1
|
Wang F, Huang P, Lin S, Dai L, Lin Z, Pan Y, Zhang C, Sun B, Wu Y, Li D. Anterior capsulotomy combined with subthalamic nucleus deep brain stimulation for tardive dystonia. J Psychiatr Res 2024; 176:148-154. [PMID: 38865864 DOI: 10.1016/j.jpsychires.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) has been reported as a therapy option for the motor dysfunction of severe tardive dystonia (TD). The major psychiatric diseases, however, are contraindications to DBS treatment in TD patients. METHODS Six severe, medically refractory TD patients undergoing bilateral anterior capsulotomy combined with bilateral subthalamic nucleus (STN)-DBS treatment were studied retrospectively at two time points: pre-operation, and 1-3 years post-operation. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to assess the dystonia and disability. Depressive, anxiety, psychiatric symptoms, and Quality of Life (QoL) were evaluated using the 17-item Hamilton Depression Scale (HAMD-17), the 14-item Hamilton Anxiety Scale (HAMA-14), the Positive and Negative Syndrome Scale (PANSS), and 36-item Short-Form Health Survey (SF-36), respectively. RESULTS After receiving the combination treatment for 25 ± 11.6 months (range, 12-41 months), significant clinical symptom improvements were reported in TD patients. BFMDRS motor and disability scores were ameliorated by 78.5 ± 32.0% (p = 0.031) and 76.5 ± 38.6% (p = 0.031), respectively. The HAMD-17 and HAMA-14 scores were reduced by 60.3 ± 27.9% (p = 0.007) and 60.0 ± 24.6% (p = 0.009), respectively. Furthermore, the PANSS scores of the comorbidity schizophrenia TD patients decreased by 58.1 ± 6.0% (p = 0.022), and the QoL improved by 59.7 ± 14.1% (SF-36, p = 0.0001). During the research, there were no notable adverse effects or problems. CONCLUSION Bilateral anterior capsulotomy combined with bilateral STN-DBS may be an effective and relatively safe treatment option for severe TD comorbid with major psychiatric disorders.
Collapse
Affiliation(s)
- Fang Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China; Contributed equally to this Research, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Contributed equally to this Research, China
| | - Suzhen Lin
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lulin Dai
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhengyu Lin
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
2
|
Hao Q, Lv G, Zheng W, Zhang Z, Ding H, OuYang J, Wu G, Xiang F, Tan Y, Wu G, Liu R. Comparison of GPi-DBS, STN-DBS, and pallidotomy in primary Meige syndrome. Brain Stimul 2023; 16:1450-1451. [PMID: 37774913 DOI: 10.1016/j.brs.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023] Open
Affiliation(s)
- Qingpei Hao
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Gaoquan Lv
- Department of Neuroradiology, Peking University People's Hospital, Beijing, China
| | - Wentao Zheng
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Zihao Zhang
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Hu Ding
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Jia OuYang
- Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China
| | - Gang Wu
- Department of Psychology, Peking University People's Hospital, Beijing, China
| | - Fanding Xiang
- Statistics Center, Beijing University of Technology, Beijing, China
| | - Yao Tan
- Clinical Research Institute, Peking University, Beijing, China
| | - Guangyong Wu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China; Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China; Department of Neurosurgery, Beijing Shunyi Hospital, Beijing, China.
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China; Functional Neurosurgery Research Center, Peking University Health Science Center, Beijing, China.
| |
Collapse
|
3
|
Szczakowska A, Gabryelska A, Gawlik-Kotelnicka O, Strzelecki D. Deep Brain Stimulation in the Treatment of Tardive Dyskinesia. J Clin Med 2023; 12:1868. [PMID: 36902655 PMCID: PMC10003252 DOI: 10.3390/jcm12051868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Tardive dyskinesia (TD) is a phenomenon observed following the predominantly long-term use of dopamine receptor blockers (antipsychotics) widely used in psychiatry. TD is a group of involuntary, irregular hyperkinetic movements, mainly in the muscles of the face, eyelid, lips, tongue, and cheeks, and less frequently in the limbs, neck, pelvis, and trunk. In some patients, TD takes on an extremely severe form, massively disrupting functioning and, moreover, causing stigmatization and suffering. Deep brain stimulation (DBS), a method used, among others, in Parkinson's disease, is also an effective treatment for TD and often becomes a method of last resort, especially in severe, drug-resistant forms. The group of TD patients who have undergone DBS is still very limited. The procedure is relatively new in TD, so the available reliable clinical studies are few and consist mainly of case reports. Unilateral and bilateral stimulation of two sites has proven efficacy in TD treatment. Most authors describe stimulation of the globus pallidus internus (GPi); less frequent descriptions involve the subthalamic nucleus (STN). In the present paper, we provide up-to-date information on the stimulation of both mentioned brain areas. We also compare the efficacy of the two methods by comparing the two available studies that included the largest groups of patients. Although GPi stimulation is more frequently described in literature, our analysis indicates comparable results (reduction of involuntary movements) with STN DBS.
Collapse
Affiliation(s)
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland
| | - Oliwia Gawlik-Kotelnicka
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland
| |
Collapse
|
4
|
Aita SL, Del Bene VA, Marotta DA, Pizer JH, Hawley NA, Niccolai L, Walker HC, Gerstenecker A, Martin RC, Clay OJ, Crowe M, Triebel KL, Hill BD. Neuropsychological Functioning in Primary Dystonia: Updated and Expanded Multidomain Meta-Analysis. Mov Disord 2022; 37:1483-1494. [PMID: 35385165 DOI: 10.1002/mds.29022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Primary dystonia is conventionally considered as a motor disorder, though an emerging literature reports associated cognitive dysfunction. OBJECTIVES Here, we conducted meta-analyses on studies comparing clinical measures of cognition in persons with primary dystonia and healthy controls (HCs). METHODS We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO (January 2000-October 2020). Analyses were modeled under random effects. We used Hedge's g as a bias-corrected estimate of effect size, where negative values indicate lower performance in dystonia versus controls. Between-study heterogeneity and bias were primarily assessed with Cochran's Q, I2 , and Egger's regression. RESULTS From 866 initial results, 20 studies met criteria for analysis (dystonia n = 739, controls n = 643; 254 effect sizes extracted). Meta-analysis showed a significant combined effect size of primary dystonia across all studies (g = -0.56, P < 0.001), with low heterogeneity (Q = 25.26, P = 0.15, I2 = 24.78). Within-domain effects of primary dystonia were motor speed = -0.84, nonmotor speed = -0.83, global cognition = -0.65, language = -0.54, executive functioning = -0.53, learning/memory = -0.46, visuospatial/construction = -0.44, and simple/complex attention = -0.37 (P-values <0.01). High heterogeneity was observed in the motor/nonmotor speed and learning/memory domains. There was no evidence of publication bias. Moderator analyses were mostly negative but possibly underpowered. Blepharospasm samples showed worse performance than other focal/cervical dystonias. Those with inherited (ie, genetic) disease etiology demonstrated worse performance than acquired. CONCLUSIONS Dystonia patients consistently demonstrated lower performances on neuropsychological tests versus HCs. Effect sizes were generally moderate in strength, clustering around -0.50 SD units. Within the speed domain, results suggested cognitive slowing beyond effects from motor symptoms. Overall, findings indicate dystonia patients experience multidomain cognitive difficulties, as detected by neuropsychological tests. © 2022 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Stephen L Aita
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA.,Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Victor A Del Bene
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Dario A Marotta
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.,Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Jasmin H Pizer
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Nanako A Hawley
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| | - Lindsay Niccolai
- Supportive Care Medicine, Moffitt Cancer Center, Tampa, Florida, USA
| | - Harrison C Walker
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Roy C Martin
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristen L Triebel
- Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Benjamin D Hill
- Department of Psychology, University of South Alabama, Mobile, Alabama, USA
| |
Collapse
|
5
|
Atkinson-Clement C, Tarrano C, Porte CA, Wattiez N, Delorme C, McGovern EM, Brochard V, Thobois S, Tranchant C, Grabli D, Degos B, Corvol JC, Pedespan JM, Krystkoviak P, Houeto JL, Degardin A, Defebvre L, Valabregue R, Rosso C, Apartis E, Vidailhet M, Pouget P, Roze E, Worbe Y. Dissociation in reactive and proactive inhibitory control in Myoclonus dystonia. Sci Rep 2020; 10:13933. [PMID: 32811896 PMCID: PMC7434767 DOI: 10.1038/s41598-020-70926-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/27/2020] [Indexed: 12/03/2022] Open
Abstract
Myoclonus-dystonia (MD) is a syndrome characterized by myoclonus of subcortical origin and dystonia, frequently associated with psychiatric comorbidities. The motor and psychiatric phenotypes of this syndrome likely result from cortico-striato-thamalo-cerebellar-cortical pathway dysfunction. We hypothesized that reactive and proactive inhibitory control may be altered in these patients. Using the Stop Signal Task, we assessed reactive and proactive inhibitory control in MD patients with (n = 12) and without (n = 21) deep brain stimulation of the globus pallidus interna and compared their performance to matched healthy controls (n = 24). Reactive inhibition was considered as the ability to stop an already initiated action and measured using the stop signal reaction time. Proactive inhibition was assessed through the influence of several consecutive GO or STOP trials on decreased response time or inhibitory process facilitation. The proactive inhibition was solely impaired in unoperated MD patients. Patients with deep brain stimulation showed impairment in reactive inhibition, independent of presence of obsessive–compulsive disorders. This impairment in reactive inhibitory control correlated with intrinsic severity of myoclonus (i.e. pre-operative score). The results point to a dissociation in reactive and proactive inhibitory control in MD patients with and without deep brain stimulation of the globus pallidus interna.
Collapse
Affiliation(s)
- Cyril Atkinson-Clement
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France
| | - Clement Tarrano
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Department of Neurology, CHU Côte de Nacre, Université Caen Normandie, Caen, France
| | - Camille-Albane Porte
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France
| | - Nicolas Wattiez
- Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne University, Paris, France
| | - Cécile Delorme
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Eavan M McGovern
- Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Department of Neurology, St Vincent's University Hospital Dublin, Dublin, Ireland
| | - Vanessa Brochard
- INSERM/APHP, Centre d'Investigation Clinique 1422, Paris, France
| | - Stéphane Thobois
- Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, University of Lyon, Bron, France.,Service de Neurologie C, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - David Grabli
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Bertrand Degos
- Department of Neurology, Hôpital Avicennes, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Jean-Christophe Corvol
- Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Pierre Krystkoviak
- Department of Neurology, Amiens University Medical Center, Amiens, France
| | - Jean-Luc Houeto
- Service de Neurologie, CIC-INSERM 1402, CHU de Poitiers, Poitiers, France
| | - Adrian Degardin
- Department of Neurology, Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Luc Defebvre
- INSERM, U1171-Degenerative and Vascular Cognitive Disorders, CHU Lille, Université de Lille, Lille, France.,Lille Centre of Excellence for Neurodegenerative Diseases (LiCEND), Lille, France
| | - Romain Valabregue
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,UMR S 975, CNRS UMR 7225, ICM, Centre de NeuroImagerie de Recherche (CENIR), Sorbonne Université, Paris, France
| | - Charlotte Rosso
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Urgences Cérébro-Vasculaires, Hôpital de la Pitié Salpêtrière, Paris, France
| | - Emmanuelle Apartis
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie Vidailhet
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Pierre Pouget
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France
| | - Emmanuel Roze
- Sorbonne University, 75005, Paris, France.,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France.,Movement Investigation and Therapeutics Team, Paris, France.,Assistance Publique-Hôpitaux de Paris, Centre d'Investigation Clinique Neurosciences, Hôpital Pitié-Salpêtrière, Paris, France.,Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Yulia Worbe
- Sorbonne University, 75005, Paris, France. .,Inserm U1127, CNRS UMR7225, UM75, ICM, 75013, Paris, France. .,Movement Investigation and Therapeutics Team, Paris, France. .,Department of Neurophysiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
| |
Collapse
|
6
|
Macerollo A, Sajin V, Bonello M, Barghava D, Alusi SH, Eldridge PR, Osman-Farah J. Deep brain stimulation in dystonia: State of art and future directions. J Neurosci Methods 2020; 340:108750. [DOI: 10.1016/j.jneumeth.2020.108750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/03/2023]
|
7
|
Wojtasiewicz T, Butala A, Anderson WS. Dystonia. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
8
|
Stavrinou LC, Liouta E, Boviatsis EJ, Leonardos A, Gatzonis S, Stathis P, Sakas DE, Angelakis E. Effect of constant-current pallidal deep brain stimulation for primary dystonia on cognition, mood and quality of life: Results from a prospective pilot trial. Clin Neurol Neurosurg 2019; 185:105460. [DOI: 10.1016/j.clineuro.2019.105460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/28/2019] [Accepted: 08/06/2019] [Indexed: 01/21/2023]
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Berardelli I, Pasquini M, Conte A, Bologna M, Berardelli A, Fabbrini G. Treatment of psychiatric disturbances in common hyperkinetic movement disorders. Expert Rev Neurother 2018; 19:55-65. [DOI: 10.1080/14737175.2019.1555475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed
| |
Collapse
|
11
|
Eggink H, Szlufik S, Coenen MA, van Egmond ME, Moro E, Tijssen MA. Non-motor effects of deep brain stimulation in dystonia: A systematic review. Parkinsonism Relat Disord 2018; 55:26-44. [DOI: 10.1016/j.parkreldis.2018.06.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 12/15/2022]
|
12
|
Huh R, Song IU, Chung M. Neuropsychological consequences of pallidal deep brain stimulation altering brain networks. J Clin Neurosci 2018; 54:50-56. [DOI: 10.1016/j.jocn.2018.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/27/2018] [Accepted: 05/17/2018] [Indexed: 02/07/2023]
|
13
|
Cury RG, Kalia SK, Shah BB, Jimenez-Shahed J, Prashanth LK, Moro E. Surgical treatment of dystonia. Expert Rev Neurother 2018; 18:477-492. [PMID: 29781334 DOI: 10.1080/14737175.2018.1478288] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Treatment of dystonia should be individualized and tailored to the specific needs of patients. Surgical treatment is an important option in medically refractory cases. Several issues regarding type of the surgical intervention, targets, and predict factors of benefit are still under debate. Areas covered: To date, several clinical trials have proven the benefit and safety of deep brain stimulation (DBS) for inherited and idiopathic isolated dystonia, whereas there is still insufficient evidence in combined and acquired dystonia. The globus pallidus internus (GPi) is the target with the best evidence, but data on the subthalamic nucleus seems also to be promising. Evidence suggests that younger patients with shorter disease duration experience greater benefit following DBS. Pallidotomy and thalamotomy are currently used in subset of carefully selected patients. The development of MRI-guided focused ultrasound might bring new options to ablation approach in dystonia. Expert commentary: GPi-DBS is effective and safe in isolated dystonia and should not be delayed when symptoms compromise quality of life and functionality. Identifying the best candidates to surgery on acquired and combined dystonias is still necessary. New insights about pathophysiology of dystonia and new technological advances will undoubtedly help to tailor surgery and optimize clinical effects.
Collapse
Affiliation(s)
- Rubens Gisbert Cury
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France.,b Department of Neurology, School of Medicine , University of São Paulo , São Paulo , Brazil
| | - Suneil Kumar Kalia
- c Division of Neurosurgery and Krembil Research Institute, Department of Surgery , University of Toronto , Toronto , Canada
| | - Binit Bipin Shah
- d Parkinson's Disease and Movement Disorders Center, Department of Neurology , University of Virginia , Charlottesville , VA , USA
| | - Joohi Jimenez-Shahed
- e Parkinson's Disease Center and Movement Disorders Clinic , Baylor College of Medicine , Houston , TX , USA
| | | | - Elena Moro
- a Service de Neurologie, Centre Hospitalier Universitaire de Grenoble , Université Grenoble Alpes , Grenoble , France
| |
Collapse
|
14
|
Mandarelli G, Moretti G, Pasquini M, Nicolò G, Ferracuti S. Informed Consent Decision-Making in Deep Brain Stimulation. Brain Sci 2018; 8:E84. [PMID: 29751598 PMCID: PMC5977075 DOI: 10.3390/brainsci8050084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) has proved useful for several movement disorders (Parkinson’s disease, essential tremor, dystonia), in which first and/or second line pharmacological treatments were inefficacious. Initial evidence of DBS efficacy exists for refractory obsessive-compulsive disorder, treatment-resistant major depressive disorder, and impulse control disorders. Ethical concerns have been raised about the use of an invasive surgical approach involving the central nervous system in patients with possible impairment in cognitive functioning and decision-making capacity. Most of the disorders in which DBS has been used might present with alterations in memory, attention, and executive functioning, which may have an impact on the mental capacity to give informed consent to neurosurgery. Depression, anxiety, and compulsivity are also common in DBS candidate disorders, and could also be associated with an impaired capacity to consent to treatment or clinical research. Despite these issues, there is limited empirical knowledge on the decision-making levels of these patients. The possible informed consent issues of DBS will be discussed by focusing on the specific treatable diseases.
Collapse
Affiliation(s)
- Gabriele Mandarelli
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
| | - Germana Moretti
- Department of Mental Health, ASL Roma 5, 00034 Colleferro, Italy.
| | - Massimo Pasquini
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
| | - Giuseppe Nicolò
- Department of Mental Health, ASL Roma 5, 00034 Colleferro, Italy.
| | - Stefano Ferracuti
- Department of Human Neurosciences (Former Department of Neurology and Psychiatry), "Sapienza" University of Rome, 00185 Rome, Italy.
| |
Collapse
|