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Runia N, Mol GJJ, Hillenius T, Hassanzadeh Z, Denys DAJP, Bergfeld IO. Effects of deep brain stimulation on cognitive functioning in treatment-resistant depression: a systematic review and meta-analysis. Mol Psychiatry 2023; 28:4585-4593. [PMID: 37730844 DOI: 10.1038/s41380-023-02262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/31/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
Deep brain stimulation (DBS) is a promising intervention for treatment-resistant depression (TRD). Effects on cognitive functioning are unclear since they have been studied in small samples. We aim to estimate the impact of DBS on cognitive functioning in TRD with a systematic review and meta-analyses. After systematically searching PubMed we included 10 studies which compared standardized neuropsychological tests before and after DBS or between active and sham DBS in TRD. Different random-effects meta-analyses were done for different cognitive (sub-)domains and for different follow-up time windows (<6 months, 6-18 months, and >18 months). We found no significant differences in cognitive functioning up to 6 months of DBS. After 6-18 months of DBS small to moderate improvements were found in verbal memory (Hedge's g = 0.22, 95% CI = [0.01-0.43], p = 0.04), visual memory (Hedge's g = 0.37, 95% CI = [0.03-0.71], p = 0.04), attention/psychomotor speed (Hedge's g = 0.26, 95% CI = [0.02-0.50], p = 0.04) and executive functioning (Hedge's g = 0.37, 95% CI = [0.15-0.59], p = 0.001). Not enough studies could be retrieved for a meta-analysis of effects after >18 months of DBS or for the comparison of active and sham DBS. Qualitatively, generally no differences in cognitive functioning between active and sham DBS were found. No cognitive decline was found in this meta-analysis up to 18 months of DBS in patients with TRD. Results even suggest small positive effects of DBS on cognitive functioning in TRD, although this should be interpreted with caution due to lack of controlled data.
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Affiliation(s)
- N Runia
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam, The Netherlands.
- Amsterdam Brain and Cognition, Amsterdam, The Netherlands.
| | - G J J Mol
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - T Hillenius
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Z Hassanzadeh
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - D A J P Denys
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, Amsterdam, The Netherlands
| | - I O Bergfeld
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, Amsterdam, The Netherlands
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Block CK, Patel M, Risk BB, Staikova E, Loring D, Esper CD, Scorr L, Higginbotham L, Aia P, DeLong MR, Wichmann T, Factor SA, Au Yong N, Willie JT, Boulis NM, Gross RE, Buetefisch C, Miocinovic S. Patients with Cognitive Impairment in Parkinson's Disease Benefit from Deep Brain Stimulation: A Case-Control Study. Mov Disord Clin Pract 2023; 10:382-391. [PMID: 36949802 PMCID: PMC10026300 DOI: 10.1002/mdc3.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/23/2022] [Accepted: 12/17/2022] [Indexed: 01/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) for Parkinson's disease (PD) is generally contraindicated in persons with dementia but it is frequently performed in people with mild cognitive impairment or normal cognition, and current clinical guidelines are primarily based on these cohorts. Objectives To determine if moderately cognitive impaired individuals including those with mild dementia could meaningfully benefit from DBS in terms of motor and non-motor outcomes. Methods In this retrospective case-control study, we identified a cohort of 40 patients with PD who exhibited moderate (two or more standard deviations below normative scores) cognitive impairment (CI) during presurgical workup and compared their 1-year clinical outcomes to a cohort of 40 matched patients with normal cognition (NC). The surgery targeted subthalamus, pallidus or motor thalamus, in a unilateral, bilateral or staged approach. Results At preoperative baseline, the CI cohort had higher Unified Parkinson's Disease Rating Scale (UPDRS) subscores, but similar levodopa responsiveness compared to the NC cohort. The NC and CI cohorts demonstrated comparable degrees of postoperative improvement in the OFF-medication motor scores, motor fluctuations, and medication reduction. There was no difference in adverse event rates between the two cohorts. Outcomes in the CI cohort did not depend on the target, surgical staging, or impaired cognitive domain. Conclusions Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.
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Affiliation(s)
- Cady K. Block
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Margi Patel
- Department of NeurologyTexas A&M University, Baylor University Medical CenterDallasTexasUSA
| | - Benjamin B. Risk
- Department of Biostatistics and BioinformaticsEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Ekaterina Staikova
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - David Loring
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christine D. Esper
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Laura Scorr
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Lenora Higginbotham
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Pratibha Aia
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Mahlon R. DeLong
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Thomas Wichmann
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Stewart A. Factor
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Nicholas Au Yong
- Department of NeurosurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Jon T. Willie
- Department of Neurosurgery, Neurology and PsychiatryWashington University School of MedicineSt LouisMissouriUSA
| | - Nicholas M. Boulis
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
| | - Robert E. Gross
- Department of NeurosurgeryEmory University School of MedicineAtlantaGeorgiaUSA
| | - Cathrin Buetefisch
- Department of Neurology, Rehabilitation Medicine and RadiologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Svjetlana Miocinovic
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
- Emory Udall Center of Excellence in Parkinson's Disease ResearchEmory National Primate Research CenterAtlantaGeorgiaUSA
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Leimbach F, Atkinson-Clement C, Socorro P, Jahanshahi M. The Effects of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease on Associative Learning of Verbal and Non-Verbal Information by Trial and Error or with Corrective Feedback. JOURNAL OF PARKINSON'S DISEASE 2022; 12:885-896. [PMID: 35342046 DOI: 10.3233/jpd-212843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Parkinson's disease (PD) and subthalamic nucleus deep brain stimulation (STN-DBS) are both known to induce cognitive changes. OBJECTIVE The aim of our study was to investigate the impact of STN-DBS on two forms of conditional associative learning (CAL), trial and error or corrective feedback learning, which differed in difficulty to test the load-dependency hypothesis of the cognitive effects of STN-DBS in PD. METHODS We recruited two groups of PD patients, those who had STN-DBS surgery bilaterally (n = 24) and a second unoperated group (n = 9) who were assessed on two versions of a task of visual CAL involving either a more difficult trial and error learning or a relatively easier corrective feedback learning. Each task was completed twice by both groups, On and Off STN-DBS for the operated group and a first and second time by the unoperated group. RESULTS With STN-DBS Off, corrective feedback learning was superior to trial and error CAL, but not with STN-DBS On. The unoperated PD group had improved performance during the second assessment. To control for the improvement observed with repeated assessment in the PD control group, we split the STN-DBS group into two subgroups based on the condition of the first assessment (Off first vs. On first). While we found no STN-DBS effects for the Off first subgroup (N = 14), we observed improved performance during the second STN-DBS Off session for the On first subgroup (N = 10). CONCLUSION The findings suggest that in PD, STN-DBS interferes with use of corrective feedback and its integration in the conditional associative learning process. Also STN stimulation affected the ability of operated patients to resolve proactive interference during learning of the arbitrary visual associations by trial and error or with corrective feedback.
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Affiliation(s)
- Friederike Leimbach
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Cyril Atkinson-Clement
- Sorbonne University, Inserm U1127, CNRS UMR7225, UM75, ICM, F-75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Pieter Socorro
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Marjan Jahanshahi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK.,The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Agrawal M, Garg K, Samala R, Rajan R, Singh M. A Scientometric Analysis of the 100 Most Cited Articles on Pallidotomy. Stereotact Funct Neurosurg 2021; 99:463-473. [PMID: 34077938 DOI: 10.1159/000516237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pallidotomy is the oldest stereotactically performed neurosurgical procedure for movement disorders. Consequently, there is a wealth of literature available on the topic. OBJECTIVES The aim of this analysis was to identify the top-cited articles on pallidotomy in order to discern the origins, spread, the current trends, and the future directions of this surgical procedure. METHODS We performed a search of the Web of Science database on 19 October 2020 using the keyword "pallidotomy." The top-100 cited articles found were arranged in descending order on the basis of citation count (CC) and citation per year (CY). Relevant conclusions were derived. RESULTS The 100 top-cited articles were published between 1961 and 2017, in 24 journals. The average CC and CY were 118.1 (range - 856-46) and 5.326 (range - 29.52-2.09), respectively. The 3 most prolific authors were Lang AE (Neurologist - Toronto), Lozano AM (Neurosurgeon - Toronto), and Vitek JL (Neurologist - Atlanta). The Journal of Neurosurgery published the highest number of top-cited articles [Neurology. 1960;10:61-9]. The maximum articles were from the USA. University of Toronto and Emory University were the most productive institutions. CONCLUSIONS Pallidotomy has gone through several ebbs and flows. Unilateral pallidotomy is currently recommended for the treatment of motor symptoms of Parkinson's disease and dystonia. The need for further research and improved technology to make the technique safer and prove its efficacy is highlighted, especially keeping in mind a large number of populations to which the prohibitively expensive deep brain stimulation is unavailable.
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Affiliation(s)
- Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghu Samala
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Lin F, Wu D, Yu J, Weng H, Chen L, Meng F, Chen Y, Ye Q, Cai G. Comparison of efficacy of deep brain stimulation and focused ultrasound in parkinsonian tremor: a systematic review and network meta-analysis. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323656. [PMID: 33461975 DOI: 10.1136/jnnp-2020-323656] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/25/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023]
Abstract
To compare the efficacy of deep brain stimulation (DBS) and MRI-guided focused ultrasound (MRIgFUS) in parkinsonian tremor. We performed a network meta-analysis based on a Bayesian framework. We searched the literature for articles published between January 1990 and October 2020 using three databases: PubMed, Embase and Cochrane Library (The Cochrane Database of Systematic Reviews). A total of 24 studies were included in our analysis, comprising data from 784 participants. Our findings revealed similar efficacy of DBS and MRIgFUS in parkinsonian tremor suppression. Compared with internal globus pallidus (GPi)-MRIgFUS, GPi-DBS -1.84 (-6.44, 2.86), pedunculopontine nucleus (PPN)_DBS -3.28 (-9.28, 2.78), PPN and caudal zona incerta (cZI)-DBS 0.40 (-6.16, 6.87), subthalamic nucleus (STN)_DBS 0.89 (-3.48, 5.30), STN and cZI-DBS 1.99 (-4.74, 8.65), ventral intermediate nucleus(VIM)_DBS 1.75 (-2.87, 6.48), VIM_FUS 0.72 (-5.27, 6.43), cZI-DBS 0.27 (-4.75, 5.36) were no significantly difference. Compared with VIM-MRIgFUS, GPi-DBS -2.55(-6.94, 2.21), GPi-FUS -0.72 (-6.43, 5.27), PPN_DBS -4.01(-9.97, 2.11), PPN and cZI-DBS -0.32 (-6.73, 6.36), STN_DBS 0.16 (-3.98, 4.6), STN and cZI-DBS 1.31(-5.18,7.87), VIM-DBS 1.00(-3.41, 5.84)and cZI-DBS -0.43 (-5.07, 4.68) were no significantly difference. With respect to the results for the treatment of motor symptoms, GPi-DBS, GPi-MRIgFUS, STN-DBS and cZI-DBS were significantly more efficacious than baseline (GPi-DBS 15.24 (5.79, 24.82), GPi-MRIgFUS 13.46 (2.46, 25.10), STN-DBS 19.62 (12.19, 27.16), cZI-DBS 14.18 (1.73, 26.89). The results from the surface under the cumulative ranking results showed that STN-DBS ranked first, followed by combined PPN and cZI-DBS, and PPN-DBS ranked last. MRIgFUS, an efficacious intervention for improving parkinsonian tremor, has not demonstrated to be inferior to DBS in parkinsonian tremor suppression. Hence, clinicians should distinguish individual patients' symptoms to ensure that the appropriate intervention and therapeutic approach are applied.
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Affiliation(s)
- Fabin Lin
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Dihang Wu
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jiao Yu
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China
| | - Huidan Weng
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China
| | - Lina Chen
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China
| | - Fangang Meng
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Chen
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China
| | - Qinyong Ye
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China
| | - Guoen Cai
- Department of Neurology, Union Hospital, Fujian Medical University, Fuzhou, China
- Institute or Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
- Department of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China
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Georgiev D, Roškar S, Čuš A, Wilkinson L, Jahanshahi M. STN-DBS Increases Proactive but Not Retroactive Interference During Verbal Learning in PD. Mov Disord 2020; 36:1010-1015. [PMID: 33332646 DOI: 10.1002/mds.28423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Proactive interference (PI) refers to the interference of previously learned materials with new learning and reflects the failure of inhibitory processes in memory. Retroactive interference (RI) refers to the unfavorable effect of new learning on the later recall of previously learned information. Although subthalamic nucleus deep brain stimulation (STN-DBS) does not affect global cognition in Parkinson's disease (PD), it has negative effects on specific aspects of cognition, including verbal fluency and executive inhibitory control of action.To this end, we set to test the acute effect of STN-DBS on PI and RI during verbal learning. METHODS Twenty PD patients with STN-DBS were tested on the California Verbal Learning Test-II using an ON/OFF stimulation design. RESULTS The results showed that stimulation increased PI ON stimulation (P = 0.012) but had no effect on RI (P = 0.816). CONCLUSIONS Our results extend the role of STN to the inhibitory control that is required during memory encoding or recall for prevention of PI. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Dejan Georgiev
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.,Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Artificial Intelligence Laboratory, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Sanja Roškar
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Anja Čuš
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Leonora Wilkinson
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Marjan Jahanshahi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.,The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Upadhyayula PS, Rennert RC, Martin JR, Yue JK, Yang J, Gillis-Buck EM, Sidhu N, Cheung CK, Lee AT, Hoshide RR, Ciacci JD. Basal impulses: findings from the last twenty years on impulsivity and reward pathways using deep brain stimulation. J Neurosurg Sci 2020; 64:544-551. [PMID: 32972108 DOI: 10.23736/s0390-5616.20.04906-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an important treatment modality for movement disorders. Its role in tasks and processes of higher cortical function continues to increase in importance and relevance. This systematic review investigates the impact of DBS on measures of impulsivity. EVIDENCE ACQUISITION A total of 45 studies were collated from PubMed (30 prospective, 8 animal, 4 questionnaire-based, and 3 computational models), excluding case reports and review articles. Two areas extensively studied are the subthalamic nucleus (STN) and nucleus accumbens (NAc). EVIDENCE SYNTHESIS While both are part of the basal ganglia, the STN and NAc have extensive connections to the prefrontal cortex, cingulate cortex, and limbic system. Therefore, understanding cause and treatment of impulsivity requires understanding motor pathways, learning, memory, and emotional processing. DBS of the STN and NAc shell can increase objective measures of impulsivity, as measured by reaction times or reward-based learning, independent from patient insight. The ability for DBS to treat impulse control disorders, and also cause and/or worsen impulsivity in Parkinson's disease, may be explained by the affected closely-related neuroanatomical areas with discrete and sometimes opposing functions. CONCLUSIONS As newer, more refined DBS technology emerges, large-scale prospective studies specifically aimed at treatment of impulsivity disorders are needed.
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Affiliation(s)
- Pavan S Upadhyayula
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Joel R Martin
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - John K Yue
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jason Yang
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Eva M Gillis-Buck
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nikki Sidhu
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Christopher K Cheung
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anthony T Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Reid R Hoshide
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA
| | - Joseph D Ciacci
- Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA -
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8
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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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Cernera S, Okun MS, Gunduz A. A Review of Cognitive Outcomes Across Movement Disorder Patients Undergoing Deep Brain Stimulation. Front Neurol 2019; 10:419. [PMID: 31133956 PMCID: PMC6514131 DOI: 10.3389/fneur.2019.00419] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/05/2019] [Indexed: 12/19/2022] Open
Abstract
Introduction: Although the benefit in motor symptoms for well-selected patients with deep brain stimulation (DBS) has been established, cognitive declines associated with DBS can produce suboptimal clinical responses. Small decrements in cognition can lead to profound effects on quality of life. The growth of indications, the expansion of surgical targets, the increasing complexity of devices, and recent changes in stimulation paradigms have all collectively drawn attention to the need for re-evaluation of DBS related cognitive outcomes. Methods: To address the impact of cognitive changes following DBS, we performed a literature review using PubMed. We searched for articles focused on DBS and cognition. We extracted information about the disease, target, number of patients, assessment of time points, cognitive battery, and clinical outcomes. Diseases included were dystonia, Tourette syndrome (TS), essential tremor (ET), and Parkinson's disease (PD). Results: DBS was associated with mild cognitive issues even when rigorous patient selection was employed. Dystonia studies reported stable or improved cognitive scores, however one study using reliable change indices indicated decrements in sustained attention. Additionally, DBS outcomes were convoluted with changes in medication dose, alleviation of motor symptoms, and learning effects. In the largest, prospective TS study, an improvement in attentional skills was noted, whereas smaller studies reported variable declines across several cognitive domains. Although, most studies reported stable cognitive outcomes. ET studies largely demonstrated deficits in verbal fluency, which had variable responses depending on stimulation setting. Recently, studies have focused beyond the ventral intermediate nucleus, including the post-subthalamic area and zona incerta. For PD, the cognitive results were heterogeneous, although deficits in verbal fluency were consistent and related to the micro-lesion effect. Conclusion: Post-DBS cognitive issues can impact both motor and quality of life outcomes. The underlying pathophysiology of cognitive changes post-DBS and the identification of pathways underpinning declines will require further investigation. Future studies should employ careful methodological designs. Patient specific analyses will be helpful to differentiate the effects of medications, DBS and the underlying disease state, including disease progression. Disease progression is often an underappreciated factor that is important to post-DBS cognitive issues.
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Affiliation(s)
- Stephanie Cernera
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL, United States
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States.,Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, FL, United States
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Mills KA, Donohue K, Swaminathan A, Leoutsakos JM, Smith G, Brandt J. Neuropsychological predictors of patient-reported cognitive decline after deep brain stimulation in Parkinson's disease. J Clin Exp Neuropsychol 2019; 41:219-228. [PMID: 30296894 PMCID: PMC6380950 DOI: 10.1080/13803395.2018.1526889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is effective for treatment of motor complications of dopaminergic therapy in Parkinson's disease (PD) but occasionally has been associated with multidomain cognitive decline. Patient- and caregiver-reported cognitive decline are clinically meaningful and increasingly recognized as important to consider when evaluating therapeutic interventions for PD. OBJECTIVE The objective was to assess presurgical neuropsychological and clinical factors associated with PD patient- and caregiver-reported cognitive decline in two or more domains after DBS. METHOD A single telephone survey was used to assess patient- and caregiver-reported cognitive decline in five domains at both one and four months after DBS surgery. Decline in two or more domains was considered multidomain cognitive decline (MDCD). Baseline demographic, clinical, and neuropsychological factors were compared in those with or without MDCD. Preoperative neuropsychological measures were evaluated as risk factors and regressed on the presence of MDCD, with demographic covariates, using multiple logistic regression. RESULTS Preoperative performance in verbal recognition memory, language knowledge, and verbal processing decline were associated with postoperative, patient-reported MDCD in the first four weeks. MDCD at four months after DBS was associated with worse preoperative verbal reasoning, verbal recall, and semantic verbal fluency. Caregiver-reported MDCD one month after DBS was associated with poorer baseline verbal memory recognition accuracy/discriminability, visuospatial problem solving, and constructional praxis. CONCLUSION Poor presurgical performance in verbal memory recognition, language processing, and visuospatial performance is associated with patient- or caregiver-reported decline following DBS surgery. Posterior cortical dysfunction seems to portend significant self-reported cognitive decline following deep brain stimulation.
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Affiliation(s)
- Kelly A Mills
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Kristyn Donohue
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Aathman Swaminathan
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jeannie-Marie Leoutsakos
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Gwenn Smith
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jason Brandt
- a Department of Neurology , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- b Department of Psychiatry & Behavioral Sciences , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Godinho F, Magnin M, Filho PT, Reis P, Moraes O, Nascimento M, Costa C, de Oliveira MO, Rocha MS. Stereotactic Lesion in the Forel's Field H: A 2-Years Prospective Open-Label Study on Motor and Nonmotor Symptoms, Neuropsychological Functions, and Quality of Life in Parkinson Disease. Neurosurgery 2019; 85:E650-E659. [DOI: 10.1093/neuros/nyz039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 01/29/2019] [Indexed: 01/12/2023] Open
Abstract
Abstract
BACKGROUND
Stereotactic lesion in the Forel's field H (campotomy) was proposed in 1963 to treat Parkinson disease (PD) symptoms. Despite its rationale, very few data on this approach have emerged. Additionally, no study has assessed its effects on nonmotor symptoms, neuropsychological functions and quality of life.
OBJECTIVE
To provide a prospective 2-yr assessment of motor, nonmotor, neuropsychological and quality of life variables after unilateral campotomy.
METHODS
Twelve PD patients were prospectively evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), the Dyskinesia Rating Scale and the Parkinson's disease quality of life questionnaire (PDQ39) before campotomy, and after 6 and 24 mo. Nonmotor, neuropsychiatric, neuropsychological and quality of life variables were assessed. The impact of PD on global health was also rated.
RESULTS
A significant reduction in contralateral rest tremor (65.7%, P < .001), rigidity (87.8%, P < .001), bradykinesia (68%, P < .001) and axial symptoms (24.2%, P < .05) in offmedication condition led to a 43.9% reduction in UPSDRS III scores 2 yr after campotomy (P < .001). Gait improved by 31.9% (P < .05) and walking time to cover 7 m was reduced by 43.2% (P < .05). Pain decreased by 33.4% (P < .01), while neuropsychiatric and neuropsychological functions did not change. Quality of life improved by 37.8% (P < .05), in line with a 46.7% reduction of disease impact on global health (P < .001).
CONCLUSION
A significant 2-yr improvement of motor symptoms, gait performance and pain was obtained after unilateral campotomy without significant changes to cognition. Quality of life markedly improved in parallel with a significant reduction of PD burden on global health.
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Affiliation(s)
- Fabio Godinho
- Department of Functional Neurosurgery, Hospital Santa Marcelina, São Paulo, Brazil
- Division of Functional Neurosurgery, Institute of Psychiatry of Hospital das Clínicas, University of São Paulo, Medicine School, São Paulo, Brazil
- Faculdade Santa Marcelina – Medicine School, São Paulo, Brazil
| | - Michel Magnin
- Centre de Recherche en Neurosciences de Lyon, NeuroPain lab, INSERM U 1028, UMR 5292 – Lyon, Rhône-Alpes, France
| | - Paulo Terzian Filho
- Department of Functional Neurosurgery, Hospital Santa Marcelina, São Paulo, Brazil
| | - Paul Reis
- Division of Functional Neurosurgery, Institute of Psychiatry of Hospital das Clínicas, University of São Paulo, Medicine School, São Paulo, Brazil
| | - Osmar Moraes
- Department of Neurosurgery, Hospital Santa Marcelina, São Paulo, Brazil
| | | | - Carlos Costa
- Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
| | - Maira Okada de Oliveira
- Department of Neurology, Hospital Santa Marcelina, São Paulo, Brazil
- Global Brain Health Institute, University of California-San Francisco, San Francisco, California
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Foley JA, Foltynie T, Limousin P, Cipolotti L. Standardised Neuropsychological Assessment for the Selection of Patients Undergoing DBS for Parkinson's Disease. PARKINSON'S DISEASE 2018; 2018:4328371. [PMID: 29971141 PMCID: PMC6009029 DOI: 10.1155/2018/4328371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/23/2018] [Accepted: 04/30/2018] [Indexed: 11/17/2022]
Abstract
DBS is an increasingly offered advanced treatment for Parkinson's disease (PD). Neuropsychological assessment is considered to be an important part of the screening for selection of candidates for this treatment. However, no standardised screening procedure currently exists. In this study, we examined the use of our standardised neuropsychological assessment for the evaluation of surgical candidates and to identify risk factors for subsequent decline in cognition and mood. A total of 40 patients were assessed before and after DBS. Evaluation of mood and case notes review was also undertaken. Before DBS, patients with PD demonstrated frequent impairments in intellectual functioning, memory, attention, and executive function, as well as high rates of mood disorder. Post-DBS, there was a general decline in verbal fluency only, and in one patient, we documented an immediate and irreversible global cognitive decline, which was associated with older age and more encompassing cognitive deficits at baseline. Case note review revealed that a high proportion of patients developed mood disorder, which was associated with higher levels of depression at baseline and greater reduction in levodopa medication. We conclude that our neuropsychological assessment is suitable for the screening of candidates and can identify baseline risk factors, which requires careful consideration before and after surgery.
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Affiliation(s)
- Jennifer A. Foley
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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Neuropsychological performance changes following subthalamic versus pallidal deep brain stimulation in Parkinson's disease: a systematic review and metaanalysis. CNS Spectr 2018; 23:10-23. [PMID: 28236811 DOI: 10.1017/s1092852917000062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies comparing subthalamus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for the management of Parkinson's disease in terms of neuropsychological performance are scarce and heterogeneous. Therefore, we performed a systematic review and metaanalysis to compare neuropsychological outcomes following STN DBS versus GPi DBS. METHODS A computer literature search of PubMed, the Web of Science, and Cochrane Central was conducted. Records were screened for eligible studies, and data were extracted and synthesized using Review Manager (v. 5.3 for Windows). RESULTS Seven studies were included in the qualitative synthesis. Of them, four randomized controlled trials (n=345 patients) were pooled in the metaanalysis models. The standardized mean difference (SMD) of change in the Stroop color-naming test favored the GPi DBS group (SMD=-0.31, p=0.009). However, other neuropsychological outcomes did not favor either of the two groups (Stroop word-reading: SMD=-0.21, p=0.08; the Wechsler Adult Intelligence Scale (WAIS) digits forward: SMD=0.08, p=0.47; Trail Making Test Part A: SMD=-0.05, p=0.65; WAIS-R digit symbol: SMD=-0.16, p=0.29; Trail Making Test Part B: SMD=-0.14, p=0.23; Stroop color-word interference: SMD=-0.16, p=0.18; phonemic verbal fluency: bilateral DBS SMD=-0.04, p=0.73, and unilateral DBS SMD=-0.05, p=0.83; semantic verbal fluency: bilateral DBS SMD=-0.09, p=0.37, and unilateral DBS SMD=-0.29, p=0.22; Boston Naming Test: SMD=-0.11, p=0.33; Beck Depression Inventory: bilateral DBS SMD=0.15, p=0.31, and unilateral DBS SMD=0.36, p=0.11). CONCLUSIONS There was no statistically significant difference in most of the neuropsychological outcomes. The present evidence does not favor any of the targets in terms of neuropsychological performance.
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Mehanna R, Bajwa JA, Fernandez H, Wagle Shukla AA. Cognitive Impact of Deep Brain Stimulation on Parkinson's Disease Patients. PARKINSON'S DISEASE 2017; 2017:3085140. [PMID: 29359065 PMCID: PMC5735627 DOI: 10.1155/2017/3085140] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022]
Abstract
Subthalamic nucleus (STN) or globus pallidus interna (GPi) deep brain stimulation (DBS) is considered a robust therapeutic tool in the treatment of Parkinson's disease (PD) patients, although it has been reported to potentially cause cognitive decline in some cases. We here provide an in-depth and critical review of the current literature regarding cognition after DBS in PD, summarizing the available data on the impact of STN and GPi DBS as monotherapies and also comparative data across these two therapies on 7 cognitive domains. We provide evidence that, in appropriately screened PD patients, worsening of one or more cognitive functions is rare and subtle after DBS, without negative impact on quality of life, and that there is very little data supporting that STN DBS has a worse cognitive outcome than GPi DBS.
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Affiliation(s)
- Raja Mehanna
- University of Texas Health Science Center, Houston, TX, USA
| | - Jawad A. Bajwa
- Parkinson's, Movement Disorders and Neurorestoration Program, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hubert Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
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15
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Rana AQ, Qureshi D, Sabeh W, Mosabbir A, Rahman E, Sarfraz Z, Rana R. Pharmacological therapies for pain in Parkinson's disease - a review paper. Expert Rev Neurother 2017; 17:1209-1219. [PMID: 28949252 DOI: 10.1080/14737175.2017.1385393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative movement disorder characterized by the loss of dopamine containing cells in the substantia nigra, with pain being one of the most common, yet frequently misunderstood symptoms. The prevalence of pain in PD populations ranges from 40-85% and is usually categorized under the following types: i) musculoskeletal pain ii) radicular and neuropathic pain iii) dystonia-related pain iv) akathitic pain and iv) central parkinsonian pain. Areas covered: The aim of this literature review was to document and present the common and uncommon pharmaceutical therapies that treat and/or alleviate these types of pain in PD. The PubMed database was searched with keywords: "Parkinson's disease", "Pain", and "Pharmacological Therapies". Research articles involving randomized, controlled trials were included as well as case studies and qualitative studies. Expert commentary: Given the increased prevalence of pain in PD populations, there is a need for a clear understanding of the types of pain treatments available and how they can be best combined to fit the specific needs of each patient.
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Affiliation(s)
- Abdul Qayyum Rana
- a Parkinson's Clinic of Eastern Toronto and Movement Disorders Center , Toronto , Canada
| | | | | | | | | | | | - Ruqqiyah Rana
- f University of Ontario Institute of Technology , Oshawa , Canada
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Cossu G, Sensi M. Deep Brain Stimulation Emergencies: How the New Technologies Could Modify the Current Scenario. Curr Neurol Neurosci Rep 2017; 17:51. [PMID: 28497305 DOI: 10.1007/s11910-017-0761-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
After 25 years of deep brain stimulation (DBS) for the treatment of Parkinson's disease, it has become increasingly recognized that a range of postoperative urgent situations and emergencies may occur. In this review we describe the possible scenarios of DBS-related emergencies: perioperative (intraoperative and early postoperative) and postoperative settings and issues from suboptimal control of motor and nonmotor symptoms in the early programming phase and during long-term follow-up. We also outline potential advantages in the management of these emergencies offered by the newest devices, emerging technologies, and new possibilities in programming.
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Affiliation(s)
- Giovanni Cossu
- Movement Disorders Unit, Department of Neurology, Brotzu General Hospital, Piazzale Ricchi 1, 09134, Cagliari, Italy.
| | - Mariachiara Sensi
- Department of Neurology, Azienda Ospedaliera Universitaria Arcispedale Sant'Anna, Ferrara, Italy
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17
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Faggiani E, Benazzouz A. Deep brain stimulation of the subthalamic nucleus in Parkinson’s disease: From history to the interaction with the monoaminergic systems. Prog Neurobiol 2017; 151:139-156. [DOI: 10.1016/j.pneurobio.2016.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 07/08/2016] [Indexed: 11/16/2022]
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18
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Impact of Combined Subthalamic Nucleus and Substantia Nigra Stimulation on Neuropsychiatric Symptoms in Parkinson's Disease Patients. PARKINSONS DISEASE 2017; 2017:7306192. [PMID: 28246572 PMCID: PMC5299199 DOI: 10.1155/2017/7306192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/30/2016] [Accepted: 12/08/2016] [Indexed: 11/17/2022]
Abstract
The goal of the study was to compare the tolerability and the effects of conventional subthalamic nucleus (STN) and combined subthalamic nucleus and substantia nigra (STN+SNr) high-frequency stimulation in regard to neuropsychiatric symptoms in Parkinson's disease patients. In this single center, randomized, double-blind, cross-over clinical trial, twelve patients with advanced Parkinson's disease (1 female; age: 61.3 ± 7.3 years; disease duration: 12.3 ± 5.4 years; Hoehn and Yahr stage: 2.2 ± 0.39) were included. Apathy, fatigue, depression, and impulse control disorder were assessed using a comprehensive set of standardized rating scales and questionnaires such as the Lille Apathy Rating Scale (LARS), Modified Fatigue Impact Scale (MFIS), Becks Depression Inventory (BDI-I), Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease Rating Scale (QUIP-RS), and Parkinson's Disease Questionnaire (PDQ-39). Three patients that were initially assigned to the STN+SNr stimulation mode withdrew from the study within the first week due to discomfort. Statistical comparison of data retrieved from patients who completed the study revealed no significant differences between both stimulation conditions in terms of mean scores of scales measuring apathy, fatigue, depression, impulse control disorder, and quality of life. Individual cases showed an improvement of apathy under combined STN+SNr stimulation. In general, combined STN+SNr stimulation seems to be safe in terms of neuropsychiatric side effects, although careful patient selection and monitoring in the short-term period after changing stimulation settings are recommended.
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19
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A fronto–striato–subthalamic–pallidal network for goal-directed and habitual inhibition. Nat Rev Neurosci 2015; 16:719-32. [DOI: 10.1038/nrn4038] [Citation(s) in RCA: 352] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gesquière-Dando A, Guedj E, Loundou A, Carron R, Witjas T, Fluchère F, Delfini M, Mundler L, Regis J, Azulay JP, Eusebio A. A preoperative metabolic marker of parkinsonian apathy following subthalamic nucleus stimulation. Mov Disord 2015; 30:1767-76. [DOI: 10.1002/mds.26349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 06/12/2015] [Accepted: 06/21/2015] [Indexed: 11/05/2022] Open
Affiliation(s)
- Aude Gesquière-Dando
- APHM; CHU Timone, Department of Neurology and Movement Disorders; Aix Marseille Université; Marseille France
- Institut de Neurosciences de la Timone UMR 7289; Aix Marseille Université; CNRS Marseille France
| | - Eric Guedj
- Institut de Neurosciences de la Timone UMR 7289; Aix Marseille Université; CNRS Marseille France
- APHM; CHU Timone, Service Central de Biophysique et Médecine Nucléaire; Aix Marseille Université; Marseille France
- CERIMED; Aix-Marseille Université; Marseille France
| | - Anderson Loundou
- APHM; CHU Timone, Unité d'Aide méthodologique à la Recherche Clinique et Epidémiologique; DRRC Marseille France
| | - Romain Carron
- APHM; CHU Timone, Department of Functional and Stereotactic Neurosurgery; Aix Marseille Université; Marseille France
| | - Tatiana Witjas
- APHM; CHU Timone, Department of Neurology and Movement Disorders; Aix Marseille Université; Marseille France
- Institut de Neurosciences de la Timone UMR 7289; Aix Marseille Université; CNRS Marseille France
| | - Frédérique Fluchère
- APHM; CHU Timone, Department of Neurology and Movement Disorders; Aix Marseille Université; Marseille France
| | - Marie Delfini
- APHM; CHU Timone, Department of Neurology and Movement Disorders; Aix Marseille Université; Marseille France
| | - Laura Mundler
- APHM; CHU Timone, Department of Neurology and Movement Disorders; Aix Marseille Université; Marseille France
| | - Jean Regis
- APHM; CHU Timone, Department of Functional and Stereotactic Neurosurgery; Aix Marseille Université; Marseille France
| | - Jean-Philippe Azulay
- APHM; CHU Timone, Department of Neurology and Movement Disorders; Aix Marseille Université; Marseille France
- Institut de Neurosciences de la Timone UMR 7289; Aix Marseille Université; CNRS Marseille France
| | - Alexandre Eusebio
- APHM; CHU Timone, Department of Neurology and Movement Disorders; Aix Marseille Université; Marseille France
- Institut de Neurosciences de la Timone UMR 7289; Aix Marseille Université; CNRS Marseille France
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Shenai MB, Romeo A, Walker HC, Guthrie S, Watts RL, Guthrie BL. Spatial topographies of unilateral subthalamic nucleus deep brain stimulation efficacy for ipsilateral, contralateral, midline, and total Parkinson disease motor symptoms. Neurosurgery 2015; 11 Suppl 2:80-8; discussion 88. [PMID: 25599197 DOI: 10.1227/neu.0000000000000613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation is a successful intervention for medically refractory Parkinson disease, although its efficacy depends on optimal electrode placement. Even though the predominant effect is observed contralaterally, modest improvements in ipsilateral and midline symptoms are also observed. OBJECTIVE To elucidate the role of contact location of unilateral deep brain stimulation on contralateral, ipsilateral, and axial subscores of Parkinson disease motor symptoms. METHODS Eighty-six patients receiving first deep brain stimulation STN electrode placements were identified, yielding 73 patients with 3-month follow-up. Total preoperative and postoperative Unified Parkinson Disease Rating Scale Part III scores were obtained and divided into contralateral, ipsilateral, and midline subscores. Contact location was determined on immediate postoperative magnetic resonance imaging. A 3-dimensional ordinary "kriging" algorithm generated spatial interpolations for total, ipsilateral, contralateral, and midline symptom categories. Interpolative reconstructions were performed in the axial planes (z = -0.5, -1.0, -1.5, -3.5, -4.5, -6.0) and a sagittal plane (x = 12.0). Interpolation error and significance were quantified by use of a cross-validation technique and quantile-quantile analysis. RESULTS There was an overall reduction in Unified Parkinson Disease Rating Scale Part III symptoms: total = 37.0 ± 24.11% (P < .05), ipsilateral = 15.9 ± 51.8%, contralateral = 56.2 ± 26.8% (P < .05), and midline = 26.5 ± 34.7%. Kriging interpolation was performed and cross-validated with quantile-quantile analysis with high correlation (R2 > 0.92) and demonstrated regions of efficacy for each symptom category. Contralateral symptoms demonstrated broad regions of efficacy across the peri-STN area. The ipsilateral and midline regions of efficacy were constrained and located along the dorsal STN and caudal zona incerta. CONCLUSION We provide evidence for a unique functional topographic window in which contralateral, ipsilateral, and midline structures may achieve the best efficacy. Although there are overlapping regions, laterality demonstrates distinct topographies. Surgical optimization should target the intersection of optimal regions for these symptom categories.
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Affiliation(s)
- Mahesh B Shenai
- *Department of Neuroscience, Inova Health System, Falls Church, Virginia, ‡Department of Neurosurgery, and §Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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Markser A, Maier F, Lewis CJ, Dembek TA, Pedrosa D, Eggers C, Timmermann L, Kalbe E, Fink GR, Burghaus L. Deep brain stimulation and cognitive decline in Parkinson's disease: The predictive value of electroencephalography. J Neurol 2015; 262:2275-84. [PMID: 26159102 DOI: 10.1007/s00415-015-7839-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
Some Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) develop new-onset cognitive decline. We examined whether clinical EEG recordings can be used to predict cognitive deterioration in PD patients undergoing STN-DBS. In this retrospective study, we used the Grand Total EEG (GTE)-score (short and total) to evaluate pre- and postoperative EEGs. In PD patients undergoing STN-DBS (N = 30), cognitive functioning was measured using Mini-Mental State Test and DemTect before and after surgery. Severity of motor impairment was assessed using the Unified Parkinson's Disease Rating Scale-III. Patients were classified into patients with or without cognitive decline after STN-DBS surgery. Epidemiological data, pre- and postoperative EEG recordings as well as neuropsychological and neurological data, electrode positions and the third ventricle width were compared. A logistic regression model was used to identify predictors of cognitive decline. Motor deficits significantly improved from pre- to post-surgery, while the mean GTE-scores increased significantly. Six patients developed cognitive deterioration 4-12 months postoperatively. These patients had significantly higher preoperative GTE-scores than patients without cognitive deterioration, although preoperative cognitive functioning was comparable. Electrode positions, brain atrophy and neurological data did not differ between groups. Logistic regression analysis identified the GTE-score as a significant predictor of postoperative cognitive deterioration. Data suggest that the preoperative GTE-score can be used to identify PD patients that are at high risk for developing cognitive deterioration after STN-DBS surgery even though their preoperative cognitive state was normal.
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Affiliation(s)
- A Markser
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - Franziska Maier
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
| | - C J Lewis
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - T A Dembek
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - D Pedrosa
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - C Eggers
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - L Timmermann
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - E Kalbe
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.,Institute of Gerontology, Psychological Gerontology and Center for Neuropsychological Diagnostics and Intervention, University of Vechta, Vechta, Germany
| | - G R Fink
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Cognitive Neuroscience, Research Centre Juelich, Juelich, Germany
| | - Lothar Burghaus
- Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
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23
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Buchanan RJ, Gjini K, Darrow D, Varga G, Robinson JL, Nadasdy Z. Glutamate and GABA concentration changes in the globus pallidus internus of Parkinson’s patients during performance of implicit and declarative memory tasks: A report of two subjects. Neurosci Lett 2015; 589:73-8. [DOI: 10.1016/j.neulet.2015.01.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/09/2015] [Accepted: 01/12/2015] [Indexed: 01/01/2023]
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Grover S, Somaiya M, Kumar S, Avasthi A. Psychiatric aspects of Parkinson's disease. J Neurosci Rural Pract 2015; 6:65-76. [PMID: 25552854 PMCID: PMC4244792 DOI: 10.4103/0976-3147.143197] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Parkinson's disease (PD) is essentially characterized by the motor symptoms in the form of resting tremor, rigidity and bradykinesia. However, over the years it has been recognized that motor symptoms are just the "tip of the iceberg" of clinical manifestations of PD. Besides motor symptoms, PD characterized by many non-motor symptoms, which include cognitive decline, psychiatric disturbances (depression, psychosis and impulse control), sleep difficulties, autonomic failures (gastrointestinal, cardiovascular, urinary, thermoregulation) and pain syndrome. This review evaluates the various aspects of psychiatric disorders including cognitive decline and sleep disturbances in patients with PD. The prevalence rate of various psychiatric disorders is high in patients with PD. In terms of risk factors, various demographic, clinical and treatment-related variables have been shown to be associated with higher risk of development of psychiatric morbidity. Evidence also suggests that the presence of psychiatric morbidity is associated with poorer outcome. Randomized controlled trials, evaluating the various pharmacological and non-pharmacological treatments for management of psychiatric morbidity in patients with PD are meager. Available evidence suggests that tricyclic antidepressants like desipramine and nortriptyline are efficacious for management of depression. Among the antipsychotics, clozapine is considered to be the best choice for management of psychosis in patients with PD. Among the various cognitive enhancers, evidence suggest efficacy of rivastigmine in management of dementia in patients with PD. To conclude, this review suggests that psychiatric morbidity is highly prevalent in patients with PD. Hence, a multidisciplinary approach must be followed to improve the overall outcome of PD. Further studies are required to evaluate the efficacy of various other measures for management of psychiatric morbidity in patients with PD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mansi Somaiya
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Kumar
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Piccoli S, Perini G, Pizzighello S, Vestri A, Ferri G, Toffanin T, Follador H, Martinuzzi A. A Long Term Effects of a New Onset Psychosis after DBS Treated with Quetiapine in a Patient with Parkinson's Disease. Psychiatry Investig 2015; 12:146-9. [PMID: 25670958 PMCID: PMC4310913 DOI: 10.4306/pi.2015.12.1.146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 12/02/2022] Open
Abstract
Deep Brain Stimulation represents a therapeutic option for PD patients. In this paper, we present and discuss a case of acute delirium and psychosis manifesting after DBS in a 58-years-old man affected by Parkinson's Disease. We highlight the importance of an exhaustive psychiatric evaluation in candidates for DBS and we underline the severity and non-reversibility of some adverse events associated with the implantation, suggesting the use of Quetiapine in the management of these effects. Acute psychosis may be listed as a potential severe adverse event associated with DBS, even in patients without a clear cut previous history of psychiatric disorders.
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Affiliation(s)
- Sara Piccoli
- Rehabilitation Unit for the Acquired Neuropsychological Disorders, "E. Medea" Scientific Institute Conegliano-Pieve di Soligo Research Center, Pieve di Soligo, Italy
| | - Giulia Perini
- Department of Mental Health ULSS 7, Pieve di Soligo, Italy
- Department of Neuroscience, University of Padoua, Padoua, Italy
| | - Silvia Pizzighello
- Rehabilitation Unit for the Acquired Neuropsychological Disorders, "E. Medea" Scientific Institute Conegliano-Pieve di Soligo Research Center, Pieve di Soligo, Italy
| | - Alec Vestri
- Rehabilitation Unit for the Acquired Neuropsychological Disorders, "E. Medea" Scientific Institute Conegliano-Pieve di Soligo Research Center, Pieve di Soligo, Italy
| | - Giovanni Ferri
- Department of Mental Health ULSS 7, Pieve di Soligo, Italy
| | | | | | - Andrea Martinuzzi
- Rehabilitation Unit for the Acquired Neuropsychological Disorders, "E. Medea" Scientific Institute Conegliano-Pieve di Soligo Research Center, Pieve di Soligo, Italy
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26
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To move or not to move: Subthalamic deep brain stimulation effects on implicit motor simulation. Brain Res 2014; 1574:14-25. [DOI: 10.1016/j.brainres.2014.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/13/2014] [Accepted: 06/06/2014] [Indexed: 11/23/2022]
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Cope TE, Grube M, Mandal A, Cooper FE, Brechany U, Burn DJ, Griffiths TD. Subthalamic deep brain stimulation in Parkinson׳s disease has no significant effect on perceptual timing in the hundreds of milliseconds range. Neuropsychologia 2014; 57:29-37. [PMID: 24613477 PMCID: PMC4022837 DOI: 10.1016/j.neuropsychologia.2014.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 02/20/2014] [Accepted: 02/22/2014] [Indexed: 11/07/2022]
Abstract
Bilateral, high-frequency stimulation of the basal ganglia (STN-DBS) is in widespread use for the treatment of the motor symptoms of Parkinson׳s disease (PD). We present here the first psychophysical investigation of the effect of STN-DBS upon perceptual timing in the hundreds of milliseconds range, with both duration-based (absolute) and beat-based (relative) tasks; 13 patients with PD were assessed with their STN-DBS ‘on’, ‘off’, and then ‘on’ again. Paired parametric analyses revealed no statistically significant differences for any task according to DBS status. We demonstrate, from the examination of confidence intervals, that any functionally relevant effect of STN-DBS on relative perceptual timing is statistically unlikely. For absolute, duration-based timing, we demonstrate that the activation of STN-DBS may either worsen performance or have no effect, but that it is unlikely to lead to significant improvement. Although these results are negative they have important implications for our understanding of perceptual timing and its relationship to motor functions within the timing network of the brain. They imply that the mechanisms involved in the perceptual processing of temporal information are likely to be functionally independent from those that underpin movement. Further, they suggest that the connections between STN and the subtantia nigra and globus pallidus are unlikely to be critical to beat-based perceptual timing. We assessed the effect of STN-DBS on both duration- and beat-based perceptual timing. DBS activation did not profoundly affect beat-based perceptual timing. An effect of DBS on duration-based timing was not demonstrated but cannot be excluded. Connections between STN and cerebellum are unlikely to be critical to perceptual timing.
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Affiliation(s)
- Thomas E Cope
- Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
| | - Manon Grube
- Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Arnab Mandal
- Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Freya E Cooper
- Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Una Brechany
- Institute for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - David J Burn
- Institute for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Timothy D Griffiths
- Auditory Group, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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Moro E, Lang AE. Criteria for deep-brain stimulation in Parkinson’s disease: review and analysis. Expert Rev Neurother 2014; 6:1695-705. [PMID: 17144783 DOI: 10.1586/14737175.6.11.1695] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deep-brain stimulation is currently the most effective surgical treatment for advanced Parkinson's disease. The relevant targets to date are the subthalamic nucleus and the globus pallidus internus, although the thalamus (ventralis intermedius nucleus) is preferred in tremor-dominant, aged Parkinson's disease patients. Long-term benefit in cardinal parkinsonian signs, motor fluctuations and dyskinesia has been reported in 5-year follow-up studies of subthalamic nucleus deep-brain stimulation. However, some psychiatric consequences have raised important issues and emphasized the need for an experienced deep-brain stimulation surgical team. This team should be multidisciplinary and involve movement disorder neurologists, neurosurgeons, neuropsychologists and psychiatrists. The recent observation that deep-brain stimulation of the pedunculopontine nucleus improves axial signs, possibly even in those less responsive to levodopa, brings new hope to the management of advanced Parkinson's disease.
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Affiliation(s)
- Elena Moro
- University of Toronto, Department of Medicine, Movement Disorders Center, 399 Bathurst Street, McL7 402, Canada.
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Lee H, Fell J, Axmacher N. Electrical engram: how deep brain stimulation affects memory. Trends Cogn Sci 2013; 17:574-84. [PMID: 24126128 DOI: 10.1016/j.tics.2013.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/10/2013] [Accepted: 09/11/2013] [Indexed: 01/20/2023]
Abstract
Deep brain stimulation (DBS) is a surgical procedure involving implantation of a pacemaker that sends electric impulses to specific brain regions. DBS has been applied in patients with Parkinson's disease, depression, and obsessive-compulsive disorder (among others), and more recently in patients with Alzheimer's disease to improve memory functions. Current DBS approaches are based on the concept that high-frequency stimulation inhibits or excites specific brain regions. However, because DBS entails the application of repetitive electrical stimuli, it primarily exerts an effect on extracellular field-potential oscillations similar to those recorded with electroencephalography. Here, we suggest a new perspective on how DBS may ameliorate memory dysfunction: it may enhance normal electrophysiological patterns underlying long-term memory processes within the medial temporal lobe.
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Affiliation(s)
- Hweeling Lee
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
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Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G, Dietrichs E, Fabbrini G, Friedman A, Kanovsky P, Kostic V, Nieuwboer A, Odin P, Poewe W, Rascol O, Sampaio C, Schüpbach M, Tolosa E, Trenkwalder C, Schapira A, Berardelli A, Oertel WH. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease. Eur J Neurol 2013; 20:5-15. [PMID: 23279439 DOI: 10.1111/j.1468-1331.2012.03866.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD. METHODS For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made. RESULTS AND CONCLUSIONS For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence.
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Affiliation(s)
- J J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Ventre-Dominey J, Bourret S, Mollion H, Broussolle E, Dominey PF. Dissociable dorsal and ventral frontostriatal working memory circuits: evidence from subthalamic stimulation in Parkinson's disease. Hum Brain Mapp 2012; 35:552-66. [PMID: 23097317 DOI: 10.1002/hbm.22205] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 11/10/2022] Open
Abstract
In this study, we investigated the neural substrates involved in visual working memory (WM) and the resulting effects of subthalamic nucleus (STN) stimulation in Parkinson's disease (PD). Cerebral activation revealed by positron emission tomography was compared among Parkinson patients with (PD-ON) or without (PD-OFF) STN stimulation, and a group of control subjects (CT) in two visual WM tasks with spatial (SP) and nonspatial (NSP) components. PD-OFF patients displayed significant reaction time (RT) deficits for both memory tasks. Although there were no significant differences in RT between patients with PD-ON and -OFF stimulation, patients with PD-ON stimulation performed comparably to controls. The memory tasks were executed with normal error rates in PD-ON and -OFF stimulation. In contrast to these behavioral results, whether the corresponding prefrontal activation was differentially affected by deep brain stimulation status in patients depended on whether the WM modality was SP versus NSP. Thus, SP WM was associated with (1) abnormal reduction in dorsolateral prefrontal activity in PD-OFF and -ON stimulation and (2) abnormal overactivation in parieto-temporal cortex in PD-OFF and in limbic circuits in PD-ON stimulation. In NSP WM, normal activation of the ventral prefrontal cortex was restored in PD-ON stimulation. In both visual modalities the posterior cerebral regions including fusiform cortex and cerebellum, displayed abnormally reduced activity in PD. These results indicate that PD induces a prefrontal hypoactivation that STN stimulation can partially restore in a modality selective manner by additional recruitment of limbic structures in SP WM or by recovery of the ventral prefrontal activation in NSP WM.
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Deistung A, Schäfer A, Schweser F, Biedermann U, Turner R, Reichenbach JR. Toward in vivo histology: a comparison of quantitative susceptibility mapping (QSM) with magnitude-, phase-, and R2*-imaging at ultra-high magnetic field strength. Neuroimage 2012; 65:299-314. [PMID: 23036448 DOI: 10.1016/j.neuroimage.2012.09.055] [Citation(s) in RCA: 340] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/17/2012] [Accepted: 09/17/2012] [Indexed: 01/13/2023] Open
Abstract
Quantitative magnetic susceptibility mapping (QSM) has recently been introduced to provide a novel quantitative and local MRI contrast. However, the anatomical contrast represented by in vivo susceptibility maps has not yet been compared systematically and comprehensively with gradient (recalled) echo (GRE) magnitude, frequency, and R(2)(*) images. Therefore, this study compares high-resolution quantitative susceptibility maps with conventional GRE imaging approaches (magnitude, frequency, R(2)(*)) in healthy individuals at 7 T with respect to anatomic tissue contrast. Volumes-of-interest were analyzed in deep and cortical gray matter (GM) as well as in white matter (WM) on R(2)(*) and susceptibility maps. High-resolution magnetic susceptibility maps of the human brain exhibited superb contrast that allowed the identification of substructures of the thalamus, midbrain and basal ganglia, as well as of the cerebral cortex. These were consistent with histology but not generally visible on magnitude, frequency or R(2)(*)-maps. Common target structures for deep brain stimulation, including substantia nigra pars reticulata, ventral intermediate nucleus, subthalamic nucleus, and the substructure of the internal globus pallidus, were clearly distinguishable from surrounding tissue on magnetic susceptibility maps. The laminar substructure of the cortical GM differed depending on the anatomical region, i.e., a cortical layer with increased magnetic susceptibility, corresponding to the Stria of Gennari, was found in the GM of the primary visual cortex, V1, whereas a layer with reduced magnetic susceptibility was observed in the GM of the temporal cortex. Both magnetic susceptibility and R(2)(*) values differed substantially in cortical GM depending on the anatomic regions. Regression analysis between magnetic susceptibility and R(2)(*) values of WM and GM structures suggested that variations in myelin content cause the overall contrast between gray and white matter on susceptibility maps and that both R(2)(*) and susceptibility values provide linear measures for iron content in GM. In conclusion, quantitative magnetic susceptibility mapping provides a non-invasive and spatially specific contrast that opens the door to the assessment of diseases characterized by variation in iron and/or myelin concentrations. Its ability to reflect anatomy of deep GM structures with superb delineation may be useful for neurosurgical applications.
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Affiliation(s)
- Andreas Deistung
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology I, Jena University Hospital - Friedrich Schiller University Jena, Philosophenweg 3, 07743 Jena, Germany.
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Pouratian N, Thakkar S, Kim W, Bronstein JM. Deep brain stimulation for the treatment of Parkinson's disease: efficacy and safety. Degener Neurol Neuromuscul Dis 2012; 2012. [PMID: 24298202 DOI: 10.2147/dnnd.s25750] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Deep brain stimulation (DBS) surgery has become increasingly utilized in the treatment of advanced Parkinson's disease. Over the past decade, a number of studies have demonstrated that DBS is superior to best medical management in appropriately selected patients. The primary targets for DBS in Parkinson's disease include the subthalamic nucleus and the internal segment of the globus pallidus, both of which improve the cardinal motor features in Parkinson's disease. Recent randomized studies have revealed that both targets are similarly effective in treating the motor symptoms of Parkinson's disease, but emerging evidence suggests that the globus pallidus may be the preferred target in many patients, based on differences in nonmotor outcomes. Here, we review appropriate patient selection, and the efficacy and safety of DBS therapy in Parkinson's disease. Best outcomes are achieved if the problems of the individual patient are considered when evaluating surgical candidates and considering whether the subthalamic nucleus or the globus pallidus internus should be targeted.
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Affiliation(s)
- Nader Pouratian
- Departments of Neurosurgery, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles ; Bioengineering, David Geffen School of Medicine at UCLA (University of California, Los Angeles), Los Angeles
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Lozachmeur C, Drapier D. [Apathy and deep brain stimulation in Parkinson's disease]. Rev Neurol (Paris) 2012; 168:620-3. [PMID: 22921249 DOI: 10.1016/j.neurol.2012.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/22/2012] [Accepted: 06/26/2012] [Indexed: 10/28/2022]
Abstract
Apathy was defined by Marin as diminished motivation not attributable to diminished level of consciousness, cognitive impairment, or emotional distress. Up to 42% of Parkinson's disease patients could be concerned. It has a pejorative impact on quality of life and could be predictive of cognitive decline. It has been shown that deep brain stimulation in Parkinson's disease may induce apathy. It seems directly related to the stimulation target, i.e. the subthalamic nucleus, since such an effect has not been observed so far in thalamic and pallidal stimulation. It should certainly not make us question the remarkable effectiveness of subthalamic stimulation in Parkinson's disease patients, but encourages us to be very careful about operability criteria. We must, in this sense, improve identification of at risk patients, seeking a thoroughly diminished motivation, loss of interest or blunting affects.
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Affiliation(s)
- C Lozachmeur
- Service de psychiatrie et de psychologie médicale, centre hospitalier universitaire Pontchaillou, Rennes, France.
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Min HK, Hwang SC, Marsh MP, Kim I, Knight E, Striemer B, Felmlee JP, Welker KM, Blaha CD, Chang SY, Bennet KE, Lee KH. Deep brain stimulation induces BOLD activation in motor and non-motor networks: an fMRI comparison study of STN and EN/GPi DBS in large animals. Neuroimage 2012; 63:1408-20. [PMID: 22967832 DOI: 10.1016/j.neuroimage.2012.08.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 08/03/2012] [Accepted: 08/04/2012] [Indexed: 01/11/2023] Open
Abstract
The combination of deep brain stimulation (DBS) and functional MRI (fMRI) is a powerful means of tracing brain circuitry and testing the modulatory effects of electrical stimulation on a neuronal network in vivo. The goal of this study was to trace DBS-induced global neuronal network activation in a large animal model by monitoring the blood oxygenation level-dependent (BOLD) response on fMRI. We conducted DBS in normal anesthetized pigs, targeting the subthalamic nucleus (STN) (n=7) and the entopeduncular nucleus (EN), the non-primate analog of the primate globus pallidus interna (n=4). Using a normalized functional activation map for group analysis and the application of general linear modeling across subjects, we found that both STN and EN/GPi DBS significantly increased BOLD activation in the ipsilateral sensorimotor network (FDR<0.001). In addition, we found differential, target-specific, non-motor network effects. In each group the activated brain areas showed a distinctive correlation pattern forming a group of network connections. Results suggest that the scope of DBS extends beyond an ablation-like effect and that it may have modulatory effects not only on circuits that facilitate motor function but also on those involved in higher cognitive and emotional processing. Taken together, our results show that the swine model for DBS fMRI, which conforms to human implanted DBS electrode configurations and human neuroanatomy, may be a useful platform for translational studies investigating the global neuromodulatory effects of DBS.
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Affiliation(s)
- Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Homer MA, Rubin SS, Horowitz TD, Richter E. Linguistic Testing During ON/OFF States of Electrical Stimulation in the Associative Portion of the Subthalamic Nucleus. Neuromodulation 2012; 15:238-45; discussion 245. [DOI: 10.1111/j.1525-1403.2012.00441.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nölte IS, Gerigk L, Al-Zghloul M, Groden C, Kerl HU. Visualization of the internal globus pallidus: sequence and orientation for deep brain stimulation using a standard installation protocol at 3.0 Tesla. Acta Neurochir (Wien) 2012; 154:481-94. [PMID: 22167532 DOI: 10.1007/s00701-011-1242-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 11/21/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Deep-brain stimulation (DBS) of the internal globus pallidus (GPi) has shown remarkable therapeutic benefits for treatment-resistant neurological disorders including dystonia and Parkinson's disease (PD). The success of the DBS is critically dependent on the reliable visualization of the GPi. The aim of the study was to evaluate promising 3.0 Tesla magnetic resonance imaging (MRI) methods for pre-stereotactic visualization of the GPi using a standard installation protocol. METHODS MRI at 3.0 T of nine healthy individuals and of one patient with PD was acquired (FLAIR, T1-MPRAGE, T2-SPACE, T2*-FLASH2D, susceptibility-weighted imaging mapping (SWI)). Image quality and visualization of the GPi for each sequence were assessed by two neuroradiologists independently using a 6-point scale. Axial, coronal, and sagittal planes of the T2*-FLASH2D images were compared. Inter-rater reliability, contrast-to-noise ratios (CNR) and signal-to-noise ratios (SNR) for the GPi were determined. For illustration, axial T2*-FLASH2D images were fused with a section schema of the Schaltenbrand-Wahren stereotactic atlas. RESULTS The GPi was best and reliably visualized in axial and to a lesser degree on coronal T2*-FLASH2D images. No major artifacts in the GPi were observed in any of the sequences. SWI offered a significantly higher CNR for the GPi compared to standard T2-weighted imaging using the standard parameters. The fusion of the axial T2*-FLASH2D images and the atlas projected the GPi clearly in the boundaries of the section schema. CONCLUSIONS Using a standard installation protocol at 3.0 T T2*-FLASH2D imaging (particularly axial view) provides optimal and reliable delineation of the GPi.
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Affiliation(s)
- Ingo S Nölte
- Medical Faculty Mannheim, Department of Neuroradiology, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany.
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An examination of the effects of subthalamic nucleus inhibition or μ-opioid receptor stimulation on food-directed motivation in the non-deprived rat. Behav Brain Res 2012; 230:365-73. [PMID: 22391117 DOI: 10.1016/j.bbr.2012.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 01/27/2012] [Accepted: 02/17/2012] [Indexed: 12/29/2022]
Abstract
The subthalamic nucleus (STN) serves important functions in regulating movement, cognition, and motivation and is connected with cortical and basal ganglia circuits that process reward and reinforcement. In order to further examine the role of the STN on motivation toward food in non-deprived rats, these experiments studied the effects of pharmacological inhibition or μ-opioid receptor stimulation of the STN on the 2-h intake of a sweetened fat diet, the amount of work exerted to earn sucrose on a progressive ratio 2 (PR-2) schedule of reinforcement, and performance on a differential reinforcement of low-rate responding (DRL) schedule for sucrose reward. Separate behavioral groups (N=6-9) were tested following bilateral inhibition of the STN with the GABA(A) receptor agonist muscimol (at 0-5 ng/0.5 μl/side) or following μ-opioid receptor stimulation with the agonist D-Ala², N-MePhe⁴, Gly-ol-enkephalin (DAMGO; at 0, 0.025 or 0.25 μg/0.5 μl/side). Although STN inhibition increased ambulatory behavior during 2-h feeding sessions, it did not significantly alter intake of the sweetened fat diet. STN inhibition also did not affect the breakpoint for sucrose pellets during a 1-h PR-2 reinforcement schedule or impact the number of reinforcers earned on a 1-h DRL-20s reinforcement schedule in non-deprived rats. In contrast, STN μ-opioid receptor stimulation significantly increased feeding on the palatable diet and reduced the reinforcers earned on a DRL-20 schedule, although DAMGO microinfusions had no effect on PR-2 performance. These data suggest that STN inhibition does not enhance incentive motivation for food in the absence of food restriction and that STN μ-opioid receptors play an important and unique role in motivational processes.
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Grubert C, Hurlemann R, Bewernick BH, Kayser S, Hadrysiewicz B, Axmacher N, Sturm V, Schlaepfer TE. Neuropsychological safety of nucleus accumbens deep brain stimulation for major depression: effects of 12-month stimulation. World J Biol Psychiatry 2011; 12:516-27. [PMID: 21736514 DOI: 10.3109/15622975.2011.583940] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) to the nucleus accumbens (NAcc-DBS) has antidepressant effects in patients suffering from treatment-resistant depression (TRD). However, limited information exists regarding the impact of NAcc-DBS on cognitive functioning. The aim of this study was to examine whether NAcc-DBS in patients with TRD has any cognitive effects. METHODS A comprehensive neuropsychological battery was administered to 10 patients with TRD before onset of bilateral NAcc-DBS and after 1 year of DBS stimulation. Neuropsychological testing covered the domains of attention, learning and memory, executive functions, visual perception, and language. Performance was analyzed at baseline and after 1 year of continuous DBS. RESULTS No evidence was found for cognitive decline following NAcc-DBS comparing test results after 1 year of NAcc-DBS with baseline. However, significantly improved cognitive performance on tests of attention, learning and memory, executive functions and visual perception was found. In addition, there was a general trend towards cognitive enhancement from below average to average performance. These procognitive effects were independent of the antidepressant effects of NAcc-DBS or changes in NAcc-DBS parameters. CONCLUSIONS These results not only support cognitive safety of NAcc-DBS but also stress its beneficial role in augmenting cognitive performance in patients with TRD.
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Affiliation(s)
- Christiane Grubert
- Department of Psychiatry and Psychotherapy, University Hospital, Bonn, Germany
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Mollion H, Dominey PF, Broussolle E, Ventre-Dominey J. Subthalamic nucleus stimulation selectively improves motor and visual memory performance in Parkinson's disease. Mov Disord 2011; 26:2019-25. [DOI: 10.1002/mds.23769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 03/30/2011] [Accepted: 04/03/2011] [Indexed: 11/09/2022] Open
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Kirsch-Darrow L, Zahodne LB, Marsiske M, Okun MS, Foote KD, Bowers D. The trajectory of apathy after deep brain stimulation: from pre-surgery to 6 months post-surgery in Parkinson's disease. Parkinsonism Relat Disord 2011; 17:182-8. [PMID: 21256069 DOI: 10.1016/j.parkreldis.2010.12.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/31/2010] [Accepted: 12/14/2010] [Indexed: 11/17/2022]
Abstract
Deep brain stimulation (DBS) has been associated with increased apathy in patients with PD, yet studies lack longitudinal data and have not assessed differences between sites of implantation (i.e. STN versus GPi). We assessed apathy prior to surgery and 6 months post-surgery using a longitudinal design-latent growth curve modeling. We hypothesized that apathy would increase post-surgery, and be related to subthalamic nucleus (versus globus pallidus interna) implantation. Forty-eight PD patients underwent unilateral surgery to either GPi or STN and completed the Apathy Scale prior to surgery and 2, 4, and 6 months post-surgery. Forty-eight matched PD controls completed the Apathy Scale at a 6-month interval. Results indicated apathy increased linearly from pre- to 6-months post-DBS by .66 points bi-monthly, while apathy in the control group did not change. There was no relationship between apathy and DBS site. Higher baseline depression was associated with higher baseline apathy, but not with change in apathy. Middle-aged adults (<65) had a steeper trajectory of apathy than older adults (≥ 65). Apathy trajectory was not related to motor severity, laterality of DBS, levodopa medication reduction, or motor changes after surgery.
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Affiliation(s)
- L Kirsch-Darrow
- Department of Clinical & Health Psychology, College of Public Health and Health, Professions, University of Florida, Box 100165, Gainesville, FL 32610, USA
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Burdick AP, Foote KD, Wu S, Bowers D, Zeilman P, Jacobson CE, Ward HE, Okun MS. Do patient's get angrier following STN, GPi, and thalamic deep brain stimulation. Neuroimage 2010; 54 Suppl 1:S227-32. [PMID: 20932923 DOI: 10.1016/j.neuroimage.2010.09.077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/22/2010] [Accepted: 09/27/2010] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The objective of the study was to examine whether deep brain stimulation (DBS) of the subthalamic nucleus (STN), the globus pallidus internus (GPi), and/or the ventralis intermedius thalamic nucleus (Vim) was associated with making patients angrier pre to post-surgical intervention. BACKGROUND Secondary outcome analysis of the NIH COMPARE Parkinson's Disease DBS trial revealed that participants were angrier and had more mood and cognitive side effects following DBS. Additionally blinded on/off analysis did not change anger scores. The sample size was small but suggested that STN DBS may have been worse than GPi in provoking anger. We endeavored to examine this question utilizing a larger dataset (the UF INFORM database), and also we included a third surgical target (Vim), which has been utilized for a different disease, essential tremor. METHODS Consecutive patients from the University of Florida Movement Disorders Center who were implanted with unilateral DBS for Parkinson's disease (STN or GPi) or essential tremor (Vim) were included. Patients originally implanted at outside institutions were excluded. Pre-operative and 4- to 6-month post-operative Visual Analog Mood Scale (VAMS) scores for all three groups were compared; additionally, pre-operative and 1- to 3-month scores were compared for STN and GPi patients. A linear regression model was utilized to analyze the relationship between the VAMS anger score and the independent variables of age, years with symptoms, Mini-Mental Status Examination (MMSE) score, handedness, ethnicity, gender, side of surgery, target of surgery, baseline Dementia Rating Scale (DRS) total score, baseline Beck Depression Index (BDI) score, micro- and macroelectrode passes, and years of education. Levodopa equivalent dosages and dopamine agonist use were analyzed for a potential impact on anger scores. RESULTS A total of 322 unilateral DBS procedures were analyzed, with STN (n=195), Vim (n=71), and GPi (n=56) making up the cohort. An ANOVA was used to detect significant differences among the three targets in the changes pre- to post-operatively. Similar to the COMPARE dataset, at 4 months, the only subscore of VAMS to reveal a significant difference between the three targets was the angry subscore, with GPi revealing a mean (standard) change of 2.38 (9.53); STN, 4.82 (14.52); and Vim, -1.17 (11.51) (p=0.012). At 1-3 months post-operation, both STN and GPi groups were significantly angrier (p=0.004), but there was no significant difference between the two groups. However, GPi patients were significantly more confused as compared to STN patients (p=0.016). The linear regression model which sought independent explanatory variables revealed a relationship between the VAMS anger score and the surgical target and the disease duration. The mean changes for STN and GPi DBS pre- to post-operation were 11.67 (p=0.001) and 8.21 (p=0.022) units more than those with Vim, respectively. For every year added of disease duration, the VAMS anger score increased by 0.24 (p=0.022). For the GPi and STN groups, number of microelectrode passes was significantly associated with angry score changes (p=0.014), with the anger score increasing 2.29 units per microelectrode pass. Independent variables not associated with the VAMS anger score included the surgery side, handedness, gender, ethnicity, education, age at surgery, MMSE, DRS, and BDI scores. Although the STN group significantly decreased in LED when compared to GPi, there was no relationship to anger scores. Similarly, dopamine agonist use was not different between STN and GPi groups and did not correlate with the VAMS anger score changes. CONCLUSIONS STN and GPi DBS for Parkinson's disease were associated with significantly higher anger scores pre- to post-DBS as compared to Vim for essential tremor. Anger score changes in STN and GPi patients seem to be associated with microelectrode passes, suggesting that it may be a lesional effect. PD patients with longer disease duration may be particularly susceptible, and this should be kept in mind when discussing the potential of DBS surgery for an individual patient. Essential tremor patients who on average have much longer disease durations did not get angrier. The changes in anger scores were not related to LED change or dopamine agonist use. Whether the induction of anger is disease-specific or target-specific is not currently known; however, our data would suggest that PD patients implanted in STN or GPi are at a potential risk. Finally, on closer inspection of the COMPARE DBS data, VAMS anger scores did not change on or off DBS, suggesting that anger changes may be more of a lesional effect rather than a stimulation induced one (Okun et al., 2009).
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Affiliation(s)
- Adam P Burdick
- University of Florida Movement Disorders Center, Department of Neurosurgery, Gainesville, FL, USA
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Naskar S, Sood SK, Goyal V, Dhara M. RETRACTED: Mechanism(s) of deep brain stimulation and insights into cognitive outcomes in Parkinson's disease. ACTA ACUST UNITED AC 2010; 65:1-13. [DOI: 10.1016/j.brainresrev.2010.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 04/12/2010] [Accepted: 04/27/2010] [Indexed: 11/30/2022]
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Klaming L, Haselager P. Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Action and Mental Competence. NEUROETHICS-NETH 2010; 6:527-539. [PMID: 24273622 PMCID: PMC3825573 DOI: 10.1007/s12152-010-9093-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 09/07/2010] [Indexed: 11/25/2022]
Abstract
Deep brain stimulation (DBS) is a well-accepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual's personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient's personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual's mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient's responsibility for action and competence of decision and raises a number of questions that need further research.
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Affiliation(s)
- Laura Klaming
- Tilburg Institute for Law, Technology, and Society, Tilburg University, P. O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Pim Haselager
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
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Rouaud T, Dondaine T, Drapier S, Haegelen C, Lallement F, Péron J, Raoul S, Sauleau P, Vérin M. Pallidal stimulation in advanced Parkinson's patients with contraindications for subthalamic stimulation. Mov Disord 2010; 25:1839-46. [DOI: 10.1002/mds.23171] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sixel-Döring F, Ebersbach G. [Long-term care after deep brain stimulation of patients with Parkinson's disease]. DER NERVENARZT 2010; 81:688-695. [PMID: 20437025 DOI: 10.1007/s00115-010-2940-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Long-term care after deep brain stimulation for Parkinson's disease requires regular technical check-ups as well as clinical follow-up. Residual or emerging difficulties with gait, balance or speech should be addressed by specific rehabilitation programs. In cases of psychosocial maladjustment, psychotherapy or family counseling may prove helpful. After consolidation of stimulation parameters, pharmacotherapy can be tailored according to the individual needs, following the same guidelines as for Parkinson's disease patients without deep brain stimulation. In cases of clinical deterioration, malfunctioning of the stimulation system, comorbidity or disease progression has to be considered and treated accordingly. Structured long-term care programs may contribute to patient satisfaction and ensure quality of life.
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Affiliation(s)
- F Sixel-Döring
- Paracelsus-Elena-Klinik, Klinikstrasse 16, Kassel, Germany.
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Lakhan SE, Callaway E. Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review. BMC Res Notes 2010; 3:60. [PMID: 20202203 PMCID: PMC2838907 DOI: 10.1186/1756-0500-3-60] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 03/04/2010] [Indexed: 12/04/2022] Open
Abstract
Background In spite of advances in psychotherapy and pharmacotherapy, there are still a significant number of patients with depression and obsessive-compulsive disorder that are not aided by either intervention. Although still in the experimental stage, deep brain stimulation (DBS) offers many advantages over other physically-invasive procedures as a treatment for these psychiatric disorders. The purpose of this study is to systematically review reports on clinical trials of DBS for obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Locations for stimulation, success rates and effects of the stimulation on brain metabolism are noted when available. The first observation of the effects of DBS on OCD and TRD came in the course of using DBS to treat movement disorders. Reports of changes in OCD and depression during such studies are reviewed with particular attention to electrode locations and associated adverse events; although these reports were adventitious observations rather than planned. Subsequent studies have been guided by more precise theories of structures involved in DBS and OICD. This study suggests stimulation sites and prognostic indicators for DBS. We also briefly review tractography, a relatively new procedure that holds great promise for the further development of DBS. Methods Articles were retrieved from MEDLINE via PubMed. Relevant references in retrieved articles were followed up. We included all articles reporting on studies of patients selected for having OCD or TRD. Adequacy of the selected studies was evaluated by the Jadad scale. Evaluation criteria included: number of patients, use of recognized psychiatric rating scales, and use of brain blood flow measurements. Success rates classified as "improved" or "recovered" were recorded. Studies of DBS for movement disorders were included if they reported coincidental relief of depression or reduction in OCD. Most of the studies involved small numbers of subjects so individual studies were reviewed. Results While the number of cases was small, these were extremely treatment-resistant patients. While not everyone responded, about half the patients did show dramatic improvement. Associated adverse events were generally trivial in younger psychiatric patients but often severe in older movement disorder patients. The procedures differed from study to study, and the numbers of patients was usually too small to do meaningful statistics or make valid inferences as to who will respond to treatment. Conclusions DBS is considered a promising technique for OCD and TRD. Outstanding questions about patient selection and electrode placement can probably be resolved by (a) larger studies, (b) genetic studies and (c) imaging studies (MRI, fMRI, PET, and tractography).
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Affiliation(s)
- Shaheen E Lakhan
- Global Neuroscience Initiative Foundation, Los Angeles, CA, USA.
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Intracranial electrode implantation produces regional neuroinflammation and memory deficits in rats. Exp Neurol 2009; 222:42-50. [PMID: 20026042 DOI: 10.1016/j.expneurol.2009.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 08/28/2009] [Accepted: 12/05/2009] [Indexed: 11/21/2022]
Abstract
Deep brain stimulation (DBS) is an established treatment for advanced Parkinson's disease (PD). The procedure entails intracranial implantation of an electrode in a specific brain structure followed by chronic stimulation. Although the beneficial effects of DBS on motor symptoms in PD are well known, it is often accompanied by cognitive impairments, the origin of which is not fully understood. To explore the possible contribution of the surgical procedure itself, we studied the effect of electrode implantation in the subthalamic nucleus (STN) on regional neuroinflammation and memory function in rats implanted bilaterally with stainless steel electrodes. Age-matched sham and intact rats were used as controls. Brains were removed 1 or 8 weeks post-implantation and processed for in vitro autoradiography with [(3)H]PK11195, an established marker of microglial activation. Memory function was assessed by the novel object recognition test (ORT) before surgery and 2 and 8 weeks after surgery. Electrode implantation produced region-dependent changes in ligand binding density in the implanted brains at 1 as well as 8 weeks post-implantation. Cortical regions showed more intense and widespread neuroinflammation than striatal or thalamic structures. Furthermore, implanted animals showed deficits in ORT performance 2 and 8 weeks post-implantation. Thus, electrode implantation resulted in a widespread and persistent neuroinflammation and sustained memory impairment. These results suggest that the insertion and continued presence of electrodes in the brain, even without stimulation, may lead to inflammation-mediated cognitive deficits in susceptible individuals, as observed in patients treated with DBS.
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