Provides Patients, Carepartners, Neurologists, and Neurosurgeons About Deep Brain Stimulation for Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:810-828. [PMID: 29077802 PMCID: PMC5860398 DOI: 10.1093/arclin/acx090] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/06/2017] [Indexed: 12/02/2022] Open
Abstract
Deep brain stimulation (DBS) is an effective (but non-curative) treatment for some of the motor symptoms and treatment complications associated with dopaminergic agents in Parkinson's disease (PD). DBS can be done relatively safely and is associated with quality of life gains. In most DBS centers, neuropsychological evaluations are performed routinely before surgery, and sometimes after surgery. The purpose of such evaluation is not to decide solely on its results whether or not to offer DBS to a given candidate, but to provide the patient and treatment team with the best available information to make reasonable risk-benefit assessments. This review provides information relevant to the questions often asked by patients and their carepartners, neurologists, and neurosurgeons about neuropsychological outcomes of DBS, including neuropsychological adverse event rates, magnitude of cognitive changes, outcomes after unilateral versus bilateral surgery directed at various targets, impact of mild cognitive impairment (MCI) on outcome, factors implicated in neurobehavioral outcomes, and safety of newer interventions or techniques such as asleep surgery and current steering.
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Affiliation(s)
- Alexander I Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ, USA
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72
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Huang Y, Aronson JP, Pilitsis JG, Gee L, Durphy J, Molho ES, Ramirez-Zamora A. Anatomical Correlates of Uncontrollable Laughter With Unilateral Subthalamic Deep Brain Stimulation in Parkinson's Disease. Front Neurol 2018; 9:341. [PMID: 29887826 PMCID: PMC5980955 DOI: 10.3389/fneur.2018.00341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 04/30/2018] [Indexed: 01/11/2023] Open
Abstract
Introduction Subthalamic nucleus deep brain stimulation (STN-DBS) is a well-established treatment for the management of motor complications in Parkinson’s disease. Uncontrollable laughter has been reported as a rare side effect of STN stimulation. The precise mechanism responsible for this unique phenomenon remains unclear. We examined in detail the DBS electrode position and stimulation parameters in two patients with uncontrollable laughter during programming after STN-DBS surgery and illustrated the anatomical correlates of the acute mood changes with STN stimulation. Case report Unilateral STN-DBS induced uncontrollable laughter with activation of the most ventral contacts in both patients. However, the location of the electrodes responsible for this adverse effect differed between the patients. In the first patient, the DBS lead was placed more inferiorly and medially within the STN. In the second patient, the DBS lead was implanted more anteriorly and inferiorly than initially planned at the level of the substantia nigra reticulata (SNr). Conclusion Unilateral STN-DBS can induce acute uncontrollable laughter with activation of electrodes located more anterior, medial, and inferior in relationship with the standard stereotactic STN target. We suggest that simulation of ventral and medial STN, surrounding limbic structures or the SNr, is the most plausible anatomical substrate responsible for this acute mood and behavioral change. Our findings provide insight into the complex functional neuroanatomical relationship of the STN and adjacent structures important for mood and behavior. DBS programming with more dorsal and lateral contacts within the STN should be entertained to minimize the emotional side effects.
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Affiliation(s)
- Yonglu Huang
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.,Department of Neurology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Joshua P Aronson
- Department of Surgery, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Lucy Gee
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Eric Steven Molho
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
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Pozzi NG, Pacchetti C. Back to the future: 30th anniversary of deep brain stimulation for Parkinson's disease. FUNCTIONAL NEUROLOGY 2018; 32:5-6. [PMID: 28380317 DOI: 10.11138/fneur/2017.32.1.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chen S, Gao G, Feng T, Zhang J. Chinese expert consensus on programming deep brain stimulation for patients with Parkinson's disease. Transl Neurodegener 2018; 7:11. [PMID: 29719720 PMCID: PMC5925823 DOI: 10.1186/s40035-018-0116-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Deep Brain Stimulation (DBS) therapy for the treatment of Parkinson’s Disease (PD) is now a well-established option for some patients. Postoperative standardized programming processes can improve the level of postoperative management and programming, relieve symptoms and improve quality of life. Main body In order to improve the quality of the programming, the experts on DBS and PD in neurology and neurosurgery in China reviewed the relevant literatures and combined their own experiences and developed this expert consensus on the programming of deep brain stimulation in patients with PD in China. Conclusion This Chinese expert consensus on postoperative programming can standardize and improve postoperative management and programming of DBS for PD.
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Affiliation(s)
- Shengdi Chen
- 1Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025 China
| | - Guodong Gao
- 2Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xian, 710038 China
| | - Tao Feng
- 3Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
| | - Jianguo Zhang
- 4Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050 China
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Chagraoui A, Boukhzar L, Thibaut F, Anouar Y, Maltête D. The pathophysiological mechanisms of motivational deficits in Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:138-152. [PMID: 29097256 DOI: 10.1016/j.pnpbp.2017.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/21/2017] [Accepted: 10/30/2017] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is a progressive degenerative disorder that leads to disabling motor symptoms and a wide variety of neuropsychiatric symptoms. Apathy is the most common psychiatric disorder in the early stages of untreated PD and can be defined as a hypodopaminergic syndrome, which also includes anxiety and depression. Apathy is also considered the core feature of the parkinsonian triad (apathy, anxiety and depression) of behavioural non-motor signs, including a motivational deficit. Moreover, apathy is recognised as a distinct chronic neuropsychiatric behavioural disorder based on specific diagnostic criteria. Given the prevalence of apathy in approximately 40% of the general Parkinson's disease population, this appears to be a contributing factor to dementia in PD; also, apathy symptoms are factors that potentially contribute to morbidity, leading to a major impairment of health-related quality of life, thus stressing the importance of understanding the pathophysiology of this disease. Several studies have clearly established a prominent role for DA-mediated signals in PD apathy. However, synergistic interaction between dopaminergic impairment resulting from the neurodegenerative process and deep brain stimulation of the subthalamic nucleus may cause or exacerbate apathy. Furthermore, serotoninergic mechanism signalling is also likely to be of importance in this pathophysiology.
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Affiliation(s)
- A Chagraoui
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France.; Department of Medical Biochemistry, Rouen University Hospital, Rouen, France.
| | - L Boukhzar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - F Thibaut
- Department of Psychiatry, University Hospital Cochin (site Tarnier), University of Paris-Descartes and INSERM U 894 Laboratory of Psychiatry and Neurosciences, Paris, France
| | - Y Anouar
- Normandie Univ, UNIROUEN, INSERM, U1239, CHU Rouen, Neuronal and Neuroendocrine Differentiation and Communication Laboratory, Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Rouen, France
| | - D Maltête
- Department of Neurology, Rouen University Hospital, Rouen, France
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Arnold Anteraper S, Guell X, Whitfield-Gabrieli S, Triantafyllou C, Mattfeld AT, Gabrieli JD, Geddes MR. Resting-State Functional Connectivity of the Subthalamic Nucleus to Limbic, Associative, and Motor Networks. Brain Connect 2018; 8:22-32. [DOI: 10.1089/brain.2017.0535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sheeba Arnold Anteraper
- A.A. Martinos Imaging Center, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, Boston, Massachusetts
| | - Xavier Guell
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Cognitive Neuroscience Research Unit (URNC), Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Susan Whitfield-Gabrieli
- A.A. Martinos Imaging Center, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Christina Triantafyllou
- Department of Radiology, A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Aaron T. Mattfeld
- Department of Psychology, Florida International University, Miami, Florida
| | - John D. Gabrieli
- A.A. Martinos Imaging Center, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Maiya R. Geddes
- A.A. Martinos Imaging Center, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
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Reinacher PC, Amtage F, Rijntjes M, Piroth T, Prokop T, Jenkner C, Kätzler J, Coenen VA. One Pass Thalamic and Subthalamic Stimulation for Patients with Tremor-Dominant Idiopathic Parkinson Syndrome (OPINION): Protocol for a Randomized, Active-Controlled, Double-Blinded Pilot Trial. JMIR Res Protoc 2018; 7:e36. [PMID: 29382631 PMCID: PMC5811645 DOI: 10.2196/resprot.8341] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/13/2017] [Accepted: 12/16/2017] [Indexed: 01/15/2023] Open
Abstract
Background Besides fluctuations, therapy refractory tremor is one of the main indications of deep brain stimulation (DBS) in patients with idiopathic Parkinson syndrome (IPS). Although thalamic DBS (ventral intermediate nucleus [Vim] of thalamus) has been shown to reduce tremor in 85-95% of patients, bradykinesia and rigidity often are not well controlled. The dentato-rubro-thalamic tract (DRT) that can directly be targeted with special diffusion tensor magnetic resonance imaging sequences has been shown as an efficient target for thalamic DBS. The subthalamic nucleus (STN) is typically chosen in younger patients as the target for dopamine-responsive motor symptoms. This study investigates a one-path thalamic (Vim/DRT) and subthalamic implantation of DBS electrodes and possibly a combined stimulation strategy for both target regions. Objective This study investigates a one path thalamic (Vim/DRT) and subthalamic implantation of DBS electrodes and a possibly combined stimulation strategy for both target regions. Methods This is a randomized, active-controlled, double-blinded (patient- and observer-blinded), monocentric trial with three treatments, three periods and six treatment sequences allocated according to a Williams design. Eighteen patients will undergo one-path thalamic (Vim/DRT) and STN implantation of DBS electrodes. After one month, a double-blinded and randomly-assigned stimulation of the thalamic target (Vim/DRT), the STN and a combined stimulation of both target regions will be performed for a period of three months each. The primary objective is to assess the quality of life obtained by the Parkinson’s Disease Questionnaire (39 items) for each stimulation modality. Secondary objectives include tremor reduction (obtained by the Fahn-Tolosa-Marin tremor rating scale, video recordings, the Unified Parkinson’s disease rating scale, and by tremor analysis), psychiatric assessment of patients, and to assess the safety of intervention. Results At the moment, the recruitment is stopped and 12 patients have been randomized and treated. A futility analysis is being carried out by means of a conditional power analysis. Conclusions The approach of the OPINION trial planned to make, for the first time, a direct comparison of the different stimulation conditions (Vim/DRT, compared to STN, compared to Vim/DRT+STN) in a homogeneous patient population and, furthermore, will allow for intraindividual comparison of each condition with the “quality of life” outcome parameter. We hypothesize that the combined stimulation of the STN and the thalamic (Vim/DRT) target will be superior with respect to the patients’ quality of life as compared to the singular stimulation of the individual target regions. If this holds true, this work might change the standardized treatment described in the previous section. Trial Registration ClinicalTrials.gov: NCT02288468; https://clinicaltrials.gov/ct2/show/NCT02288468 (Archived by WebCite at http://www.webcitation.org/6wlKnt2pJ); and German Clinical Trials Register: DRKS00007526; https://www.drks.de/drks_ web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00007526 (Archived by WebCite at http://www.webcitation.org/6wlKyXZZL).
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Affiliation(s)
- Peter Christoph Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Florian Amtage
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Tobias Piroth
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Neurology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Thomas Prokop
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carolin Jenkner
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Clinical Trials Unit Freiburg, Medical Center, University of Freiburg, Freiburg, Germany
| | - Jürgen Kätzler
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Clinical Trials Unit Freiburg, Medical Center, University of Freiburg, Freiburg, Germany
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hell F, Taylor PCJ, Mehrkens JH, Bötzel K. Subthalamic stimulation, oscillatory activity and connectivity reveal functional role of STN and network mechanisms during decision making under conflict. Neuroimage 2018; 171:222-233. [PMID: 29307607 DOI: 10.1016/j.neuroimage.2018.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/27/2017] [Accepted: 01/01/2018] [Indexed: 01/12/2023] Open
Abstract
Inhibitory control is an important executive function that is necessary to suppress premature actions and to block interference from irrelevant stimuli. Current experimental studies and models highlight proactive and reactive mechanisms and claim several cortical and subcortical structures to be involved in response inhibition. However, the involved structures, network mechanisms and the behavioral relevance of the underlying neural activity remain debated. We report cortical EEG and invasive subthalamic local field potential recordings from a fully implanted sensing neurostimulator in Parkinson's patients during a stimulus- and response conflict task with and without deep brain stimulation (DBS). DBS made reaction times faster overall while leaving the effects of conflict intact: this lack of any effect on conflict may have been inherent to our task encouraging a high level of proactive inhibition. Drift diffusion modelling hints that DBS influences decision thresholds and drift rates are modulated by stimulus conflict. Both cortical EEG and subthalamic (STN) LFP oscillations reflected reaction times (RT). With these results, we provide a different interpretation of previously conflict-related oscillations in the STN and suggest that the STN implements a general task-specific decision threshold. The timecourse and topography of subthalamic-cortical oscillatory connectivity suggest the involvement of motor, frontal midline and posterior regions in a larger network with complementary functionality, oscillatory mechanisms and structures. While beta oscillations are functionally associated with motor cortical-subthalamic connectivity, low frequency oscillations reveal a subthalamic-frontal-posterior network. With our results, we suggest that proactive as well as reactive mechanisms and structures are involved in implementing a task-related dynamic inhibitory signal. We propose that motor and executive control networks with complementary oscillatory mechanisms are tonically active, react to stimuli and release inhibition at the response when uncertainty is resolved and return to their default state afterwards.
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Affiliation(s)
- Franz Hell
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377 Munich, Germany; Graduate School of Systemic Neurosciences, GSN, Ludwig-Maximilians-Universität München, Grosshadernerstr. 2, D-82152 Martinsried, Germany.
| | - Paul C J Taylor
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377 Munich, Germany; Graduate School of Systemic Neurosciences, GSN, Ludwig-Maximilians-Universität München, Grosshadernerstr. 2, D-82152 Martinsried, Germany; German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377 Munich, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377 Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377 Munich, Germany; Graduate School of Systemic Neurosciences, GSN, Ludwig-Maximilians-Universität München, Grosshadernerstr. 2, D-82152 Martinsried, Germany
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Çavdar S, Özgür M, Çakmak YÖ, Kuvvet Y, Kunt SK, Sağlam G. Afferent projections of the subthalamic nucleus in the rat: emphasis on bilateral and interhemispheric connections. Acta Neurobiol Exp (Wars) 2018. [DOI: 10.21307/ane-2018-023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Witt K, Kalbe E, Erasmi R, Ebersbach G. [Nonpharmacological treatment procedures for Parkinson's disease]. DER NERVENARZT 2017; 88:383-390. [PMID: 28251243 DOI: 10.1007/s00115-017-0298-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nonpharmacological treatment strategies in Parkinson' disease include heterogeneous treatment modalities, such as physiotherapy, occupational therapy, speech therapy, cognitive training and deep brain stimulation as well as noninvasive brain stimulation strategies. Even in the early stages of Parkinson's disease nonpharmacological interventions, such as active exercise therapy and speech therapy can be indicated taking the individual symptoms of a patient into account. Mild cognitive deficits are frequently detected in the course of the disease and progression of these disorders to dementia in the advanced stages of the disease is not uncommon. The starting point for a cognitive training, training strategy and training frequency is unknown and currently under investigation. Deep brain stimulation is an established treatment modality, which should be considered when motor fluctuations cannot be adequately controlled by pharmacological treatment. This therapeutic option depends on patient-specific needs and has to be managed by a multiprofessional team. Non-invasive neurostimulation techniques, such as transcranial magnetic stimulation and transcranial direct current stimulation are experimental tools and cannot currently be recommended for general use.
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Affiliation(s)
- K Witt
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian Albrechts Universität Kiel, Rosalind Franklin Straße 10, 24105, Kiel, Deutschland.
| | - E Kalbe
- Medizinische Psychologie | Neuropsychologie und Gender Studies & Center für Neuropsychologische Diagnostik und Intervention (CeNDI), Zentrum für Neurologie und Psychiatrie, Uniklinik Köln, Köln, Deutschland
| | - R Erasmi
- Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian Albrechts Universität Kiel, Rosalind Franklin Straße 10, 24105, Kiel, Deutschland
| | - G Ebersbach
- Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson, Beelitz-Heilstätten, Deutschland
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81
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Programming for Stimulation-Induced Transient Nonmotor Psychiatric Symptoms after Bilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. PARKINSONS DISEASE 2017; 2017:2615619. [PMID: 28894620 PMCID: PMC5574315 DOI: 10.1155/2017/2615619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/21/2017] [Accepted: 07/10/2017] [Indexed: 11/17/2022]
Abstract
Background Stimulation-induced transient nonmotor psychiatric symptoms (STPSs) are side effects following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) patients. We designed algorithms which (1) determine the electrode contacts that induce STPSs and (2) provide a programming protocol to eliminate STPS and maintain the optimal motor functions. Our objective is to test the effectiveness of these algorithms. Materials and Methods 454 PD patients who underwent programming sessions after STN-DBS implantations were retrospectively analyzed. Only STPS patients were enrolled. In these patients, the contacts inducing STPS were found and the programming protocol algorithms used. Results Eleven patients were diagnosed with STPS. Of these patients, two had four episodes of crying, and two had four episodes of mirthful laughter. In one patient, two episodes of abnormal sense of spatial orientation were observed. Hallucination episodes were observed twice in one patient, while five patients recorded eight episodes of hypomania. There were no statistical differences between the UPDRS-III under the final stimulation parameter (without STPS) and previous optimum UPDRS-III under the STPSs (p = 1.000). Conclusion The flow diagram used for determining electrode contacts that induce STPS and the programming protocol employed in the treatment of these symptoms are effective.
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Lhommée E, Boyer F, Wack M, Pélissier P, Klinger H, Schmitt E, Bichon A, Fraix V, Chabardès S, Mertens P, Castrioto A, Kistner A, Broussolle E, Thobois S, Krack P. Personality, dopamine, and Parkinson's disease: Insights from subthalamic stimulation. Mov Disord 2017. [PMID: 28643887 DOI: 10.1002/mds.27065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Subthalamic stimulation improves the motor and neuropsychiatric symptoms of Parkinson's disease. However, the impact of this treatment on impulse control and personality is the subject of heavy debate. The objective of this study was to investigate personality changes after subthalamic stimulation. METHODS Using Cloninger's biosocial model, we assessed personality in 73 Parkinson's disease patients before and 12 months after subthalamic stimulation accompanied by a drastic reduction in dopaminergic medication. Changes in psychobehavioral symptoms were measured using a battery of validated clinical scales (apathy, depression, anxiety, hyperemotionality, mania, psychosis, punding, and impulse control behaviors). RESULTS One year after surgery, the harm avoidance personality domain total score increased compared with the baseline (+2.8; 34 patients; P < 0.001), as did 3 of its 4 subdomains: anticipatory worry (+0.7; 10 patients; P = 0.005), shyness (+0.6; 7 patients; P = 0.03), and fatigability (+1.1; 10 patients; P = 0.0014). Evolution of the shyness personality trait correlated with the decrease in dopaminergic medication. Total scores in the other personality domains remained unchanged, except for extravagance, a subdomain of novelty seeking, and persistence, a subdomain of reward dependence, which both decreased following surgery (-0.3; 7 patients; and -0.6; 9 patients; P = 0.03 and P = 0.0019, respectively). Although apathy increased, other psychobehavioral symptoms, including impulse control behaviors and neuropsychiatric nonmotor fluctuations, improved. Depression and anhedonia remained stable. Scores in hypodopaminergia and neuropsychiatric nonmotor OFF correlated with harm avoidance. Scores in hyperdopaminergia and neuropsychiatric nonmotor ON correlated with novelty seeking. CONCLUSIONS When subthalamic stimulation is applied in Parkinson's disease, significant changes in personality traits are observed, which may be related to postoperative tapering of dopaminergic treatment. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - François Boyer
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France
| | - Maxime Wack
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Service d'épidémiologie et évaluation cliniques, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Pierre Pélissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Amélie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Valérie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Stéphan Chabardès
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France.,Department of neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Patrick Mertens
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Lyon, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Emmanuel Broussolle
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France.,Present address: Department of Clinical Neuroscience, Hôpitaux Universitaires de Genève, Faculty University of Geneva, Switzerland
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Jia F, Hu W, Zhang J, Wagle Shukla A, Almeida L, Meng FG, Okun MS, Li L. Variable frequency stimulation of subthalamic nucleus in Parkinson's disease: Rationale and hypothesis. Parkinsonism Relat Disord 2017; 39:27-30. [PMID: 28392298 DOI: 10.1016/j.parkreldis.2017.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/27/2017] [Accepted: 03/19/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Fumin Jia
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Wei Hu
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Jianguo Zhang
- Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Leonardo Almeida
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA
| | - Fan-Gang Meng
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Michael S Okun
- University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, FL, USA.
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China; Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China; Man-machine-environment Engineering Institute, School of Aerospace Engineering, Tsinghua University, Beijing, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.
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Abstract
Parkinson disease is the second-most common neurodegenerative disorder that affects 2-3% of the population ≥65 years of age. Neuronal loss in the substantia nigra, which causes striatal dopamine deficiency, and intracellular inclusions containing aggregates of α-synuclein are the neuropathological hallmarks of Parkinson disease. Multiple other cell types throughout the central and peripheral autonomic nervous system are also involved, probably from early disease onwards. Although clinical diagnosis relies on the presence of bradykinesia and other cardinal motor features, Parkinson disease is associated with many non-motor symptoms that add to overall disability. The underlying molecular pathogenesis involves multiple pathways and mechanisms: α-synuclein proteostasis, mitochondrial function, oxidative stress, calcium homeostasis, axonal transport and neuroinflammation. Recent research into diagnostic biomarkers has taken advantage of neuroimaging in which several modalities, including PET, single-photon emission CT (SPECT) and novel MRI techniques, have been shown to aid early and differential diagnosis. Treatment of Parkinson disease is anchored on pharmacological substitution of striatal dopamine, in addition to non-dopaminergic approaches to address both motor and non-motor symptoms and deep brain stimulation for those developing intractable L-DOPA-related motor complications. Experimental therapies have tried to restore striatal dopamine by gene-based and cell-based approaches, and most recently, aggregation and cellular transport of α-synuclein have become therapeutic targets. One of the greatest current challenges is to identify markers for prodromal disease stages, which would allow novel disease-modifying therapies to be started earlier.
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86
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Levodopa/carbidopa intestinal gel (LCIG) infusion as mono- or combination therapy. J Neural Transm (Vienna) 2017; 124:1005-1013. [PMID: 28229223 DOI: 10.1007/s00702-017-1698-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/14/2017] [Indexed: 01/16/2023]
Abstract
Levodopa/carbidopa intestinal gel (LCIG) infusion is an effective escalating therapy in patients with Parkinson disease (PD) suffering from motor fluctuations and dyskinesia. Levodopa/carbidopa given continuously as infusion provides an optimized application of the most effective and best tolerable antiparkinsonian drug. It has been proven to have a superior motor effect compared with oral levodopa and to improve also non-motor symptoms. However, invasiveness, discomfort resulting from carrying an external device, and side effects associated with the way of administration limit its application in PD patients. At present, there are no guidelines that delineate to which patients LCIG should be offered as monotherapy, in combination with oral and/or transdermal medication, or as additional therapy to deep brain stimulation (DBS). Based on clinical studies, we propose an expert consensus for neurologists addressing the question when LCIG therapy should be recommended and in which cases LCIG infusion is suggested in combination with other antiparkinsonian drugs and/or DBS. We describe how LCIG should be initiated and what we consider necessary for clinical follow-up. We suggest an algorithm facilitating decision-making with respect to the currently available invasive PD therapies, namely infusion with subcutaneous apomorphine, LCIG, and DBS.
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87
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Medical Management of Parkinson's Disease after Initiation of Deep Brain Stimulation. Can J Neurol Sci 2017; 43:626-34. [PMID: 27670207 DOI: 10.1017/cjn.2016.274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this review, we have gathered all the available evidence to guide medication management after deep brain stimulation (DBS) in Parkinson's disease (PD). Surprisingly, we found that almost no study addressed drug-based management in the postoperative period. Dopaminergic medications are usually reduced, but whether the levodopa or dopamine agonist is to be reduced is left to the personal preference of the treating physician. We have summarized the pros and cons of both approaches. No study on the management of cognitive problems after DBS has been done, and only a few studies have explored the pharmacological management of such DBS-resistant symptoms as voice (amantadine), balance (donepezil) or gait disorders (amantadine, methylphenidate). As for the psychiatric problems so frequently reported in PD patients, researchers have directed their attention to the complex interplay between stimulation and reduction of dopaminergic drugs only recently. In conclusion, studies addressing medical management following DBS are still needed and will certainly contribute to the ultimate success of DBS procedures.
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88
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No genetic association between attention-deficit/hyperactivity disorder (ADHD) and Parkinson's disease in nine ADHD candidate SNPs. ACTA ACUST UNITED AC 2017; 9:121-127. [PMID: 28176268 DOI: 10.1007/s12402-017-0219-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 01/18/2017] [Indexed: 01/01/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and Parkinson's disease (PD) involve pathological changes in brain structures such as the basal ganglia, which are essential for the control of motor and cognitive behavior and impulsivity. The cause of ADHD and PD remains unknown, but there is increasing evidence that both seem to result from a complicated interplay of genetic and environmental factors affecting numerous cellular processes and brain regions. To explore the possibility of common genetic pathways within the respective pathophysiologies, nine ADHD candidate single nucleotide polymorphisms (SNPs) in seven genes were tested for association with PD in 5333 cases and 12,019 healthy controls: one variant, respectively, in the genes coding for synaptosomal-associated protein 25 k (SNAP25), the dopamine (DA) transporter (SLC6A3; DAT1), DA receptor D4 (DRD4), serotonin receptor 1B (HTR1B), tryptophan hydroxylase 2 (TPH2), the norepinephrine transporter SLC6A2 and three SNPs in cadherin 13 (CDH13). Information was extracted from a recent meta-analysis of five genome-wide association studies, in which 7,689,524 SNPs in European samples were successfully imputed. No significant association was observed after correction for multiple testing. Therefore, it is reasonable to conclude that candidate variants implicated in the pathogenesis of ADHD do not play a substantial role in PD.
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89
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Kurtis MM, Rajah T, Delgado LF, Dafsari HS. The effect of deep brain stimulation on the non-motor symptoms of Parkinson's disease: a critical review of the current evidence. NPJ Parkinsons Dis 2017; 3:16024. [PMID: 28725706 PMCID: PMC5516616 DOI: 10.1038/npjparkd.2016.24] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/15/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022] Open
Abstract
The benefit of deep brain stimulation (DBS) in controlling the motor symptoms of Parkinson's disease is well established, however, the impact on the non-motor symptoms (NMS) remains to be elucidated, although the growing investigative efforts are promising. This article reviews the reported data and considers the level of evidence available with regard to the effect of DBS on NMS total burden and on the cognitive, neuropsychiatric, sleep, pain, dysautonomic, and weight domains. Multiple case series suggest that DBS improves the burden of NMS by reducing prevalence, intensity, and non-motor fluctuations. There is level I evidence on the effect of DBS on cognition and mood. Slight cognitive decline has been reported in most class I studies, although the functional effect is probably minimal. Two randomized prospective studies reported no change in depression while improvement of anxiety has been reported by a class I trial. Prospective cohort studies point to improvement of hyperdopaminergic behaviors, such as impulse control disorders, while others report that hypodopaminergic states, like apathy, can appear after DBS. There is only class III evidence supporting the benefit of DBS on other NMS such as nocturnal sleep, pain, dysautonomia (urinary, gastrointestinal, cardiovascular, and sweating), and weight loss. Although preliminary results are promising, randomized prospectively controlled trials with NMS as primary end points are necessary to further explore the effect of DBS on these often invalidating symptoms and offer conclusions about efficacy.
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Affiliation(s)
- Mónica M Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Thadshani Rajah
- Kings Parkinson's Centre of Excellence, Kings College and Kings College Hospital, London, UK
| | - Luisa F Delgado
- Fundación Universitaria de Ciencias de la Salud, Hospital San José—Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Hashemiyoon R, Kuhn J, Visser-Vandewalle V. Putting the Pieces Together in Gilles de la Tourette Syndrome: Exploring the Link Between Clinical Observations and the Biological Basis of Dysfunction. Brain Topogr 2017; 30:3-29. [PMID: 27783238 PMCID: PMC5219042 DOI: 10.1007/s10548-016-0525-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/20/2016] [Indexed: 12/21/2022]
Abstract
Gilles de la Tourette syndrome is a complex, idiopathic neuropsychiatric disorder whose pathophysiological mechanisms have yet to be elucidated. It is phenotypically heterogeneous and manifests more often than not with both motor and behavioral impairment, although tics are its clinical hallmark. Tics themselves present with a complex profile as they characteristically wax and wane and are often preceded by premonitory somatosensory sensations to which it is said a tic is the response. Highly comorbid with obsessive-compulsive disorder and attention deficit-hyperactivity disorder, it is purported to be an epigenetic, neurodevelopmental spectrum disorder with a complex genetic profile. It has a childhood onset, occurs disproportionately in males, and shows spontaneous symptomatic attenuation by adulthood in the majority of those afflicted. Although not fully understood, its neurobiological basis is linked to dysfunction in the cortico-basal ganglia-thalamo-cortical network. Treatment modalities for Tourette syndrome include behavioral, pharmacological and surgical interventions, but there is presently no cure for the disorder. For those severely affected, deep brain stimulation (DBS) has recently become a viable therapeutic option. A key factor to attaining optimal results from this surgery is target selection, a topic still under debate due to the complex clinical profile presented by GTS patients. Depending on its phenotypic expression and the most problematic aspect of the disorder for the individual, one of three brain regions is most commonly chosen for stimulation: the thalamus, globus pallidus, or nucleus accumbens. Neurophysiological analyses of intra- and post-operative human electrophysiological recordings from clinical DBS studies suggest a link between tic behavior and activity in both the thalamus and globus pallidus. In particular, chronic recordings from the thalamus have shown a correlation between symptomatology and (1) spectral activity in gamma band power and (2) theta/gamma cross frequency coherence. These results suggest gamma oscillations and theta/gamma cross correlation dynamics may serve as biomarkers for dysfunction. While acute and chronic recordings from human subjects undergoing DBS have provided better insight into tic genesis and the neuropathophysiological mechanisms underlying Tourette syndrome, these studies are still sparse and the field would greatly benefit from further investigations. This review reports data and discoveries of scientific and clinical relevance from a wide variety of methods and provides up-to-date information about our current understanding of the pathomechanisms underlying Tourette syndrome. It gives a comprehensive overview of the current state of knowledge and addresses open questions in the field.
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Affiliation(s)
- Rowshanak Hashemiyoon
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany
- Johanniter Hospital, EVKLN, Oberhausen, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
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91
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Merkl A, Röck E, Schmitz-Hübsch T, Schneider GH, Kühn AA. Effects of subthalamic nucleus deep brain stimulation on emotional working memory capacity and mood in patients with Parkinson's disease. Neuropsychiatr Dis Treat 2017; 13:1603-1611. [PMID: 28684915 PMCID: PMC5485890 DOI: 10.2147/ndt.s126397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In Parkinson's disease (PD), cognitive symptoms and mood changes may be even more distressing for the patient than motor symptoms. OBJECTIVE Our aim was to determine the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on working memory (WM) and mood. METHODS Sixteen patients with PD were assessed with STN-DBS switched on (DBS-ON) and with dopaminergic treatment (Med-ON) compared to switched off (DBS-OFF) and without dopaminergic treatment (Med-OFF). The primary outcome measures were a Visual Analog Mood Scale (VAMS) and an emotional 2-back WM task at 12 months after DBS in the optimal DBS-ON/Med-ON setting compared to DBS-OFF/Med-OFF. RESULTS Comparison of DBS-OFF/Med-OFF to DBS-ON/Med-ON revealed a significant increase in alertness (meanoff/off =51.59±24.54; meanon/on =72.75; P=0.016) and contentedness (meanoff/off =38.73±24.41; meanon/on =79.01±17.66; P=0.001, n=16), and a trend for reduction in sedation (P=0.060), which was related to stimulation as shown in a subgroup of seven patients. The N-back task revealed a significant increase in accuracy with DBS-ON/Med-ON compared to DBS-OFF/Med-OFF (82.0% vs 76.0%, respectively) (P=0.044), regardless of stimulus valence. CONCLUSION In line with previous studies, we found that patients rated themselves subjectively as more alert, content, and less sedated during short-term DBS-ON. Accuracy in the WM task increased with the combination of DBS and medication, possibly related to higher alertness of the patients. Our results add to the currently mixed results described for DBS on WM and suggest that there are no deleterious DBS effects on this specific cognitive domain.
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Affiliation(s)
- Angela Merkl
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,Department of Psychiatry and Psychotherapy, Charité - University Medicine Berlin, Campus Benjamin Franklin
| | - Eva Röck
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum
| | - Tanja Schmitz-Hübsch
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,NeuroCure, Charité - University Medicine Berlin
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Campus Virchow Klinikum
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Campus Virchow Klinikum.,NeuroCure, Charité - University Medicine Berlin.,Berlin School of Mind and Brain, Charité - University Medicine Berlin, Berlin, Germany
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92
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Janssen MLF, Temel Y, Delaville C, Zwartjes DGM, Heida T, De Deurwaerdère P, Visser-Vandewalle V, Benazzouz A. Cortico-subthalamic inputs from the motor, limbic, and associative areas in normal and dopamine-depleted rats are not fully segregated. Brain Struct Funct 2016; 222:2473-2485. [PMID: 28013397 DOI: 10.1007/s00429-016-1351-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022]
Abstract
The subthalamic nucleus (STN) receives monosynaptic glutamatergic afferents from different areas of the cortex, known as the "hyperdirect" pathway. The STN has been divided into three distinct subdivisions, motor, limbic, and associative parts in line with the concept of parallel information processing. The extent to which the parallel information processing coming from distinct cortical areas overlaps in the different territories of the STN is still a matter of debate and the proposed role of dopaminergic neurons in maintaining the coherence of responses to cortical inputs in each territory is not documented. Using extracellular electrophysiological approaches, we investigated to what degree the motor and non-motor regions in the STN are segregated in control and dopamine (DA) depleted rats. We performed electrical stimulation of different cortical areas and recorded STN neuronal responses. We showed that motor and non-motor cortico-subthalamic pathways are not fully segregated, but partially integrated in the rat. This integration was mostly present through the indirect pathway. The spatial distribution and response latencies were the same in sham and 6-hydroxydopamine lesioned animals. The inhibitory phase was, however, less apparent in the lesioned animals. In conclusion, this study provides the first evidence that motor and non-motor cortico-subthalamic pathways in the rat are not fully segregated, but partially integrated. This integration was mostly present through the indirect pathway. We also show that the inhibitory phase induced by GABAergic inputs from the external segment of the globus pallidus is reduced in the DA-depleted animals.
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Affiliation(s)
- Marcus L F Janssen
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 146, Rue Léo-Saignat, 33000, Bordeaux Cedex, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Maastricht University Medical Center, 6202 AZ, Maastricht, The Netherlands
| | - Yasin Temel
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, 6202 AZ, Maastricht, The Netherlands
| | - Claire Delaville
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 146, Rue Léo-Saignat, 33000, Bordeaux Cedex, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France
| | - Daphne G M Zwartjes
- MIRA Institute for Biomedical Technology and Technical Medicine, Department of Electrical Engineering, Mathematics and Computer Science, Biomedical Signals and Systems group, Twente University, 7500 AE, Enschede, The Netherlands
| | - Tjitske Heida
- MIRA Institute for Biomedical Technology and Technical Medicine, Department of Electrical Engineering, Mathematics and Computer Science, Biomedical Signals and Systems group, Twente University, 7500 AE, Enschede, The Netherlands
| | - Philippe De Deurwaerdère
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 146, Rue Léo-Saignat, 33000, Bordeaux Cedex, France
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France
| | | | - Abdelhamid Benazzouz
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 146, Rue Léo-Saignat, 33000, Bordeaux Cedex, France.
- CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000, Bordeaux, France.
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Coenen VA, Amtage F, Volkmann J, Schläpfer TE. Deep Brain Stimulation in Neurological and Psychiatric Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:519-26. [PMID: 26334979 DOI: 10.3238/arztebl.2015.0519] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is the chronic electrical stimulation of selected target sites in the brain through stereotactically implanted electrodes. More than 150 000 patients around the world have been treated to date with DBS for medically intractable conditions. The indications for DBS include movement disorders, epilepsy, and some types of mental illness. METHODS This review is based on relevant publications retrieved by a selective search in PubMed and the Cochrane Library, and on the current guidelines of the German Neurological Society (Deutsche Gesellschaft für Neurologie, DGN). RESULTS DBS is usually performed to treat neurological diseases, most often movement disorders and, in particular, Parkinson's disease. Multiple randomized controlled trials (RCTs) have shown that DBS improves tremor, dyskinesia, and quality of life in patients with Parkinson's disease by 25% to 50%, depending on the rating scales used. DBS for tremor usually involves stimulation in the cerebello-thalamo-cortical regulatory loop. In an RCT of DBS for the treatment of primary generalized dystonia, the patients who underwent DBS experienced a 39.3% improvement of dystonia, compared to only 4.9% in the control group. Two multicenter trials of DBS for depression were terminated early because of a lack of efficacy. CONCLUSION DBS is an established treatment for various neurological and psychiatric diseases. It has been incorporated in the DGN guidelines and is now considered a standard treatment for advanced Parkinson's disease. The safety and efficacy of DBS can be expected to improve with the application of new technical developments in electrode geometry and new imaging techniques. Controlled trials would be helpful so that DBS could be extended to further indications, particularly psychiatric ones.
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Affiliation(s)
- Volker A Coenen
- Abteilung Stereotaktische und Funktionelle Neurochirurgie, Universitätsklinikum der Albert-Ludwigs-Universität Freiburg, Klinik für Neurologie und Neurophysiologie, Albert-Ludwigs-Universität Freiburg, Neurologische Klinik und Poliklinik, Universit7auml;sklinikum Würzburg, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum
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94
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UMEMURA A, OYAMA G, SHIMO Y, NAKAJIMA M, NAKAJIMA A, JO T, SEKIMOTO S, ITO M, MITSUHASHI T, HATTORI N, ARAI H. Current Topics in Deep Brain Stimulation for Parkinson Disease. Neurol Med Chir (Tokyo) 2016; 56:613-625. [PMID: 27349658 PMCID: PMC5066082 DOI: 10.2176/nmc.ra.2016-0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/04/2016] [Indexed: 01/30/2023] Open
Abstract
There is a long history of surgical treatment for Parkinson disease (PD). After pioneering trials and errors, the current primary surgical treatment for PD is deep brain stimulation (DBS). DBS is a promising treatment option for patients with medically refractory PD. However, there are still many problems and controversies associated with DBS. In this review, we discuss current issues in DBS for PD, including patient selection, clinical outcomes, complications, target selection, long-term outcomes, management of axial symptoms, timing of surgery, surgical procedures, cost-effectiveness, and new technology.
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Affiliation(s)
- Atsushi UMEMURA
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Genko OYAMA
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasushi SHIMO
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Madoka NAKAJIMA
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Asuka NAKAJIMA
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takayuki JO
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoko SEKIMOTO
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masanobu ITO
- Department of Psychiatry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takumi MITSUHASHI
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka HATTORI
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hajime ARAI
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
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95
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Fiore VG, Dolan RJ, Strausfeld NJ, Hirth F. Evolutionarily conserved mechanisms for the selection and maintenance of behavioural activity. Philos Trans R Soc Lond B Biol Sci 2016; 370:rstb.2015.0053. [PMID: 26554043 PMCID: PMC4650127 DOI: 10.1098/rstb.2015.0053] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Survival and reproduction entail the selection of adaptive behavioural repertoires. This selection manifests as phylogenetically acquired activities that depend on evolved nervous system circuitries. Lorenz and Tinbergen already postulated that heritable behaviours and their reliable performance are specified by genetically determined programs. Here we compare the functional anatomy of the insect central complex and vertebrate basal ganglia to illustrate their role in mediating selection and maintenance of adaptive behaviours. Comparative analyses reveal that central complex and basal ganglia circuitries share comparable lineage relationships within clusters of functionally integrated neurons. These clusters are specified by genetic mechanisms that link birth time and order to their neuronal identities and functions. Their subsequent connections and associated functions are characterized by similar mechanisms that implement dimensionality reduction and transition through attractor states, whereby spatially organized parallel-projecting loops integrate and convey sensorimotor representations that select and maintain behavioural activity. In both taxa, these neural systems are modulated by dopamine signalling that also mediates memory-like processes. The multiplicity of similarities between central complex and basal ganglia suggests evolutionarily conserved computational mechanisms for action selection. We speculate that these may have originated from ancestral ground pattern circuitries present in the brain of the last common ancestor of insects and vertebrates.
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Affiliation(s)
- Vincenzo G Fiore
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Raymond J Dolan
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, UK
| | | | - Frank Hirth
- Institute of Psychiatry, Psychology & Neuroscience, Department of Basic & Clinical Neuroscience, King's College London, London, UK
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96
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de Chazeron I, Pereira B, Chereau-Boudet I, Durif F, Lemaire JJ, Brousse G, Ulla M, Derost P, Debilly B, Llorca PM. Impact of localisation of deep brain stimulation electrodes on motor and neurobehavioural outcomes in Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87:758-66. [PMID: 26296870 DOI: 10.1136/jnnp-2015-310953] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 07/28/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) represents a well-established treatment in advanced Parkinson's disease (PD) for motor signs, but it is still debated concerning psychiatric effects. OBJECTIVE Exploration of relation between position of active electrode contacts and neuropsychological and motor change after STN DBS procedure for PD. METHODS A cohort of 34 patients who underwent STN DBS was followed for 6 months. Preoperative and postoperative assessments included mood evaluation (depression and mania) and motor status. Active contact localisation was identified regarding position into the STN (4 groups: IN meant contacts were IN-IN IN-BORDER; OUT: OUT-OUT or OUT-BORDER; BORDER: BORDER-BORDER; IN-OUT: IN-OUT) and compared with clinical outcomes. RESULTS STN DBS significantly improved motor scores and reduced dopaminergic medication when compared with baseline and active lead groups: the best result was seen with the IN group. At 3 and 6 months postsurgery, depression and manic scores do not significantly differ compared with baseline and between leads groups. Focusing on symptom domains and compared with baseline, a significant loss of appetite was observed for the IN group at M3 and a significant increase in appetite from baseline was observed at M3 for the OUT group. Graphic representations illustrate that postsurgery evolution parameters at M3 or M6 are very good discriminant variables and well differentiate all leading groups. CONCLUSIONS Stimulation of zona incerta may influence appetite and weight gain. Our clinical results seem to support a personalised DBS-targeted Parkinson therapy including individual motor and non-motor parameters.
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Affiliation(s)
- I de Chazeron
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - I Chereau-Boudet
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - F Durif
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Neurology A, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J J Lemaire
- GCNC-EA 728, Image-Guided Clinical Neuroscience and Connectomics, université dAuvergne, Clermont université, hôpital Gabriel Montpied, Clermont-Ferrand, France Service de neurochirurgie, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - G Brousse
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - M Ulla
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Neurology A, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P Derost
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Neurology A, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - B Debilly
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Neurology A, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P M Llorca
- Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand, France Department of Psychiatry B, CHU Clermont-Ferrand, Clermont-Ferrand, France
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97
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Cozac VV, Ehrensperger MM, Gschwandtner U, Hatz F, Meyer A, Monsch AU, Schuepbach M, Taub E, Fuhr P. Older Candidates for Subthalamic Deep Brain Stimulation in Parkinson's Disease Have a Higher Incidence of Psychiatric Serious Adverse Events. Front Aging Neurosci 2016; 8:132. [PMID: 27375478 PMCID: PMC4896943 DOI: 10.3389/fnagi.2016.00132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 05/25/2016] [Indexed: 12/02/2022] Open
Abstract
Objective: To investigate the incidence of serious adverse events (SAE) of subthalamic deep brain stimulation (STN-DBS) in elderly patients with Parkinson's disease (PD). Methods: We investigated a group of 26 patients with PD who underwent STN-DBS at mean age 63.2 ± 3.3 years. The operated patients from the EARLYSTIM study (mean age 52.9 ± 6.6) were used as a comparison group. Incidences of SAE were compared between these groups. Results: A higher incidence of psychosis and hallucinations was found in these elderly patients compared to the younger patients in the EARLYSTIM study (p < 0.01). Conclusions: The higher incidence of STN-DBS-related psychiatric complications underscores the need for comprehensive psychiatric pre- and postoperative assessment in older DBS candidates. However, these psychiatric SAE were transient, and the benefits of DBS clearly outweighed its adverse effects.
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Affiliation(s)
- Vitalii V Cozac
- Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Michael M Ehrensperger
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Florian Hatz
- Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Antonia Meyer
- Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Andreas U Monsch
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging Basel, Switzerland
| | - Michael Schuepbach
- Department of Neurology, University Hospital Bern and University of BernBern, Switzerland; Département de Neurologie, Assistance-Publique Hôpitaux de Paris, Centre d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Université Pierre et Marie Curie, Paris 6 et Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire (CHU) Pitié-SalpêtrièreParis, France
| | - Ethan Taub
- Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, Hospital of the University of Basel Basel, Switzerland
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98
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Allert N, Gippert SM, Sajonz BEA, Nelles C, Bewernick B, Schlaepfer TE, Coenen VA. Arachnophobia alleviated by subthalamic nucleus stimulation for Parkinson's disease. J Neural Transm (Vienna) 2016; 123:631-5. [PMID: 27198699 DOI: 10.1007/s00702-016-1546-1] [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: 02/27/2016] [Accepted: 04/01/2016] [Indexed: 11/30/2022]
Abstract
We report on a Parkinson patient with motor fluctuations and dyskinesias in whom deep brain stimulation (DBS) of the subthalamic nucleus (STN) not only improved motor symptoms but also pre-existing arachnophobia. Arachnophobia had been unchanged by the course of Parkinson's disease but rapidly improved with STN-DBS. Both, motor effects and the improvement of arachnophobia were stable during 2 years follow-up. To our knowledge this is the first report on STN stimulation effects on a specific phobia.
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Affiliation(s)
- Niels Allert
- Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, 53177, Bonn, Germany.
| | - Sabrina M Gippert
- Department of Psychiatry and Psychotherapy, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Bastian E A Sajonz
- Stereotaxy and MR-based OR Techniques/Department of Neurosurgery, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.,Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, 79106, Freiburg im Breisgau, Germany
| | - Christoph Nelles
- Neurological Rehabilitation Center Godeshoehe, Waldstrasse 2-10, 53177, Bonn, Germany
| | - Bettina Bewernick
- Department of Psychiatry and Psychotherapy, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Thomas E Schlaepfer
- Department of Psychiatry and Psychotherapy, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Volker A Coenen
- Stereotaxy and MR-based OR Techniques/Department of Neurosurgery, Bonn University Medical Center, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.,Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, 79106, Freiburg im Breisgau, Germany
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100
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Coenen VA, Rijntjes M, Prokop T, Piroth T, Amtage F, Urbach H, Reinacher PC. One-pass deep brain stimulation of dentato-rubro-thalamic tract and subthalamic nucleus for tremor-dominant or equivalent type Parkinson's disease. Acta Neurochir (Wien) 2016; 158:773-781. [PMID: 26876564 PMCID: PMC4791468 DOI: 10.1007/s00701-016-2725-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/27/2016] [Indexed: 11/17/2022]
Abstract
Background Refractory tremor in tremor-dominant (TD) or equivalent-type (EQT) idiopathic Parkinson’s syndrome (IPS) poses the challenge of choosing the best target region to for deep brain stimulation (DBS). While the subthalamic nucleus is typically chosen in younger patients as the target for dopamine-responsive motor symptoms, it is more complicated if tremor does not (fully) respond under trial conditions. In this report, we present the first results from simultaneous bilateral DBS of the DRT (dentato-rubro-thalamic tract) and the subthalamic nucleus (STN) in two elderly patients with EQT and TD IPS and dopamine-refractory tremor. Methods Two patients received bilateral octopolar DBS electrodes in the STN additionally traversing the DRT region. Achieved electrode positions were determined with helical CT, overlaid onto DTI tractography data, and compared with clinical data of stimulation response. Results Both patients showed immediate and sustained improvement of their tremor, bilaterally. Conclusions The proposed approach appears to be safe and feasible and a combined stimulation of the two target regions was performed tailored to the patients’ symptoms. Clinically, no neuropsychiatric effects were seen. Our pilot data suggest a viable therapeutic option to treat the subgroup of TD and EQT IPS and with tremor as the predominant symptom. A clinical study to further investigate this approach (OPINION: www.clinicaltrials.gov; NCT02288468) is the focus of our ongoing research.
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