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Direct visualization of deep brain stimulation targets in patients with Parkinson's disease via 3-T quantitative susceptibility mapping. Acta Neurochir (Wien) 2021; 163:1335-1345. [PMID: 33576911 DOI: 10.1007/s00701-021-04715-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The direct visualization of brain nuclei on magnetic resonance (MR) images is important for target localization during deep brain stimulation (DBS) in patients with Parkinson's disease (PD). We demonstrated the superiority of 3-T high-resolution submillimeter voxel size quantitative susceptibility mapping (QSM) for delineating the subthalamic nucleus (STN) and the globus pallidus internus (GPi). METHODS Preoperative 3-T QSM and T2 weighted (T2w) images were obtained from ten patients with PD. Qualitative visualization scores were analyzed by two neurosurgeons on both images using a 4-point and 5-point scale, respectively. Images were also compared with regard to contrast-to-noise ratios (CNRs) and edge detection power for the STN and GPi. The Wilcoxon rank-sum test and the signed-rank test were used to compare measurements between the two images. RESULTS Visualization scores for the STN and GPi, the mean CNR of the STN relative to the zona incerta (ZI) and the substantia nigra, and the mean CNR of the GPi relative to the internal capsule (IC) and the globus pallidum externum, were significantly higher on QSM images than on T2w images (P < 0.01). The edge detection powers of the STN-ZI and GPi-IC on QSM were significantly larger (by 2.6- and 3.8-fold, respectively) than those on T2w images (P < 0.01). QSM detected asymmetry of the STN in two patients. CONCLUSIONS QSM images provided improved delineation ability for the STN and GPi when compared to T2w images. Our findings are important for patients with PD who undergo DBS surgery, particularly those with asymmetric bilateral nuclei.
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Yu K, Ren Z, Guo S, Li J, Li Y. Effects of pedunculopontine nucleus deep brain stimulation on gait disorders in Parkinson's Disease: A meta-analysis of the literature. Clin Neurol Neurosurg 2020; 198:106108. [PMID: 32763669 DOI: 10.1016/j.clineuro.2020.106108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The pedunculopontine nucleus (PPN) is considered a promising target to alleviate gait disorders. We aimed to evaluate the effects of PPN stimulation on motor symptoms and gait disorders in patients with Parkinson's disease (PD) to help assess the potential role of PPN-DBS treatment in gait disorders. METHODS Studies were searched for low-frequency PPN stimulation to treat gait disorders and freezing of gait (FOG) in the PubMed, Embase, Cochrane Library, Web of Science, and ClinicalKey up to April 2020. Outcomes of Unified Parkinson's Disease Rating Scale (UPDRS) part III, subitems 27-30; UPDRS subitems 13 and 14; the Freezing of Gait Questionnaire (FOGQ), and the Gait and Falls Questionnaire (GFQ) were extracted and evaluated during PPN On-stimulation compared to preoperation or Off-stimulation in both Off- and On-medication states. RESULTS There was a significant improvement in subitems 27-30 with PPN On-stimulation versus Off-stimulation in Off-medication and On-medication states, but no improvement in UPDRS part III. The occurrence of FOG and falls also declined between PPN On-stimulation and presurgery, with a significant improvement in subitem 13 and subitem 14 in Off-medication and On-medication states, GFQ, and FQGQ. Heterogeneity in stimulation frequency, follow-up, electrode location, and unilateral or bilateral stimulation existed among the included studies. CONCLUSIONS In some conditions and in some selective PD patients, low-frequency PPN-DBS has beneficial effects on FOG and falls but no wider benefits on rigidity, resting tremor, or bradykinesia.
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Affiliation(s)
- Kaijia Yu
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Zhiwei Ren
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Song Guo
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
| | - Jianyu Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China.
| | - Yongjie Li
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, PR China
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Vizcarra JA, Situ-Kcomt M, Artusi CA, Duker AP, Lopiano L, Okun MS, Espay AJ, Merola A. Subthalamic deep brain stimulation and levodopa in Parkinson's disease: a meta-analysis of combined effects. J Neurol 2018; 266:289-297. [PMID: 29909467 DOI: 10.1007/s00415-018-8936-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION While subthalamic nucleus deep brain stimulation (STN-DBS) and levodopa improve motor symptoms in Parkinson disease (PD) to a similar magnitude, their combined effect remains unclear. We sought to evaluate whether STN-DBS and levodopa yield differential effects on motor outcomes, dyskinesia, and activities of daily living (ADL) when combined compared to when administered alone. METHODS We conducted a meta-analysis of all studies reporting motor, dyskinesia, and ADL outcomes after bilateral STN-DBS in PD with presurgical Unified Parkinson's Disease Rating Scale (UPDRS-III) in Medication-OFF and Medication-ON states and postsurgical assessments in four conditions: Stimulation-ON/Medication-ON, Stimulation-ON/Medication-OFF, Stimulation-OFF/Medication-ON, and Stimulation-OFF/Medication-OFF. Dyskinesia duration (UPDRS item 32) and ADL (UPDRS-II) were compared between high and low postsurgical levodopa equivalent daily dose (LEDD) reduction. Random-effects meta-analyses using generic-inverse variance were conducted. Confidence in outcomes effect sizes was assessed. RESULTS Twelve studies were included (n = 401 patients). Stimulation-ON/Medication-ON was associated with an UPDRS-III improvement of - 35.7 points [95% confidence interval, - 40.4, - 31.0] compared with Stimulation-OFF/Medication-OFF, - 11.2 points [- 14.0, - 8.4] compared with Stimulation-OFF/Medication-ON, and - 9.5 points [- 11.0, - 8.0] compared to Stimulation-ON/Medication-OFF within 5 years. The difference was maintained beyond 5 years by - 28.6 [- 32.8, - 24.4], - 8.1 [- 10.2, - 5.9], and - 8.0 [- 10.3, - 5.6], respectively. No difference was observed between Stimulation-ON/Medication-OFF and Stimulation-OFF/Medication-ON within and beyond 5 years. Dyskinesia duration and ADL outcomes were similar in high vs. low postsurgical LEDD reduction. CONCLUSION Subthalamic nucleus deep brain stimulation and levodopa independently lessened motor severity in PD to a similar magnitude, but their combined effect was greater than either treatment alone, suggesting therapeutic synergism.
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Affiliation(s)
- Joaquin A Vizcarra
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson St, Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Miguel Situ-Kcomt
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10126, Turin, Italy
| | - Andrew P Duker
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson St, Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, via Cherasco 15, 10126, Turin, Italy
| | - Michael S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
| | - Alberto J Espay
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson St, Suite 2300, Cincinnati, OH, 45267-0525, USA
| | - Aristide Merola
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, 260 Stetson St, Suite 2300, Cincinnati, OH, 45267-0525, USA.
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Jitkritsadakul O, Bhidayasiri R, Kalia SK, Hodaie M, Lozano AM, Fasano A. Systematic review of hardware-related complications of Deep Brain Stimulation: Do new indications pose an increased risk? Brain Stimul 2017; 10:967-976. [DOI: 10.1016/j.brs.2017.07.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/21/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
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Improvement of Advanced Parkinson's Disease Manifestations with Deep Brain Stimulation of the Subthalamic Nucleus: A Single Institution Experience. Brain Sci 2016; 6:brainsci6040058. [PMID: 27983589 PMCID: PMC5187572 DOI: 10.3390/brainsci6040058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 11/26/2022] Open
Abstract
We present our experience at the University of Illinois at Chicago (UIC) in deep brain stimulation (DBS) of the subthalamic nucleus (STN), describing our surgical technique, and reporting our clinical results, and morbidities. Twenty patients with advanced Parkinson’s disease (PD) who underwent bilateral STN-DBS were studied. Patients were assessed preoperatively and followed up for one year using the Unified Parkinson’s Disease Rating Scale (UPDRS) in “on” and “off” medication and “on” and “off” stimulation conditions. At one-year follow-up, we calculated significant improvement in all the motor aspects of PD (UPDRS III) and in activities of daily living (UPDRS II) in the “off” medication state. The “off” medication UPDRS improved by 49.3%, tremors improved by 81.6%, rigidity improved by 50.0%, and bradykinesia improved by 39.3%. The “off” medication UPDRS II scores improved by 73.8%. The Levodopa equivalent daily dose was reduced by 54.1%. The UPDRS IVa score (dyskinesia) was reduced by 65.1%. The UPDRS IVb score (motor fluctuation) was reduced by 48.6%. Deep brain stimulation of the STN improves the cardinal motor manifestations of the idiopathic PD. It also improves activities of daily living, and reduces medication-induced complications.
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Saleh S, Swanson KI, Lake WB, Sillay KA. Awake Neurophysiologically Guided versus Asleep MRI-Guided STN DBS for Parkinson Disease: A Comparison of Outcomes Using Levodopa Equivalents. Stereotact Funct Neurosurg 2016; 93:419-26. [DOI: 10.1159/000442425] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022]
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[Stereotactic radiosurgery for movement disorders]. Neurol Neurochir Pol 2012; 46:52-62. [PMID: 22426763 DOI: 10.5114/ninp.2012.27449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nowadays, functional neurosurgery is an established treatment for movement disorders such as Parkinson's disease, essential tremor, and dystonia. The effectiveness and safety of neuromodulation procedures (deep brain stimulation) replaced in the last years ablative irreversible stereotactic lesions for movement disorders. Stereotactic radiosurgery with gamma knife is a non-invasive form of treatment for movement disorders. The main limitation of stereotactic radiosurgery is the impossibility of electrophysiological confirmation of the target structure. Nevertheless, patients with advanced age and significant medical conditions that preclude classic open stereotactic procedures or patients who must receive anticoagulation therapy may gain great functional benefit using gamma knife stereotactic radiosurgery.
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Smith KL, Herron B, Dowell-Mesfin N, Wu H, Kim SJ, Shain W, Hynd MR. Knockdown of cortical transthyretin expression around implanted neural prosthetic devices using intraventricular siRNA injection in the brain. J Neurosci Methods 2012; 203:398-406. [DOI: 10.1016/j.jneumeth.2011.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/22/2011] [Accepted: 09/22/2011] [Indexed: 10/17/2022]
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Zhang G, Zhang JH, Feng J, Li Q, Wu X, Qin X. Electrical stimulation of olfactory bulb downregulates RGMa expression after ischemia/reperfusion injury in rats. Brain Res Bull 2011; 86:254-61. [DOI: 10.1016/j.brainresbull.2011.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 07/23/2011] [Accepted: 08/01/2011] [Indexed: 11/16/2022]
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Mandat T, Tykocki T, Koziara H, Koziorowski D, Brodacki B, Rola R, Bonicki W, Nauman P. Subthalamic deep brain stimulation for the treatment of Parkinson disease. Neurol Neurochir Pol 2011; 45:32-6. [PMID: 21384291 DOI: 10.1016/s0028-3843(14)60057-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE The role of subthalamic nucleus deep brain stimulation (STN DBS) in the treatment of Parkinson disease (PD) is well established. The authors present a group of patients diagnosed with PD who were treated with STN DBS. MATERIAL AND METHODS Between 2008 and 2009, 32 female and 34 male patients with PD were treated with STN DBS. Mean age at implantation was 57 ± 12 years. PD lasted from 6 to 21 years (mean 10 years). Patients were qualified for the surgery according to the CAPSIT-PD criteria. The STN was identified with direct and indirect methods. Macrostimulation and microrecording for STN identification were used in all cases. A unilateral STN DBS system was implanted in two cases and bilateral implantation was performed among rest of the group. Outcome was assessed six months after implantation. Results : The mean reduction of UPDRS III score among 51 patients who underwent follow-up was 45% (5-89%). Reduction of levodopa consumption varied from 15 to 100%. Infection forced the authors to remove the DBS system in one case four months after implantation. Skin erosion above the internal pulse generator was noted in four cases. CONCLUSIONS Cardinal symptoms of Parkinson's disease can be safely and effectively treated with STN DBS in selected group of patients.
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Affiliation(s)
- Tomasz Mandat
- Centrum Onkologii - Instytut, Klinika Nowotworów Układu Nerwowego, ul. Roentgena 5, 02-781 Warszawa.
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