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Hendriks M, Vinke RS, Georgiev D. Gender discrepancies and differences in motor and non-motor symptoms, cognition, and psychological outcomes in the treatment of Parkinson's disease with subthalamic deep brain stimulation. Front Neurol 2024; 14:1257781. [PMID: 38259647 PMCID: PMC10800523 DOI: 10.3389/fneur.2023.1257781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Available data suggest that there may be gender differences in the effect of STN-DBS in the treatment of Parkinson's disease (PD). The aim of this study was to review data on gender discrepancies and gender differences in clinical outcomes in PD patients treated with deep brain stimulation of the subthalamic nucleus (STN-DBS). Included were original studies that specifically examined gender discrepancies or gender differences in PD patients with STN-DBS. Men receive more DBS than women, for various indications. The decision-making process for DBS in women compared to men is more influenced by personal preferences and external factors. Motor symptoms improve in both genders, but bradykinesia improves more in men. The postoperative reduction of the levodopa equivalent daily dose seems to be more pronounced in men. Men show more cognitive deterioration and less improvement than women after STN-DBS. Women show more depressive symptoms before surgery, but they improve similarly to men. Men show more improvement in impulsivity and less decrease in impulsive behaviour symptoms than women. Anxiety and personality traits remain unchanged in both genders. Voice quality improves more in men and deteriorates less often than in women. Men gain fat-free mass and fat mass, but women only gain fat mass. Regarding sexual function the evidence is inconsistent. More urinary symptoms improve in women than in men. Pain and restless leg syndrome seems to improve more in men. Regarding quality of life, the evidence seems to be inconsistent, and activities of daily living seems to improve in both genders. Better prospective controlled studies, focusing directly on gender differences in PD patients treated with STN-DBS, are needed to better explain gender differences in STN-DBS for PD.
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Affiliation(s)
- Martijn Hendriks
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ruben Saman Vinke
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Dejan Georgiev
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Laboratory for Artificial Intelligence, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
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Eghlidos Z, Rahimian Z, Vadiee G, Jahangiri S. Effects of subthalamic deep brain stimulation on non-motor symptoms of Parkinson's disease: A meta-analysis. Acta Neurol Scand 2022; 146:115-125. [PMID: 35611557 DOI: 10.1111/ane.13652] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation (DBS) is a well-defined treatment for motor symptoms in advanced PD. Although several studies have investigated the DBS effect on non-motor symptoms (NMS), controversial results exist regarding this matter. The aim of this meta-analysis and systematic review was to assess the bilateral subthalamic nucleus (STN) DBS effect on NMS of PD. We conducted a systematic search on the literature of Web of Science (WOS), PubMed/MEDLINE, Scopus, Cochrane, and Embase. An additional hand search was also done. Finally, a meta-analysis was conducted on 10 studies containing pre- and post-bilateral STN-DBS data regarding NMS acquired using Non-Motor Symptoms Scale for Parkinson's Disease (NMSS) or Non-Motor Symptoms Questionnaire (NMSQ). A random-effects model was used to determine weighted mean differences, and the heterogeneity index was evaluated using Cochrane's Q test. Our study results indicated that bilateral STN-DBS significantly reduced total NMSS and NMSQ score (WMD -17.73; 95% confidence interval [CI] -20.28 to -15.18, WMD -2.19; 95% CI -2.98 to -1.40), respectively, and no publication bias was found. Regarding each of the NMSS domains, DBS significantly reduced the scores of following domains: sleep (WMD -5.98; 95% CI -6.82 to -5.15), miscellaneous (WMD -4.19; 95% CI -4.96 to -3.43), urinary (WMD -2.99; 95% CI -3.78 to -2.19), sexual (WMD -0.65; 95% CI -1.16 to -0.14), and attention/memory (WMD -0.59; 95% CI -1.15 to -0.03). This meta-analysis demonstrated that bilateral STN-DBS has beneficial effects on NMS of PD.
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Affiliation(s)
| | | | - Gholamreza Vadiee
- Department of Neurosurgery Urmia University of Medical Sciences Urmia Iran
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Anticipatory human subthalamic area beta-band power responses to dissociable tastes correlate with weight gain. Neurobiol Dis 2021; 154:105348. [PMID: 33781923 PMCID: PMC9208339 DOI: 10.1016/j.nbd.2021.105348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
The availability of enticing sweet, fatty tastes is prevalent in the modern diet and contribute to overeating and obesity. In animal models, the subthalamic area plays a role in mediating appetitive and consummatory feeding behaviors, however, its role in human feeding is unknown. We used intraoperative, subthalamic field potential recordings while participants (n = 5) engaged in a task designed to provoke responses of taste anticipation and receipt. Decreased subthalamic beta-band (15-30 Hz) power responses were observed for both sweet-fat and neutral tastes. Anticipatory responses to taste-neutral cues started with an immediate decrease in beta-band power from baseline followed by an early beta-band rebound above baseline. On the contrary, anticipatory responses to sweet-fat were characterized by a greater and sustained decrease in beta-band power. These activity patterns were topographically specific to the subthalamic nucleus and substantia nigra. Further, a neural network trained on this beta-band power signal accurately predicted (AUC ≥ 74%) single trials corresponding to either taste. Finally, the magnitude of the beta-band rebound for a neutral taste was associated with increased body mass index after starting deep brain stimulation therapy. We provide preliminary evidence of discriminatory taste encoding within the subthalamic area associated with control mechanisms that mediate appetitive and consummatory behaviors.
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He W, Li H, Lai Y, Wu Y, Wu Y, Ramirez-Zamora A, Yi W, Zhang C. Weight Change After Subthalamic Nucleus Deep Brain Stimulation in Patients With Isolated Dystonia. Front Neurol 2021; 12:632913. [PMID: 33716933 PMCID: PMC7944092 DOI: 10.3389/fneur.2021.632913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment method for advanced Parkinson's disease (PD) and isolated dystonia and provides marked improvement of major motor symptoms. In addition, non-motor effects have been reported including weight gain (WG) in patients with PD after STN-DBS. However, it is still unclear whether patients with isolated dystonia also experience WG. Methods: Data from 47 patients with isolated dystonia who underwent bilateral STN-DBS surgery between October 2012 and June 2019 were retrospectively collected. The severity of dystonia was assessed via the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Changes in the body mass index (BMI) and BFMDRS score were analyzed using paired Student's t-tests. Regression analysis was performed to identify factors that affected the BMI after surgery. Results: Postoperative WG was observed in 78.7% of patients. The percentage of overweight and obese patients increased from 25.5% (before STN-DBS) to 48.9% (at the last follow-up). The mean BMI and mean percentage change in BMI increased by 1.32 ± 1.83 kg/m2 (P < 0.001) and 6.28 ± 8.34%, respectively. BMI increased more in female than in male patients. At the last follow-up, BFMDRS movement and disability scores improved by 69.76 ± 33.23% and 65.66 ± 31.41%, respectively (both P < 0.001). The final regression model analysis revealed that sex and preoperative BMI alone were independently associated with BMI change (P < 0.05). Conclusions: STN-DBS is associated with postoperative WG with patients with isolated dystonia. WG is more prominent in female patients and is associated with preoperative weight but not with the efficacy of STN-DBS on motor symptoms.
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Affiliation(s)
- Weibin He
- Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Hongxia Li
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Lai
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhao Wu
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Adolfo Ramirez-Zamora
- Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Wei Yi
- Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Volonté MA, Clarizio G, Galantucci S, Scamarcia PG, Cardamone R, Barzaghi LR, Falautano M, Mortini P, Comi G, Filippi M. Long term follow-up in advanced Parkinson's disease treated with DBS of the subthalamic nucleus. J Neurol 2021; 268:2821-2830. [PMID: 33598766 DOI: 10.1007/s00415-021-10430-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder, affecting both motor and non-motor systems. Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been an approved treatment for PD for more than 30 years, but few data are available regarding its long-term effectiveness. OBJECTIVE The aim of this study is to evaluate patients' outcome, both from a motor and non-motor perspective, 9 to 14 years after DBS implantation. We have investigated patients with advanced PD and treated with STN-DBS, in relation to key clinical features of PD. METHODS 18 patients were assessed both retrospectively and prospectively. They underwent motor examination, neuropsychological evaluation and questionnaires on the quality of life, preoperatively, as well as 1, 9 and 14 years after DBS surgery. All patients were implanted with STN-DBS at San Raffaele Hospital between 2004 and 2010. RESULTS 13 males and five females underwent DBS implantation with a mean PD duration of 11 years. Stimulation significantly improved med-off/stim-on condition up to 9 years, compared to the preoperative off state, and med-on/stim-on condition at 14 years, compared to med-on/stim-off state. Long term improvement specifically involved tremor and rigidity, as well as dopaminergic daily dose. At the same time, STN-DBS had no long-lasting effect on axial symptoms and cognitive functions. CONCLUSIONS STN-DBS remains an effective therapy for advanced PD, also over the years. Despite the underlying progression of the disease, this treatment extends the period in which the overall quality of life is still acceptable.
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Affiliation(s)
| | - Giacomo Clarizio
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Lina Raffaella Barzaghi
- Neurosurgery and Radiosurgery Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Monica Falautano
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Mortini
- Neurosurgery and Radiosurgery Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Samborska-Ćwik J, Szlufik S, Friedman A, Mandat T, Przybyszewski A, Koziorowski D. Influence of Bilateral Subthalamic Nucleus Deep Brain Stimulation on the Lipid Profile in Patients With Parkinson's Disease. Front Neurol 2020; 11:563445. [PMID: 33154734 PMCID: PMC7586310 DOI: 10.3389/fneur.2020.563445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Subthalamic nucleus deep brain stimulation (STN-DBS) is a valuable alternative to pharmacotherapy alone in an advanced Parkinson's disease (PD). Given the growing number of patients with STN-DBS, its impact on the comorbidities should be considered. Aim: The aim of this study was to evaluate the influence of bilateral STN-DBS on the lipid profile in patients with PD. Methods: Three groups of parkinsonian patients were included: 20 treated pharmacologically–PHT group, 20 newly qualified for STN-DBS–DBS group, and 14 postoperative patients (median 30 months after surgery)–POP group. Plasma concentrations of the total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and body weight were measured thrice in 9 ± 2 month intervals. Results: A significant increase in the LDL-C concentration is observed early after surgery in the DBS group (11.4 mg/dl, P < 0.01) followed by adverse changes in the HDL-C (−7.7 mg/dl, P = 0.01) and TG (14.1 mg/dl, P = 0.05) plasma levels. In the POP group, the average level of TC at the first visit was significantly higher (P < 0.01) than in the other groups and the TG level was higher than in the PHT group during the follow-up (P < 0.01). A strong positive correlation with body weight alteration after surgery was observed only for long-term changes in the TG levels. Conclusions: Our data indicate that STN-DBS may negatively affect the cardiometabolic profile of patients. Similarly to body weight gain, an increase in the LDL-C concentration occurred early after surgery while adverse changes in the HDL-C and TG plasma levels were more gradual.
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Affiliation(s)
- Joanna Samborska-Ćwik
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Stanisław Szlufik
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Friedman
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Mandat
- Department of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Andrzej Przybyszewski
- Department of Informatics, Polish-Japanese Academy of Information Technology, Warsaw, Poland
| | - Dariusz Koziorowski
- Department of Neurology, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland
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7
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Internal States Influence the Representation and Modulation of Food Intake by Subthalamic Neurons. Neurosci Bull 2020; 36:1355-1368. [PMID: 32567027 DOI: 10.1007/s12264-020-00533-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/16/2020] [Indexed: 01/02/2023] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN) is an effective therapy for motor deficits in Parkinson's disease (PD), but commonly causes weight gain in late-phase PD patients probably by increasing feeding motivation. It is unclear how STN neurons represent and modulate feeding behavior in different internal states. In the present study, we found that feeding caused a robust activation of STN neurons in mice (GCaMP6 signal increased by 48.4% ± 7.2%, n = 9, P = 0.0003), and the extent varied with the size, valence, and palatability of food, but not with the repetition of feeding. Interestingly, energy deprivation increased the spontaneous firing rate (8.5 ± 1.5 Hz, n = 17, versus 4.7 ± 0.7 Hz, n = 18, P = 0.03) and the depolarization-induced spikes in STN neurons, as well as enhanced the STN responses to feeding. Optogenetic experiments revealed that stimulation and inhibition of STN neurons respectively reduced (by 11% ± 6%, n = 6, P = 0.02) and enhanced (by 36% ± 15%, n = 7, P = 0.03) food intake only in the dark phase. In conclusion, our results support the hypothesis that STN neurons are activated by feeding behavior, depending on energy homeostatic status and the palatability of food, and modulation of these neurons is sufficient to regulate food intake.
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Steinhardt J, Münte TF, Schmid SM, Wilms B, Brüggemann N. A systematic review of body mass gain after deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease. Obes Rev 2020; 21:e12955. [PMID: 31823457 DOI: 10.1111/obr.12955] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
This systematic review investigated the effects of deep brain stimulation of the subthalamic nucleus on extent and time course of body mass changes in patients with Parkinson's disease. A computerized search identified relevant articles using a priori defined inclusion and exclusion criteria. A descriptive analysis was calculated for the main outcome parameters body mass and BMI. Thirty-eight out of 206 studies fulfilled the inclusion criteria (979 patients aged 59.0±7.5 years). Considering the longest follow-up time for each study, body mass and BMI showed a mean increase across studies of +5.71kg (p < .0001; d = 0.64) and +1.8kg/m2 (p < .0001; d = 1.61). The time course of body mass gain revealed a continuous increase ranging from +3.25kg (d = 0.69) at 3 months, +3.88kg (d = 0.21) at 6 months, +6.35kg (d = 0.72) at 12 months, and +6.11kg (d = 1.02) greater than 12 months. Changes in BMI were associated with changes in disease severity (r = 0.502, p = .010) and pharmacological treatment (r = 0.440, p = .0231). Data suggest that body mass gain is one of the most common side effects of deep brain stimulation going beyond normalization of preoperative weight loss. Considering the negative health implications of overweight, we recommend the development of tailored therapies to prevent overweight and associated metabolic disorders following this treatment.
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Affiliation(s)
- Julia Steinhardt
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Sebastian M Schmid
- Institute of Psychology II, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Britta Wilms
- Institute of Psychology II, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Limousin P, Foltynie T. Long-term outcomes of deep brain stimulation in Parkinson disease. Nat Rev Neurol 2020; 15:234-242. [PMID: 30778210 DOI: 10.1038/s41582-019-0145-9] [Citation(s) in RCA: 227] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The efficacy of deep brain stimulation (DBS) for Parkinson disease (PD) is well established for up to 1 or 2 years, but long-term outcome data are still limited. In this Review, we critically discuss the evidence on the long-term outcomes of DBS and consider the clinical implications. Although many patients are lost to follow-up, the evidence indicates that subthalamic nucleus DBS improves motor function for up to 10 years, although the magnitude of improvement tends to decline over time. Functional scores recorded during on-medication periods worsen more quickly than those recorded in off periods, consistent with the degeneration of non-dopaminergic pathways. Dyskinesia, motor fluctuations and activities of daily living in off periods remain improved at 5 years, but quality-of-life scores have usually fallen below preoperative levels. The incidence and severity of dementia among patients receiving DBS are comparable to those among patients who receive medical treatment. Severe adverse events are rare, but adverse events such as dysarthria are common and probably under-reported. Long-term data on the outcomes of globus pallidus interna DBS are limited and mostly confirm the efficacy for dyskinesia. A trend towards offering DBS in the earlier stages of PD creates a need to identify factors that predict long-term outcomes and to discuss realistic expectations with patients preoperatively.
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Affiliation(s)
- Patricia Limousin
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK. .,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, University College London, Queen Square Institute of Neurology, London, UK.,National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Lange M, Mauerer J, Schlaier J, Janzen A, Zeman F, Bogdahn U, Brawanski A, Hochreiter A. Underutilization of deep brain stimulation for Parkinson's disease? A survey on possible clinical reasons. Acta Neurochir (Wien) 2017; 159:771-778. [PMID: 28258308 DOI: 10.1007/s00701-017-3122-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Only 10% of the up to 15% of patients with advanced Parkinson's disease (PD) eligible for deep brain stimulation (DBS) are referred to specialized centers. This survey evaluated the reasons for the reluctance of patients and referring physicians regarding DBS. METHODS Two different questionnaires containing multiple choice and open verbalized questions were developed, one for neurologists and one for patients with PD. The first questionnaire was sent to 87 neurologists in private practice in the catchment area of the authors' medical center, the second to patient support groups in the same region with the help of the German Parkinson Association. RESULTS Of the addressed neurologists, 56.3% completed the questionnaire; 61.2% of them estimated the risk of intracerebral hemorrhage as the most severe complication at 4.3% on average; 30.6% were concerned about patients developing mood changes or depression after DBS. Only 16.3% felt unable to care for patients after DBS; 61.2% already had personal experience with patients after DBS and reported good clinical outcome in 90.0% of patients. Although 87.8% claimed to know the specific criteria for DBS, only 40.8% could actively describe them. Only 14.0% could state each of the three main criteria. Of the 46 patients, 88.1% completing the questionnaire had obtained information on DBS from regional patient organizations and 54.8% also from a physician; 44.7% assumed the risk of severe complications to be ≥5.0%. Not being satisfied with their medical treatment was reported by 22.2%, of whom more than 70% considered DBS a further treatment option. CONCLUSIONS The latter numbers indicate that treating neurologists tend to overestimate the reluctance of their patients to undergo DBS. Therefore, education of patients and neurologists should be improved and give more realistic figures on the actual outcomes and frequencies of possible complications.
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Affiliation(s)
- Max Lange
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
- Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany.
| | - Josef Mauerer
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Jürgen Schlaier
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
- Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany
| | - Annette Janzen
- Center for Deep Brain Stimulation, University Medical Center Regensburg, Regensburg, Germany
- Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
| | - Andreas Hochreiter
- Department of Neurosurgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany
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11
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Kurtis MM, Rajah T, Delgado LF, Dafsari HS. The effect of deep brain stimulation on the non-motor symptoms of Parkinson's disease: a critical review of the current evidence. NPJ Parkinsons Dis 2017; 3:16024. [PMID: 28725706 PMCID: PMC5516616 DOI: 10.1038/npjparkd.2016.24] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/15/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022] Open
Abstract
The benefit of deep brain stimulation (DBS) in controlling the motor symptoms of Parkinson's disease is well established, however, the impact on the non-motor symptoms (NMS) remains to be elucidated, although the growing investigative efforts are promising. This article reviews the reported data and considers the level of evidence available with regard to the effect of DBS on NMS total burden and on the cognitive, neuropsychiatric, sleep, pain, dysautonomic, and weight domains. Multiple case series suggest that DBS improves the burden of NMS by reducing prevalence, intensity, and non-motor fluctuations. There is level I evidence on the effect of DBS on cognition and mood. Slight cognitive decline has been reported in most class I studies, although the functional effect is probably minimal. Two randomized prospective studies reported no change in depression while improvement of anxiety has been reported by a class I trial. Prospective cohort studies point to improvement of hyperdopaminergic behaviors, such as impulse control disorders, while others report that hypodopaminergic states, like apathy, can appear after DBS. There is only class III evidence supporting the benefit of DBS on other NMS such as nocturnal sleep, pain, dysautonomia (urinary, gastrointestinal, cardiovascular, and sweating), and weight loss. Although preliminary results are promising, randomized prospectively controlled trials with NMS as primary end points are necessary to further explore the effect of DBS on these often invalidating symptoms and offer conclusions about efficacy.
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Affiliation(s)
- Mónica M Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Thadshani Rajah
- Kings Parkinson's Centre of Excellence, Kings College and Kings College Hospital, London, UK
| | - Luisa F Delgado
- Fundación Universitaria de Ciencias de la Salud, Hospital San José—Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Strowd RE, Herco M, Passmore-Griffin L, Avery B, Haq I, Tatter SB, Tate J, Siddiqui MS. Association between subthalamic nucleus deep brain stimulation and weight gain: Results of a case-control study. Clin Neurol Neurosurg 2015; 140:38-42. [PMID: 26619034 DOI: 10.1016/j.clineuro.2015.11.002] [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: 03/27/2015] [Revised: 09/29/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate whether weight change in patients with Parkinson's disease (PD) is different in those undergoing deep brain stimulation (DBS) of the subthalamic nucleus (STN) compared to those not undergoing DBS. PATIENTS AND METHODS A retrospective case-control study was performed in PD patients who had undergone STN DBS (cases) compared to matched PD patients without DBS (controls). Demographic and clinical data including Unified Parkinson's Disease Rating Scale (UPDRS) motor scores were collected. Repeated measures mixed model regression was used to identify variables associated with weight gain. RESULTS Thirty-five cases and 34 controls were identified. Baseline age, gender, diagnosis and weight were similar. Duration of diagnosis was longer in cases (6.3 vs 4.9 years, p=0.0015). At 21.3 months, cases gained 2.9 kg (+4.65%) while controls lost 1.8 kg (-3.05%, p<0.02). Postoperative UPDRS motor scores improved by 49% indicating surgical efficacy. Only younger age (p=0.0002) and DBS (p=0.008) were significantly associated with weight gain. CONCLUSION In this case-control study, PD patients undergoing STN DBS experienced post-operative weight gain that was significantly different from the weight loss observed in non-DBS PD controls. Patients, especially overweight individuals, should be informed that STN DBS can result in weight gain.
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Affiliation(s)
- Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC 27103, USA
| | - Maja Herco
- East Carolina School of Medicine, Greenville, NC, USA
| | - Leah Passmore-Griffin
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston Salem, NC 27103, USA
| | - Bradley Avery
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC 27103, USA
| | - Ihtsham Haq
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC 27103, USA
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston Salem, NC 27103, USA
| | - Jessica Tate
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC 27103, USA
| | - Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC 27103, USA.
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13
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Bang Henriksen M, Johnsen EL, Sunde N, Vase A, Gjelstrup MC, Østergaard K. Surviving 10 years with deep brain stimulation for Parkinson's disease--a follow-up of 79 patients. Eur J Neurol 2014; 23:53-61. [PMID: 25492023 DOI: 10.1111/ene.12614] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Deep brain stimulation (DBS) for severe Parkinson's disease (PD) outperforms the best medical treatment in controlling motor symptoms and improving quality of life. Nevertheless disease progression cannot be controlled, and the development of dementia over time is nearly inevitable, often resulting in nursing home placement. Ten-year survival, development of hallucinations, dementia and nursing home placement were examined and adverse events were assessed. METHOD Patient files were scrutinized from baseline up to 10 years of treatment or death on all 79 PD patients treated with DBS of the subthalamic nucleus from 1998 to 2003 at Aarhus University Hospital. RESULTS Twenty-four patients died during the follow-up period of 10 years. Age above 60 years at surgery increased mortality 2.3-fold (P = 0.04). Of the 55 surviving patients 29 (53%) were demented and 19 (35%) were in nursing homes. Average time from operation to dementia was 5.6 ± 2.9 years. Hallucinations and nursing home placement were associated with increased mortality. CONCLUSION Survival of 70% after a mean of 25 years of PD including 10 years with DBS illustrates that this is a selected group of PD patients. The prevalence of dementia steadily increased after surgery as expected from disease progression and can be an early event. Compared with the few similar long-term studies, the present study presents a larger cohort followed at the same DBS center for a longer period of time and none was lost to follow-up, making conclusions more valid. The present findings are of significant prognostic help for the patient, caregiver and physician when treatment with DBS has to be decided.
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Affiliation(s)
- M Bang Henriksen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - E L Johnsen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - N Sunde
- Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - A Vase
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - M C Gjelstrup
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
| | - K Østergaard
- Department of Neurology, Aarhus University Hospital, Nørrebrogade, Aarhus C, Denmark
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14
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Sauleau P, Le Jeune F, Drapier S, Houvenaghel JF, Dondaine T, Haegelen C, Lalys F, Robert G, Drapier D, Vérin M. Weight gain following subthalamic nucleus deep brain stimulation: A PET study. Mov Disord 2014; 29:1781-7. [DOI: 10.1002/mds.26063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022] Open
Affiliation(s)
- Paul Sauleau
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
| | - Florence Le Jeune
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Eugene Marquis Center; Department of Oncology; Rennes France
| | - Sophie Drapier
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
| | - Jean-François Houvenaghel
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
| | - Thibaut Dondaine
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
| | - Claire Haegelen
- “MediCIS” Laboratory (UMR 1099 LTSI), INSERM; University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
| | - Florent Lalys
- “MediCIS” Laboratory (UMR 1099 LTSI), INSERM; University of Rennes 1; Rennes France
| | - Gabriel Robert
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
| | - Dominique Drapier
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
| | - Marc Vérin
- “Behavior and Basal Ganglia” research unit (EA 4712); University of Rennes 1; Rennes France
- Rennes University Hospital; Rennes France
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15
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Aiello M, Eleopra R, Rumiati RI. Body weight and food intake in Parkinson's disease. A review of the association to non-motor symptoms. Appetite 2014; 84:204-11. [PMID: 25453591 DOI: 10.1016/j.appet.2014.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/29/2014] [Accepted: 10/13/2014] [Indexed: 12/21/2022]
Abstract
Research on eating behaviours has extensively highlighted that cognitive systems interact with the metabolic system in driving food intake and in influencing body weight regulation. Parkinson's disease is a good model for studying these complex interactions since alterations in both body weight and cognitive domains have been frequently reported among these patients. Interestingly, even if different non-motor symptoms may characterize the course of the disease, their contribution to weight and food preference has been poorly investigated. This review describes body weight alterations and eating habits in patients with Parkinson's disease, including those who underwent deep brain stimulation surgery. In particular, the review considers the link between non-motor symptoms, affecting sensory perception, cognition, mood and motivation, and food intake and weight alterations. The take home message is twofold. First, we recommend a comprehensive approach in order to develop effective strategies in the management of patients' weight. Second, we also suggest that investigating this issue in patients with Parkinson's disease may provide some useful information about the mechanisms underlying food and weight regulation in healthy subjects.
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Affiliation(s)
| | - Roberto Eleopra
- S.O.C. Neurologia, Azienda Ospedaliero Universitaria "Santa Maria della Misericordia", Udine, Italy
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16
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Kistner A, Lhommée E, Krack P. Mechanisms of body weight fluctuations in Parkinson's disease. Front Neurol 2014; 5:84. [PMID: 24917848 PMCID: PMC4040467 DOI: 10.3389/fneur.2014.00084] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/16/2014] [Indexed: 11/13/2022] Open
Abstract
Typical body weight changes are known to occur in Parkinson’s disease (PD). Weight loss has been reported in early stages as well as in advanced disease and malnutrition may worsen the clinical state of the patient. On the other hand, an increasing number of patients show weight gain under dopamine replacement therapy or after surgery. These weight changes are multifactorial and involve changes in energy expenditure, perturbation of homeostatic control, and eating behavior modulated by dopaminergic treatment. Comprehension of the different mechanisms contributing to body weight is a prerequisite for the management of body weight and nutritional state of an individual PD patient. This review summarizes the present knowledge and highlights the necessity of evaluation of body weight and related factors, as eating behavior, energy intake, and expenditure in PD.
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Affiliation(s)
- Andrea Kistner
- Movement Disorder Unit, Department of Psychiatry and Neurology, University Hospital Grenoble , Grenoble , France ; Unité 836, Équipe 11, INSERM, Grenoble Institut des Neurosciences , Grenoble , France
| | - Eugénie Lhommée
- Movement Disorder Unit, Department of Psychiatry and Neurology, University Hospital Grenoble , Grenoble , France ; Unité 836, Équipe 11, INSERM, Grenoble Institut des Neurosciences , Grenoble , France
| | - Paul Krack
- Movement Disorder Unit, Department of Psychiatry and Neurology, University Hospital Grenoble , Grenoble , France ; Unité 836, Équipe 11, INSERM, Grenoble Institut des Neurosciences , Grenoble , France ; Joseph Fourier University , Grenoble , France
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