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Velásquez MDV, Albarracín AE, Boscán K, Angel LB, Izquierdo RE, Ramírez MM, Migliore BDC, Charris JE, Garrido MDR, Israel A, López SE, Angel JE. Efecto del compuesto N-2,6-dicloro-aralquil-2-Aminoindano en la conducta estereotipada de ratas. Acción dopaminérgica selectiva central sobre los ganglios basales más que en las estructuras límbicas. INVESTIGACIÓN CLÍNICA 2023. [DOI: 10.54817/ic.v64n1a02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Dopamine 1 is involved in neurodegenerative disorders affect-ing the central nervous system (CNS), such as Parkinson’s disease. Despite the absence of some available drugs capable of preventing, stopping or curing the progression of such diseases, there are numerous compounds designed, synthesized, and pharmacologically tested which give rise to pharmacophoric generalizations about the dopaminergic receptor required for the search of a drug able to improve or cure those pathologies. N-aralkyl-2-aminoindane de-rivatives have shown selective activity in the central dopaminergic system. Both the N-[(2,4-dichlorophenyl)-1-methyl-ethyl]-2-aminoindane hydrochloride 2and N-[(3,4-dichlorophenyl)-1-methyl-ethyl]-2-aminoindane hydrochloride 3 showed an agonistic activity mediated by central dopaminergic mechanisms. To contribute to the search of new drugs able to re-establish homeostasis in the dopaminergic transmission in Parkinson’s disease, the compound N-2,6-dichloro-aralkyl-2-aminoindane 4 was designed through medicinal chemistry strategies that contain pharmacophoric approximations of prodrugs. The phar-macological evaluation of compound 4 in the stereotyped behavior of male Sprague Dawley rats showed agonistic activity through the activation of central dopaminergic mechanisms and a higher selectivity in the responses of stereo-typed behavior characteristic of the basal ganglia over the typical responses from limbic structures.
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Affiliation(s)
- Marienmy del V. Velásquez
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
| | - Alexander E. Albarracín
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
| | - Kelvin Boscán
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
| | - Ligia B. Angel
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
| | - Rodolfo E. Izquierdo
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
| | - María M. Ramírez
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
| | - Biagina del C. Migliore
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
| | - Jaime E. Charris
- Laboratorio de Síntesis Orgánica, Facultad de Farmacia, Universidad Central de Venezuela, Caracas, Venezuela
| | - María del R. Garrido
- Laboratorio de Neuropéptidos, Facultad de Farmacia, Universidad Central de Venezuela, Caracas, Venezuela
| | - Anita Israel
- Laboratorio de Neuropéptidos, Facultad de Farmacia, Universidad Central de Venezuela, Caracas, Venezuela
| | - Simón E. López
- Department of Chemistry, University of Florida, Gainesville, Florida, USA
| | - Jorge E. Angel
- Laboratorio de Síntesis Orgánica, Diseño y Evaluación Farmacológica de Nuevos Productos. Departamento de Química, Facultad Experimental de Ciencias, Universidad del Zulia, Maracaibo, Venezuela
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Arten TL, Hamdan AC. NExecutive functions and memory in Parkinson's disease patients with Deep Brain Stimulation. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: A Meta-Analysis of Mood Effects. Neuropsychol Rev 2021; 31:385-401. [PMID: 33606174 DOI: 10.1007/s11065-020-09467-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/22/2020] [Indexed: 12/15/2022]
Abstract
This meta-analysis examines mood changes after bilateral subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). Deep brain stimulation improves motor outcomes in Parkinson's disease but there appears to be conflicting reports as to subsequent mood outcomes. Pubmed, PsychINFO and SCOPUS were searched for studies assessing mood outcomes in PD patients who had undergone STN-DBS published between January 2003 and the end of January 2019. Random effects meta-analyses were conducted for all outcome groups with at least two studies homogenous in design and measure. Forty-eight studies, providing data on negative moods (such as depression, anxiety, apathy, and anger) and positive moods (pleasure and euphoria) were assessed. Results of the meta-analysis suggest that post-DBS, depression and anxiety symptoms improve and there is a reduction in negative affect, an increase in apathy, and in energy level. Although there have been reported cases of mania post-DBS surgery, the meta-analysis suggested no significant changes in symptoms of mania in the broader DBS population. Considerable heterogeneity was found and partially addressed through meta-regression and qualitative assessment of the included STN-DBS controlled studies. The major strengths of this meta-analysis, include attention to outcome validity, heterogeneity, independence of samples, and clinical utility, with the potential to improve post-operative safety through comprehensive consideration of mood and psychological adjustment. It appears that STN-DBS is a relatively safe and, in the case of mood symptomatology, an advantageous treatment of Parkinson's disease.
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Drummond NM, Chen R. Deep brain stimulation and recordings: Insights into the contributions of subthalamic nucleus in cognition. Neuroimage 2020; 222:117300. [PMID: 32828919 DOI: 10.1016/j.neuroimage.2020.117300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022] Open
Abstract
Recent progress in targeted interrogation of basal ganglia structures and networks with deep brain stimulation in humans has provided insights into the complex functions the subthalamic nucleus (STN). Beyond the traditional role of the STN in modulating motor function, recognition of its role in cognition was initially fueled by side effects seen with STN DBS and later revealed with behavioral and electrophysiological studies. Anatomical, clinical, and electrophysiological data converge on the view that the STN is a pivotal node linking cognitive and motor processes. The goal of this review is to synthesize the literature to date that used DBS to examine the contributions of the STN to motor and non-motor cognitive functions and control. Multiple modalities of research have provided us with an enhanced understanding of the STN and reveal that it is critically involved in motor and non-motor inhibition, decision-making, motivation and emotion. Understanding the role of the STN in cognition can enhance the therapeutic efficacy and selectivity not only for existing applications of DBS, but also in the development of therapeutic strategies to stimulate aberrant circuits to treat non-motor symptoms of Parkinson's disease and other disorders.
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Affiliation(s)
- Neil M Drummond
- Krembil Research Institute, University Health Network, Toronto, ON M5T 2S8, Canada.
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON M5T 2S8, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
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Scherrer S, Smith AH, Gowatsky J, Palmese CA, Jimenez-Shahed J, Kopell BH, Mayberg HS, Figee M. Impulsivity and Compulsivity After Subthalamic Deep Brain Stimulation for Parkinson's Disease. Front Behav Neurosci 2020; 14:47. [PMID: 32390809 PMCID: PMC7191054 DOI: 10.3389/fnbeh.2020.00047] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/17/2020] [Indexed: 01/04/2023] Open
Abstract
Impulsivity and compulsivity are prominent non-motor problems in Parkinson’s disease (PD). Despite 20 years of research, there is still an ongoing debate as to whether subthalamic deep brain stimulation (STN DBS) for PD exacerbates or improves these symptoms. Here, we review how STN DBS affects clinical symptoms and neurocognitive aspects of impulsivity and compulsivity. When comparing patients post- to pre-surgery, in the majority of studies STN DBS for PD is associated with a decrease in clinically diagnosed impulse-control disorders and disorders of compulsivity. To avoid confounds, such as post-surgical decreases in dopaminergic medication doses, comparisons can also be made between DBS “On” versus “Off” conditions. These experimentally assayed effects of STN DBS with respect to neurocognitive aspects of impulsivity and compulsivity are more mixed. STN DBS improves behavioral flexibility without impairing negative feedback learning, delay discounting, or inhibitory control, as long as stimulation is restricted to the dorsal STN. However, STN DBS may drive impulsive actions when a subject is faced with competing choices. We discuss how motivated responses may be either enhanced or impaired by STN DBS depending on engagement of dorsal or ventral STN-mediated circuits. Future studies should combine structural and functional circuit measures with behavioral testing in PD patients on and off medication and stimulation. A more sophisticated understanding of how to modulate cortico-striatal-thalamo-cortical loops will increase the likelihood that these circuit manipulation techniques can successfully be applied to a wider range of neuropsychiatric disorders.
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Affiliation(s)
- Sara Scherrer
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andrew H Smith
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jaimie Gowatsky
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christina A Palmese
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joohi Jimenez-Shahed
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Brian H Kopell
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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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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Dandekar MP, Fenoy AJ, Carvalho AF, Soares JC, Quevedo J. Deep brain stimulation for treatment-resistant depression: an integrative review of preclinical and clinical findings and translational implications. Mol Psychiatry 2018; 23:1094-1112. [PMID: 29483673 DOI: 10.1038/mp.2018.2] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
Although deep brain stimulation (DBS) is an established treatment choice for Parkinson's disease (PD), essential tremor and movement disorders, its effectiveness for the management of treatment-resistant depression (TRD) remains unclear. Herein, we conducted an integrative review on major neuroanatomical targets of DBS pursued for the treatment of intractable TRD. The aim of this review article is to provide a critical discussion of possible underlying mechanisms for DBS-generated antidepressant effects identified in preclinical studies and clinical trials, and to determine which brain target(s) elicited the most promising outcomes considering acute and maintenance treatment of TRD. Major electronic databases were searched to identify preclinical and clinical studies that have investigated the effects of DBS on depression-related outcomes. Overall, 92 references met inclusion criteria, and have evaluated six unique DBS targets namely the subcallosal cingulate gyrus (SCG), nucleus accumbens (NAc), ventral capsule/ventral striatum or anterior limb of internal capsule (ALIC), medial forebrain bundle (MFB), lateral habenula (LHb) and inferior thalamic peduncle for the treatment of unrelenting TRD. Electrical stimulation of these pertinent brain regions displayed differential effects on mood transition in patients with TRD. In addition, 47 unique references provided preclinical evidence for putative neurobiological mechanisms underlying antidepressant effects of DBS applied to the ventromedial prefrontal cortex, NAc, MFB, LHb and subthalamic nucleus. Preclinical studies suggest that stimulation parameters and neuroanatomical locations could influence DBS-related antidepressant effects, and also pointed that modulatory effects on monoamine neurotransmitters in target regions or interconnected brain networks following DBS could have a role in the antidepressant effects of DBS. Among several neuromodulatory targets that have been investigated, DBS in the neuroanatomical framework of the SCG, ALIC and MFB yielded more consistent antidepressant response rates in samples with TRD. Nevertheless, more well-designed randomized double-blind, controlled trials are warranted to further assess the efficacy, safety and tolerability of these more promising DBS targets for the management of TRD as therapeutic effects have been inconsistent across some controlled studies.
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Affiliation(s)
- M P Dandekar
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A J Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - J C Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, Brazil
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Carrozzino D, Morberg BM, Siri C, Pezzoli G, Bech P. Evaluating psychiatric symptoms in Parkinson's Disease by a clinimetric analysis of the Hopkins Symptom Checklist (SCL-90-R). Prog Neuropsychopharmacol Biol Psychiatry 2018; 81:131-137. [PMID: 29100973 DOI: 10.1016/j.pnpbp.2017.10.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 12/28/2022]
Abstract
Although psychiatric comorbidity in Parkinson's Disease (PD) has often been studied, the individual psychiatric symptoms have rarely been evaluated from a clinimetric point of view in an attempt to measure how much the symptoms have been bothering or distressing the PD patients. The current study is therefore aimed at evaluating from a clinimetric viewpoint the severity of psychiatric symptoms affecting PD patients by using the Hopkins Symptom Checklist (SCL-90-R) to show its measurement-driven construct validity (scalability). The conventional nine SCL-90-R subscales (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideas, and psychoticism), as well as the clinical most valid subscales from the SCL-28 version (depression, anxiety, interpersonal sensitivity, and neurasthenia) were analysed according to a clinimetric approach by comparing PD patients with a control group from a general population study. Scalability was tested by the non-parametric item response theory model by use of a Mokken analysis. Among the various SCL-90-R or SCL-28 subscales we identified from the clinimetric analysis that the somatization, anxiety, phobic anxiety, psychoticism, and neurasthenia (apathy), as well as the SCL-90-R GSI, were the most impaired psychiatric syndromes reaching a clinically significant effect size above 0.80, whereas the total SCL-28 GSI obtained an effect size of just 0.80. Our clinimetric analysis has shown that patients with PD not only are bothered with diverse somatic symptoms, but also with specific secondary psychiatric comorbidities which are clinically severe markers of impairment in the day-to-day function implying a negative cooping approach.
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Affiliation(s)
- Danilo Carrozzino
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark; Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Bo Mohr Morberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Chiara Siri
- Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy
| | - Gianni Pezzoli
- Parkinson Institute, ASST G.Pini-CTO, ex ICP, Milan, Italy
| | - Per Bech
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
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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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Xu H, Zheng F, Krischek B, Ding W, Xiong C, Wang X, Niu C. Subthalamic nucleus and globus pallidus internus stimulation for the treatment of Parkinson's disease: A systematic review. J Int Med Res 2017; 45:1602-1612. [PMID: 28701061 PMCID: PMC5718722 DOI: 10.1177/0300060517708102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Deep brain stimulation (DBS) for treatment of advanced Parkinson’s disease (PD) has two anatomical targets: the subthalamic nucleus (STN) and the globus pallidus internus (GPI). The clinical effectiveness of these two stimulation targets was compared in the present study. Methods A systematic review and meta-analysis was performed to evaluated the postoperative changes in the United Parkinson’s Disease Rating Scale (UPDRS) on- and off-phase, on-stimulation motor scores; activities of daily living score (ADLS); and levodopa equivalent dose (LED) after STN and GPI stimulation. Randomized and nonrandomized controlled trials of PD treated by STN and GPI stimulation were considered for inclusion. Results Eight published reports of eligible studies involving 599 patients met the inclusion criteria. No significant differences were observed between the STN and GPI groups in the on-medication, on-stimulation UPDRS motor score [mean difference, 2.15; 95% confidence interval (CI), −0.96–5.27] or ADLS (mean difference, 3.40; 95% CI, 0.95–7.76). Significant differences in favor of STN stimulation were noted in the off-medication, on-stimulation UPDRS motor score (mean difference, 1.67; 95% CI, 0.98–2.37) and LED (mean difference, 130.24; 95% CI, 28.82–231.65). Conclusion The STN may be the preferred target for DBS in consideration of medication reduction, economic efficiency, and motor function improvement in the off phase. However, treatment decisions should be made according to the individual patient’s symptoms and expectations.
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Affiliation(s)
- Hao Xu
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.,2 Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Zheng
- 3 Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China.,4 Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Boris Krischek
- 4 Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Wanhai Ding
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Chi Xiong
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xin Wang
- 5 Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Chaoshi Niu
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
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Olchik MR, Ghisi M, Ayres A, Schuh AFS, Oppitz PP, Rieder CRDM. The Impact of Deep Brain Stimulation on the Quality of Life and Swallowing in Individuals with Parkinson's Disease. Int Arch Otorhinolaryngol 2017; 22:125-129. [PMID: 29619099 PMCID: PMC5882365 DOI: 10.1055/s-0037-1603466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/21/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction
Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD). However, there is little evidence regarding the effect of DBS on dysphagia.
Objective
To assess the swallowing and quality of life of individuals with PD before and after DBS surgery.
Methods
Our sample consisted of people who had undergone DBS surgery in a referral hospital in the state of Rio Grande do Sul, Brazil. The inclusion criteria were a diagnosis of PD and having undergone DBS surgery. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Evaluations of each patient's swallowing were performed before and after surgery. The assessment consisted of anamnesis, clinical assessment, the Functional Oral Intake Scale, clinical evaluation of swallowing, and the Hoehn and Yahr scale.
Results
The sample included 10 individuals, all male, with a mean age of 57.3 years (±4.7), a mean disease duration of 13.0 years (±2.4), and mean level education of 8.1 years (±4.0). In the clinical evaluation of the swallowing, a significant improvement after DBS was not observed. However, little changes in the signs and symptoms of dysphagia that had a positive impact on the quality of life were observed. Furthermore, there was no relation between the patients' motor subtype and swallowing pre- and post-DBS.
Conclusion
There was an improvement in the quality of life of the patients after DBS. However, the improvement in the clinical signs and symptoms of dysphagia did not cause an overall improvement in the swallowing function.
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Affiliation(s)
- Maira Rozenfel Olchik
- Departament of Surgery and Orthopedics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marciéle Ghisi
- Graduation in Speech Therapy, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Annelise Ayres
- Post-Graduation Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Paulo Petry Oppitz
- Neurosurgery Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carlos Roberto de Mello Rieder
- Medical School, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Department of Neurology and Movement Disorders, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Romann AJ, Beber BC, Olchik MR, Rieder CRM. Different outcomes of phonemic verbal fluency in Parkinson's disease patients with subthalamic nucleus deep brain stimulation. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:216-220. [PMID: 28489140 DOI: 10.1590/0004-282x20170024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/06/2017] [Indexed: 11/22/2022]
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is a surgical technique to treat motor symptoms in patients with Parkinson's disease (PD). Studies have shown that STN-DBS may cause a decline in verbal fluency performance. We aimed to verify the effects of STN-DBS on the performance of phonemic verbal fluency in Brazilian PD patients. Sixteen participants were evaluated on the Unified Parkinson's Disease Rating Scale - Part III and for phonemic fluency ("FAS" version) in the conditions of on- and off-stimulation. We identified two different patterns of phonemic verbal fluency outcomes. The results indicate that there may be no expected pattern of effect of bilateral STN-DBS in the phonemic fluency, and patients may present with different outcomes for some reason not well understood.
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Affiliation(s)
- Aline Juliane Romann
- Universidade Federal do Rio Grande do Sul, Programa de Pós Graduação em Medicina: Ciências Médicas, Porto Alegre RS, Brasil
| | - Bárbara Costa Beber
- Universidade Federal do Rio Grande do Sul, Programa de Pós Graduação em Medicina: Ciências Médicas, Porto Alegre RS, Brasil.,Faculdade Nossa Senhora de Fátima, Faculdade de Fonoaudiologia, Caxias do Sul RS, Brasil
| | - Maira Rozenfeld Olchik
- Universidade Federal do Rio Grande do Sul, Programa de Pós Graduação em Medicina: Ciências Médicas, Porto Alegre RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Porto Alegre RS, Brasil
| | - Carlos R M Rieder
- Universidade Federal do Rio Grande do Sul, Programa de Pós Graduação em Medicina: Ciências Médicas, Porto Alegre RS, Brasil.,Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brasil.,Universidade Federal Ciências da Saúde, Porto Alegre RS, Brasil
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Tait DS, Phillips JM, Blackwell AD, Brown VJ. Effects of lesions of the subthalamic nucleus/zona incerta area and dorsomedial striatum on attentional set-shifting in the rat. Neuroscience 2017; 345:287-296. [PMID: 27522961 PMCID: PMC5321403 DOI: 10.1016/j.neuroscience.2016.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022]
Abstract
Patients with Parkinson's disease (PD) show cognitive impairments, including difficulty in shifting attention between perceptual dimensions of complex stimuli. Inactivation of the subthalamic nucleus (STN) has been shown to be effective in ameliorating the motor abnormalities associated with striatal dopamine (DA) depletion, but it is possible that STN inactivation might result in additional, perhaps attentional, deficits. This study examined the effects of: DA depletion from the dorsomedial striatum (DMS); lesions of the STN area; and the effects of the two lesions together, on the ability to shift attentional set in the rat. In a single session, rats performed the intradimensional/extradimensional (ID/ED) test of attentional set-shifting. This comprises a series of seven, two-choice discriminations, including acquisitions of novel discriminations in which the relevant stimulus is either in the currently attended dimension (ID) or the currently unattended dimension (ED shift) and reversals (REVs) following each acquisition stage. Bilateral lesions were made by injection of 6-hydroxydopamine (6-OHDA) into the DMS, resulting in a selective impairment in reversal learning. Large bilateral ibotenic acid lesions centered on the STN resulted in an increase in trials to criterion in the initial stages, but learning rate improved within the session. There was no evidence of a 'cost' of set-shifting - the ED stage was completed in fewer trials than the ID stage - and neither was there a cost of reversal learning. Strikingly, combined lesions of both regions did not resemble the effects of either lesion alone and resulted in no apparent deficits.
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Affiliation(s)
- David S Tait
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife KY16 9JP, UK.
| | - Janice M Phillips
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife KY16 9JP, UK
| | - Andrew D Blackwell
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife KY16 9JP, UK
| | - Verity J Brown
- School of Psychology and Neuroscience, University of St Andrews, St Andrews, Fife KY16 9JP, UK
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Abdel-Salam OME. Prevalence, clinical features and treatment of depression in Parkinson’s disease: An update. World J Neurol 2015; 5:17-38. [DOI: 10.5316/wjn.v5.i1.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 01/10/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is one of the most prevalent neurodegenerative diseases which typically affects individuals over 65 years. Although the symptomatology is predominantly motor, neuropsychiatric manifestations, e.g., depression, apathy, anxiety, and cognitive impairment occur in the course of the illness and can have a great impact on the quality of life in these patients. Parkinson’s disease is commonly comorbid with depression with prevalence rates of depression, generally higher than those reported in general population. Depression in PD is frequently underestimated and consequently undertreated, which have significant effects on the quality of life in these patients. The neurobiology of depression in PD is complex and involves alterations in dopaminergic, serotonergic, noradrenergic and possibly other neurotransmitter systems which are affected in the course of the disease. The tricyclic antidepressants and the selective serotonin reuptake inhibitors are the two classes of antidepressant drugs used for depressive symptoms in PD. Several published studies suggested that both classes are of comparable efficacy. Other serotonergic antidepressants, e.g., nefazodone and trazodone have also been of benefit. Meanwhile, there are limited data available on other drugs but these suggest a benefit from the serotonin and noradrenaline reuptake inhibitors such as mirtazapine, venlafaxine, atomoxetine and duloxetine. Some of the drugs used in symptomatic treatment of PD, e.g., the irreversible selective inhibitors of the enzyme monoamine oxidase-B, rasagiline and selegiline as well as the dopamine receptor agonist pramipexole are likely to have direct antidepressant activity independent of their motor improving action. This would make these drugs an attractive option in depressed subjects with PD. The aim of this review is to provide an updated data on the prevalence, clinical features of depression in subjects with PD. The effects of antiparkinsonian and antidepressant drugs on depressive symptoms in these patients are also discussed.
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