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Hacker ML, Rajamani N, Neudorfer C, Hollunder B, Oxenford S, Li N, Sternberg AL, Davis TL, Konrad PE, Horn A, Charles D. Connectivity Profile for Subthalamic Nucleus Deep Brain Stimulation in Early Stage Parkinson Disease. Ann Neurol 2023; 94:271-284. [PMID: 37177857 PMCID: PMC10846105 DOI: 10.1002/ana.26674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/18/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This study was undertaken to describe relationships between electrode localization and motor outcomes from the subthalamic nucleus (STN) deep brain stimulation (DBS) in early stage Parkinson disease (PD) pilot clinical trial. METHODS To determine anatomical and network correlates associated with motor outcomes for subjects randomized to early DBS (n = 14), voxelwise sweet spot mapping and structural connectivity analyses were carried out using outcomes of motor progression (Unified Parkinson Disease Rating Scale Part III [UPDRS-III] 7-day OFF scores [∆baseline➔24 months, MedOFF/StimOFF]) and symptomatic motor improvement (UPDRS-III ON scores [%∆baseline➔24 months, MedON/StimON]). RESULTS Sweet spot mapping revealed a location associated with slower motor progression in the dorsolateral STN (anterior/posterior commissure coordinates: 11.07 ± 0.82mm lateral, 1.83 ± 0.61mm posterior, 3.53 ± 0.38mm inferior to the midcommissural point; Montreal Neurological Institute coordinates: +11.25, -13.56, -7.44mm). Modulating fiber tracts from supplementary motor area (SMA) and primary motor cortex (M1) to the STN correlated with slower motor progression across STN DBS subjects, whereas fiber tracts originating from pre-SMA and cerebellum were negatively associated with motor progression. Robustness of the fiber tract model was demonstrated in leave-one-patient-out (R = 0.56, p = 0.02), 5-fold (R = 0.50, p = 0.03), and 10-fold (R = 0.53, p = 0.03) cross-validation paradigms. The sweet spot and fiber tracts associated with motor progression revealed strong similarities to symptomatic motor improvement sweet spot and connectivity in this early stage PD cohort. INTERPRETATION These results suggest that stimulating the dorsolateral region of the STN receiving input from M1 and SMA (but not pre-SMA) is associated with slower motor progression across subjects receiving STN DBS in early stage PD. This finding is hypothesis-generating and must be prospectively tested in a larger study. ANN NEUROL 2023;94:271-284.
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Affiliation(s)
- Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nanditha Rajamani
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Barbara Hollunder
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt University of Berlin, Berlin, Germany
| | - Simon Oxenford
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Ningfei Li
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
| | - Alice L Sternberg
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter E Konrad
- Department of Neurosurgery, West Virginia University, Morgantown, WV, USA
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Free University of Berlin and Humboldt University of Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery and Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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Yao J, Shen Z, Jin H, Ma T, Wang J, Li S, Zeng M, Liu X, Peng Y. Dexmedetomidine after deep brain stimulation for prevention of delirium in elderly patients with Parkinson's disease: protocol for a single-centre, randomised, double-blind, placebo-controlled trial in China. BMJ Open 2023; 13:e070185. [PMID: 37433729 DOI: 10.1136/bmjopen-2022-070185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Parkinson's disease is one of the most common neurodegenerative diseases. Deep brain stimulation (DBS) can improve motor symptoms in patients with middle and late Parkinson's disease, reduce the use of levodopa, and thus reduce drug-related side effects. Postoperative delirium can significantly reduce the short-term and long-term quality of life in elderly patients, which can be alleviated by dexmedetomidine (DEX). However, whether prophylactic DEX could reduce the incidence of postoperative delirium in patients with Parkinson's disease was still unknown. METHODS AND ANALYSIS This is a single-centre, randomised, double-blinded, placebo-controlled group trial. A total of 292 patients aged 60 years and above elected for DBS will be stratified according to DBS procedure, subthalamic nucleus or globus pallidus interna, then randomly allocated to the DEX group or the placebo control group with a 1:1 ratio, respectively. In the DEX group, patients will be injected with the DEX continuously with an electronic pump at a rate of 0.1 µg/kg/hour for 48 hours at the beginning of general anaesthesia induction. In the control group, normal saline will be administered at the same rate for patients as in the DEX group. The primary endpoint is the incidence of postoperative delirium within 5 days after surgery. Postoperative delirium is assessed by the combination of the Richmond Anxiety Scale and the Confusion Assessment Method (CAM) for the intensive care unit or the 3-minute diagnostic interview for CAM as applicable. The secondary endpoints include the incidence of adverse events and non-delirium complications, the length of stay in the intensive care unit and hospital and all-cause 30-day mortality after the operation. ETHICS AND DISSEMINATION The protocol has been approved by the Ethics Committee of Beijing Tiantan Hospital of Capital Medical University (KY2022-003-03). The results of this study will be disseminated through presentation at scientific conferences and publication in scientific journals. TRIAL REGISTRATION NUMBER NCT05197439.
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Affiliation(s)
- Jingxin Yao
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongyuan Shen
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hailong Jin
- Department of Anesthesiology, Beijing Daxing District People's Hospital, Capital Medical University, Beijing, China
| | - Tingting Ma
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hacker ML, Meystedt JC, Turchan M, Cannard KR, Harper K, Fan R, Ye F, Davis TL, Konrad PE, Charles D. Eleven-Year Outcomes of Deep Brain Stimulation in Early-Stage Parkinson Disease. Neuromodulation 2023; 26:451-458. [PMID: 36567243 PMCID: PMC10198566 DOI: 10.1016/j.neurom.2022.10.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The deep brain stimulation (DBS) in early-stage Parkinson's disease (PD) pilot clinical trial randomized 30 patients (Hoehn & Yahr II off; medication duration 0.5-4 years; without dyskinesia/motor fluctuations) to optimal drug therapy (ODT) (early ODT) or bilateral subthalamic nucleus (STN) DBS plus ODT (early DBS+ODT). This study aims to report the 11-year outcomes of patients who completed the DBS in early-stage PD pilot clinical trial. MATERIALS AND METHODS Attempts were made to contact all 29 subjects who completed the two-year trial to participate in an 11-year follow-up study. Mixed-effects models compared overall trend in outcomes for randomization groups (fixed-effects: assigned treatment, year, their interaction; random-effect: subject) to account for repeated measures. RESULTS Twelve subjects participated in this 11-year follow-up study (n = 8 early ODT, n = 4 early DBS+ODT). Participating subjects were 70.0 ± 4.8 years old with a PD medication duration of 13.7 ± 1.7 years (early DBS duration 11.5 ± 1.3 years, n = 4). Three early ODT subjects received STN-DBS as standard of care (DBS duration 6.5 ± 2.0 years). Early ODT subjects had worse motor complications (Unified Parkinson's Disease Rating Scale [UPDRS]-IV) than early DBS+ODT subjects over the 11-year follow-up period (between-group difference = 3.5 points; pinteraction = 0.03). Early DBS+ODT was well-tolerated after 11 years and showed comparable outcomes to early ODT for other UPDRS domains, Parkinson Disease Questionnaire-39 (PDQ-39), and levodopa equivalent daily dose (LEDD). CONCLUSIONS Eleven years after randomization, early DBS+ODT subjects had fewer motor complications than early ODT subjects. These results should be interpreted with caution because only 40% of pilot trial subjects participated in this 11-year follow-up study. The Food and Drug Administration has approved the conduct of a pivotal clinical trial evaluating DBS in early-stage PD (IDEG050016). CLINICAL TRIAL REGISTRATION The Clinicaltrials.gov registration number for the study is NCT00282152.
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Affiliation(s)
- Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | - Maxim Turchan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin R Cannard
- Department of Neurology, Walter Reed National Military Center, Bethesda, MD, USA
| | - Kelly Harper
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Run Fan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter E Konrad
- Department of Neurosurgery, West Virginia University, Morgantown, WV, USA
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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Li XN, Hao DP, Qu MJ, Zhang M, Ma AB, Pan XD, Ma AJ. Development and Validation of a Plasma FAM19A5 and MRI-Based Radiomics Model for Prediction of Parkinson's Disease and Parkinson's Disease With Depression. Front Neurosci 2022; 15:795539. [PMID: 34975391 PMCID: PMC8718551 DOI: 10.3389/fnins.2021.795539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Prediction and early diagnosis of Parkinson’s disease (PD) and Parkinson’s disease with depression (PDD) are essential for the clinical management of PD. Objectives: The present study aimed to develop a plasma Family with sequence similarity 19, member A5 (FAM19A5) and MRI-based radiomics nomogram to predict PD and PDD. Methods: The study involved 176 PD patients and 181 healthy controls (HC). Sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure FAM19A5 concentration in the plasma samples collected from all participants. For enrolled subjects, MRI data were collected from 164 individuals (82 in the PD group and 82 in the HC group). The bilateral amygdala, head of the caudate nucleus, putamen, and substantia nigra, and red nucleus were manually labeled on the MR images. Radiomics features of the labeled regions were extracted. Further, machine learning methods were applied to shrink the feature size and build a predictive radiomics signature. The resulting radiomics signature was combined with plasma FAM19A5 concentration and other risk factors to establish logistic regression models for the prediction of PD and PDD. Results: The plasma FAM19A5 levels (2.456 ± 0.517) were recorded to be significantly higher in the PD group as compared to the HC group (2.23 ± 0.457) (P < 0.001). Importantly, the plasma FAM19A5 levels were also significantly higher in the PDD subgroup (2.577 ± 0.408) as compared to the non-depressive subgroup (2.406 ± 0.549) (P = 0.045 < 0.05). The model based on the combination of plasma FAM19A5 and radiomics signature showed excellent predictive validity for PD and PDD, with AUCs of 0.913 (95% CI: 0.861–0.955) and 0.937 (95% CI: 0.845–0.970), respectively. Conclusion: Altogether, the present study reported the development of nomograms incorporating radiomics signature, plasma FAM19A5, and clinical risk factors, which might serve as potential tools for early prediction of PD and PDD in clinical settings.
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Affiliation(s)
- Xue-Ning Li
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Da-Peng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mei-Jie Qu
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - An-Bang Ma
- Shanghai Xunshi Technology Co., Ltd., Shanghai, China
| | - Xu-Dong Pan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Cerebrovascular, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ai-Jun Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.,Institute of Cerebrovascular, The Affiliated Hospital of Qingdao University, Qingdao, China
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Koh EJ, Golubovsky JL, Rammo R, Momin A, Walter B, Fernandez HH, Machado A, Nagel SJ. Estimating the Risk of Deep Brain Stimulation in the Modern Era: 2008 to 2020. Oper Neurosurg (Hagerstown) 2021; 21:277-290. [PMID: 34392372 DOI: 10.1093/ons/opab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/16/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) was first approved by the United States Food and Drug Administration in 1997. Although the fundamentals of DBS remain the same, hardware, software, and imaging have evolved significantly. OBJECTIVE To test our hypothesis that the aggregate complication rate in the medical literature in the past 12 years would be lower than what is often cited based on early experience with DBS surgery. METHODS PubMed, PsycINFO, and EMBASE were queried for studies from 2008 to 2020 that included patients treated with DBS from 2007 to 2019. This yielded 34 articles that evaluated all complications of DBS surgery, totaling 2249 patients. RESULTS The overall complication rate in this study was 16.7% per patient. There was found to be a systemic complication rate of 0.89%, intracranial complication rate of 2.7%, neurological complication rate of 4.6%, hardware complication rate of 2.2%, and surgical site complication rate of 3.4%. The infection and erosion rate was 3.0%. CONCLUSION This review suggests that surgical complication rates have decreased since the first decade after DBS was first FDA approved. Understanding how to minimize complications from the inception of a technique should receive more attention.
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Affiliation(s)
- Eun Jeong Koh
- Department of Neurosurgery, Jeonbuk National University Medical School, Jeonju, Jeonbuk, Republic of Korea
| | - Joshua L Golubovsky
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard Rammo
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arbaz Momin
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Benjamin Walter
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hubert H Fernandez
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Andre Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sean J Nagel
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
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Hacker ML, Turchan M, Heusinkveld LE, Currie AD, Millan SH, Molinari AL, Konrad PE, Davis TL, Phibbs FT, Hedera P, Cannard KR, Wang L, Charles D. Deep brain stimulation in early-stage Parkinson disease: Five-year outcomes. Neurology 2020; 95:e393-e401. [PMID: 32601120 PMCID: PMC7455319 DOI: 10.1212/wnl.0000000000009946] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/26/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To report 5-year outcomes from the subthalamic nucleus (STN) deep brain stimulation (DBS) in early-stage Parkinson disease (PD) pilot clinical trial. METHODS The pilot was a prospective, single-blind clinical trial that randomized patients with early-stage PD (Hoehn & Yahr II off medications) to receive bilateral STN DBS plus optimal drug therapy (ODT) vs ODT alone (IDEG050016, NCT0282152, IRB040797). Participants who completed the 2-year trial participated in this observational follow-up study, which included annual outpatient visits through 5 years. This analysis includes 28 patients who were taking PD medications for 6 months to 4 years at enrollment. Outcomes were analyzed using both proportional odds logistic regression and linear mixed effects models. RESULTS Early STN DBS + ODT participants required lower levodopa equivalent daily doses (p = 0.04, β = -240 mg, 95% confidence interval [CI] -471 to -8) and had 0.06 times the odds of requiring polypharmacy at 5 years compared to early ODT participants (p = 0.01, odds ratio [OR] 0.06, 95% CI 0.00 to 0.65). The odds of having worse rest tremor for early STN DBS + ODT participants were 0.21 times those of early ODT participants (p < 0.001, OR 0.21, 95% CI 0.09 to 0.45). The safety profile was similar between groups. CONCLUSIONS These results suggest that early DBS reduces the need for and complexity of PD medications while providing long-term motor benefit over standard medical therapy. Further investigation is warranted, and the Food and Drug Administration has approved the conduct of a prospective, multicenter, pivotal clinical trial of DBS in early-stage PD (IDEG050016). CLASSIFICATION OF EVIDENCE This study provides Class II evidence that DBS implanted in early-stage PD decreases the risk of disease progression and polypharmacy compared to optimal medical therapy alone.
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Affiliation(s)
- Mallory L Hacker
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD.
| | - Maxim Turchan
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Lauren E Heusinkveld
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Amanda D Currie
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Sarah H Millan
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Anna L Molinari
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Peter E Konrad
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Thomas L Davis
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Fenna T Phibbs
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Peter Hedera
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Kevin R Cannard
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - Li Wang
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
| | - David Charles
- From the Departments of Neurology (M.L.H., M.T., L.E.H., A.D.C., S.H.M., A.L.M., T.L.D., F.T.P., P.H., D.C.), Neurosurgery (P.E.K.), and Biostatistics (L.W.), Vanderbilt University Medical Center, Nashville, TN; and Department of Neurology (K.R.C.), Walter Reed National Military Center, Bethesda, MD
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Porta M, Servello D, Zekaj E, Gonzalez-Escamilla G, Groppa S. Pre-dopa Deep Brain Stimulation: Is Early Deep Brain Stimulation Able to Modify the Natural Course of Parkinson's Disease? Front Neurosci 2020; 14:492. [PMID: 32581675 PMCID: PMC7292013 DOI: 10.3389/fnins.2020.00492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/20/2020] [Indexed: 12/23/2022] Open
Abstract
Deep brain stimulation (DBS) is an established therapy for the management of Parkinson’s disease (PD). However, DBS is indicated as the disease progresses and motor complications derived from pharmacological therapy arise. Here, we evaluate the potential of DBS prior to levodopa (L-Dopa) in improving quality of life (QoL), challenging the state of the art for DBS therapy. We present data on clinical manifestation, decision finding during early indication to DBS, and trajectories after DBS. We further discuss current paradigms for DBS and hypothesize on possible mechanisms. Six patients, between 50 and 67 years old, presenting at least 5 years of PD symptoms, and without L-Dopa therapy initiation, received subthalamic nucleus (STN) DBS implantation. In the six PD cases, indication for DBS was not driven by motor complications, as supported by current guidelines, but by relevant QoL impairment and patient’s reluctance to initiate L-Dopa treatment. All patients treated with STN-DBS prior to L-Dopa presented improvement in motor and non-motor symptoms and significant QoL improvement. All patients reduced the intake of dopamine agonists, and five are currently free from L-Dopa medication, with no reported adverse events. We introduce a multicenter observational study to investigate whether early DBS treatment may affect the natural course of PD. Early application of DBS instead of L-Dopa administration could have a pathophysiological basis and be prompted by a significant incline on QoL through disease progression; however, the clinical value of this proposed paradigm shift should be addressed in clinical trials aimed at modulating the natural course of PD.
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Affiliation(s)
- Mauro Porta
- Center for Movement Disorders and Tourette Syndrome, Galeazzi Hospital, Milan, Italy
| | | | - Edvin Zekaj
- Functional Neurosurgery Unit, Galeazzi Hospital, Milan, Italy
| | - Gabriel Gonzalez-Escamilla
- Movement Disorders and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Bullard AJ, Hutchison BC, Lee J, Chestek CA, Patil PG. Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays. Neuromodulation 2019; 23:411-426. [DOI: 10.1111/ner.13069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/05/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Autumn J. Bullard
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | | | - Jiseon Lee
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
| | - Cynthia A. Chestek
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Electrical Engineering and Computer Science University of Michigan Ann Arbor MI USA
| | - Parag G. Patil
- Department of Biomedical Engineering University of Michigan Ann Arbor MI USA
- Department of Neurosurgery University of Michigan Medical School Ann Arbor MI USA
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9
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Grace Cannard K, Hacker ML, Molinari A, Heusinkveld LE, Currie AD, Charles D. Recruitment and Retention in Clinical Trials of Deep Brain Stimulation in Early-Stage Parkinson's Disease: Past Experiences and Future Considerations. JOURNAL OF PARKINSONS DISEASE 2019; 8:421-428. [PMID: 30010145 DOI: 10.3233/jpd-181381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical trials are often hindered by inadequate patient recruitment. Overly optimistic investigator predictions of participation can lead to unmet recruitment goals and costly trial extensions. A patient-focused approach estimating recruitment in clinical trials may provide higher accuracy. OBJECTIVE To assess the feasibility of recruitment in a future deep brain stimulation (DBS) in early-stage Parkinson's disease (PD) multicenter trial by understanding motivations and concerns to participation of past and potential future DBS in early-stage PD clinical trial subjects. METHODS To identify motivating factors and barriers influencing trial participation, an end-of-trial survey was administered to subjects enrolled in a DBS in early-stage PD pilot trial with subjects randomized to receive DBS plus optimal drug therapy (DBS+ODT) or ODT alone (NCT#00282152, IDE#G050016). Pilot trial survey results were analyzed in conjunction with results of a previously-reported survey querying PD patients about potential participation in a trial for DBS in early-stage PD with similar inclusion/exclusion criteria. RESULTS Pilot trial subjects reported high levels of satisfaction with their participation in the study. Similar motivations and barriers to participation were expressed in comparable proportions by subjects who successfully completed the pilot trial and patients with early-stage PD considering enrollment in a comparable DBS study. CONCLUSIONS The FDA has approved a prospective, randomized, double-blind, phase III, multicenter, pivotal clinical trial evaluating DBS in early-stage PD (IDE#G050016). These results suggest that the successful recruitment and retention of early-stage PD subjects, as observed in the pilot trial, is attainable in a future pivotal trial.
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Affiliation(s)
- K Grace Cannard
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mallory L Hacker
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna Molinari
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren E Heusinkveld
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Laboratory of Molecular Immunology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Amanda D Currie
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Plassard AJ, Bao S, D'Haese PF, Pallavaram S, Claassen DO, Dawant BM, Landman BA. Multi-modal imaging with specialized sequences improves accuracy of the automated subcortical grey matter segmentation. Magn Reson Imaging 2019; 61:131-136. [PMID: 31121202 PMCID: PMC6980439 DOI: 10.1016/j.mri.2019.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/23/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
Abstract
The basal ganglia and limbic system, particularly the thalamus, putamen, internal and external globus pallidus, substantia nigra, and sub-thalamic nucleus, comprise a clinically relevant signal network for Parkinson's disease. In order to manually trace these structures, a combination of high-resolution and specialized sequences at 7 T are used, but it is not feasible to routinely scan clinical patients in those scanners. Targeted imaging sequences at 3 T have been presented to enhance contrast in a select group of these structures. In this work, we show that a series of atlases generated at 7 T can be used to accurately segment these structures at 3 T using a combination of standard and optimized imaging sequences, though no one approach provided the best result across all structures. In the thalamus and putamen, a median Dice Similarity Coefficient (DSC) over 0.88 and a mean surface distance <1.0 mm were achieved using a combination of T1 and an optimized inversion recovery imaging sequences. In the internal and external globus pallidus a DSC over 0.75 and a mean surface distance <1.2 mm were achieved using a combination of T1 and inversion recovery imaging sequences. In the substantia nigra and sub-thalamic nucleus a DSC of over 0.6 and a mean surface distance of <1.0 mm were achieved using the inversion recovery imaging sequence. On average, using T1 and optimized inversion recovery together significantly improved segmentation results than over individual modality (p < 0.05 Wilcoxon sign-rank test).
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Affiliation(s)
- Andrew J Plassard
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA
| | - Shunxing Bao
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA.
| | - Pierre F D'Haese
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA
| | - Srivatsan Pallavaram
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA
| | - Daniel O Claassen
- Neurology, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA
| | - Benoit M Dawant
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA
| | - Bennett A Landman
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA; Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN 37235, USA
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11
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Gao JX, Li Y, Wang SN, Chen XC, Lin LL, Zhang H. Overexpression of microRNA-183 promotes apoptosis of substantia nigra neurons via the inhibition of OSMR in a mouse model of Parkinson's disease. Int J Mol Med 2018; 43:209-220. [PMID: 30431059 PMCID: PMC6257840 DOI: 10.3892/ijmm.2018.3982] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to investigate the effect of microRNA-183 (miR-183) on substantia nigra neurons by targeting oncostatin M receptor (OSMR) in a mouse model of Parkinson’s disease (PD). The positive expression rates of OSMR and the apoptosis of substantia nigra neurons were detected by immunohistochemistry and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling, respectively. Substantia nigra neurons in normal and PD mice were cultured in vitro. The association between miR-183 and OSMR was verified using a dual luciferase reporter gene assay. The expression of miR-183 and the phosphoinositide 3-kinase-Akt signaling pathway-associated genes were detected by reverse transcription-quantitative polymerase chain reaction and western blot analysis, respectively. Cell apoptosis was detected by flow cytometry. OSMR is the target gene of miR-183. The number of OSMR-positive cells and the apoptotic rate of substantia nigra neurons were increased in the PD group. Neurons transfected with miR-183 mimic exhibited elevated expression levels of miR-183, B-cell lymphoma 2 (Bcl-2)-associated X protein (Bax) and caspase-9 and increased apoptotic rate, and reduced expression levels of OSMR, Akt, phosphorylated (p-)Akt, glycogen synthase kinase-3 (GSK-3β), p-GSK-3β, Bcl-2, insulin-like growth factor 1 (IGF-1), mammalian target of rapamycin (mTOR) and p-mTOR. The miR-183 inhibitor decreased the expression levels of miR-183, Bax and caspase-9 and the apoptotic rate; however, increased the expression of OSMR, Akt, p-Akt, GSK-3β, p-GSK-3β, Bcl-2, IGF-1, mTOR and p-mTOR. The results of the present study provide evidence that the overexpression of miR-183 promotes the apoptosis of substantia nigra neurons by inhibiting the expression of OSMR.
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Affiliation(s)
- Jin-Xia Gao
- Department of Anesthesiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Yu Li
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Sai-Nan Wang
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Xing-Chi Chen
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Lu-Lu Lin
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Hui Zhang
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
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12
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Lawson RA, McDonald C, Burn DJ. Defining delirium in idiopathic Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2018; 64:29-39. [PMID: 30279060 DOI: 10.1016/j.parkreldis.2018.09.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/28/2018] [Accepted: 09/21/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Parkinson's disease patients may be at increased risk of delirium and developing adverse outcomes, such as cognitive decline and increased mortality. Delirium is an acute state of confusion that has overlapping symptoms with Parkinson's dementia, making it difficult to identify. This study aimed to determine the diagnostic criteria, prevalence, management strategies and outcomes of delirium in Parkinson's through a systematic review of the literature. METHODS Seven databases were used to identify all articles published before February 2017 comprising two key terms: "Parkinson's Disease" and "delirium". Data were extracted from studies meeting predefined inclusion criteria. RESULTS Twenty articles were identified. Delirium prevalence in Parkinson's ranged from 0.3 to 60% depending on setting; a diagnosis of Parkinson's was associated with an increased risk of developing delirium. Delirium was identified/diagnosed using seven different criteria. Delirium may be associated with an increased length of hospital stay and worsening motor symptoms. We did not identify any studies examining the management of delirium in Parkinson's. DISCUSSION This review highlights the paucity of well-designed, appropriately powered studies investigating delirium in Parkinson's. The results suggest that delirium is a significant issue in people with Parkinson's and that having delirium may be a risk factor for adverse outcomes, particularly in inpatient settings. Further prospective research is needed to accurately determine the prevalence of delirium in Parkinson's, its management strategies and outcomes, and to evaluate diagnostic criteria to differentiate between the overlapping symptoms of Parkinson's and delirium.
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Affiliation(s)
- Rachael A Lawson
- Institute of Neuroscience, Newcastle University, UK; Newcastle University Institute for Ageing, Newcastle University, UK.
| | - Claire McDonald
- Institute of Neuroscience, Newcastle University, UK; Gateshead Health NHS Foundation Trust, UK
| | - David J Burn
- Faculty of Medical Science, Newcastle University, UK
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13
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Schilling KG, Gao Y, Stepniewska I, Janve V, Landman BA, Anderson AW. Anatomical accuracy of standard-practice tractography algorithms in the motor system - A histological validation in the squirrel monkey brain. Magn Reson Imaging 2018; 55:7-25. [PMID: 30213755 DOI: 10.1016/j.mri.2018.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/06/2018] [Accepted: 09/06/2018] [Indexed: 01/15/2023]
Abstract
For two decades diffusion fiber tractography has been used to probe both the spatial extent of white matter pathways and the region to region connectivity of the brain. In both cases, anatomical accuracy of tractography is critical for sound scientific conclusions. Here we assess and validate the algorithms and tractography implementations that have been most widely used - often because of ease of use, algorithm simplicity, or availability offered in open source software. Comparing forty tractography results to a ground truth defined by histological tracers in the primary motor cortex on the same squirrel monkey brains, we assess tract fidelity on the scale of voxels as well as over larger spatial domains or regional connectivity. No algorithms are successful in all metrics, and, in fact, some implementations fail to reconstruct large portions of pathways or identify major points of connectivity. The accuracy is most dependent on reconstruction method and tracking algorithm, as well as the seed region and how this region is utilized. We also note a tremendous variability in the results, even though the same MR images act as inputs to all algorithms. In addition, anatomical accuracy is significantly decreased at increased distances from the seed. An analysis of the spatial errors in tractography reveals that many techniques have trouble properly leaving the gray matter, and many only reveal connectivity to adjacent regions of interest. These results show that the most commonly implemented algorithms have several shortcomings and limitations, and choices in implementations lead to very different results. This study should provide guidance for algorithm choices based on study requirements for sensitivity, specificity, or the need to identify particular connections, and should serve as a heuristic for future developments in tractography.
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Affiliation(s)
- Kurt G Schilling
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Yurui Gao
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | | | - Vaibhav Janve
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bennett A Landman
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA; Department of Electrical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Adam W Anderson
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
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14
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Towards unambiguous reporting of complications related to deep brain stimulation surgery: A retrospective single-center analysis and systematic review of the literature. PLoS One 2018; 13:e0198529. [PMID: 30071021 PMCID: PMC6071984 DOI: 10.1371/journal.pone.0198529] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 05/21/2018] [Indexed: 02/04/2023] Open
Abstract
Background and objective To determine rates of adverse events (AEs) related to deep brain stimulation (DBS) surgery or implanted devices from a large series from a single institution. Sound comparisons with the literature require the definition of unambiguous categories, since there is no consensus on the reporting of such AEs. Patients and methods 123 consecutive patients (median age 63 yrs; female 45.5%) treated with DBS in the subthalamic nucleus (78 patients), ventrolateral thalamus (24), internal pallidum (20), and centre médian-parafascicular nucleus (1) were analyzed retrospectively. Both mean and median follow-up time was 4.7 years (578 patient-years). AEs were assessed according to three unambiguous categories: (i) hemorrhages including other intracranial complications because these might lead to neurological deficits or death, (ii) infections and similar AEs necessitating the explantation of hardware components as this results in the interruption of DBS therapy, and (iii) lead revisions for various reasons since this involves an additional intracranial procedure. For a systematic review of the literature AE rates were calculated based on primary data presented in 103 publications. Heterogeneity between studies was assessed with the I2 statistic and analyzed further by a random effects meta-regression. Publication bias was analyzed with funnel plots. Results Surgery- or hardware-related AEs (23) affected 18 of 123 patients (14.6%) and resolved without permanent sequelae in all instances. In 2 patients (1.6%), small hemorrhages in the striatum were associated with transient neurological deficits. In 4 patients (3.3%; 0.7% per patient-year) impulse generators were removed due to infection. In 2 patients electrodes were revised (1.6%; 0.3% per patient-year). There was no lead migration or surgical revision because of lead misplacement. Age was not statistically significant different (p>0.05) between patients affected by AEs or not. AE rates did not decline over time and similar incidences were found among all patients (423) implanted with DBS systems at our institution until December 2016. A systematic literature review revealed that exact AE rates could not be determined from many studies, which could not be attributed to study designs. Average rates for intracranial complications were 3.8% among studies (per-study analysis) and 3.4% for pooled analysis of patients from different studies (per-patient analysis). Annual hardware removal rates were 3.6 and 2.4% for per-study and per-patient analysis, respectively, and lead revision rates were 4.1 and 2.6%, respectively. There was significant heterogeneity between studies (I2 ranged between 77% and 91% for the three categories; p< 0.0001). For hardware removal heterogeneity (I2 = 87.4%) was reduced by taking study size (p< 0.0001) and publication year (p< 0.01) into account, although a significant degree of heterogeneity remained (I2 = 80.0%; p< 0.0001). Based on comparisons with health care-related databases there appears to be publication bias with lower rates for hardware-related AEs in published patient cohorts. Conclusions The proposed categories are suited for an unequivocal assessment of AEs even in a retrospective manner and useful for benchmarking. AE rates in the present cohorts from our institution compare favorable with the literature.
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15
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Lang AE, Espay AJ. Disease Modification in Parkinson's Disease: Current Approaches, Challenges, and Future Considerations. Mov Disord 2018; 33:660-677. [DOI: 10.1002/mds.27360] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology; University of Toronto; Toronto Ontario Canada
| | - Alberto J. Espay
- UC Gardner Neuroscience Institute and Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology; University of Cincinnati; Cincinnati Ohio USA
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16
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D’Haese PF, Konrad PE, Dawant BM. Big Data and Deep Brain Stimulation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Eijkholt M, Cabrera LY, Ramirez-Zamora A, Pilitsis JG. Shaking Up the Debate: Ensuring the Ethical Use of DBS Intervention Criteria for Mid-Stage Parkinson's Patients. Neuromodulation 2017; 20:411-416. [DOI: 10.1111/ner.12608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/06/2017] [Accepted: 03/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marleen Eijkholt
- Center for Ethics & Humanities in the Life Sciences; Michigan State University; Grand Rapids MI USA
| | - Laura Y. Cabrera
- Center for Ethics & Humanities in the Life Sciences; Michigan State University; East Lansing MI USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Center for Movement Disorders and Neurorestoration; University of Florida; Gainesville FL USA
| | - Julie G. Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center; Albany NY USA
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18
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Plassard AJ, D'Haese PF, Pallavaram S, Newton AT, Claassen DO, Dawant BM, Landman BA. Multi-Modal and Targeted Imaging Improves Automated Mid-Brain Segmentation. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2017; 10133. [PMID: 28781412 DOI: 10.1117/12.2254428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The basal ganglia and limbic system, particularly the thalamus, putamen, internal and external globus pallidus, substantia nigra, and sub-thalamic nucleus, comprise a clinically relevant signal network for Parkinson's disease. In order to manually trace these structures, a combination of high-resolution and specialized sequences at 7T are used, but it is not feasible to scan clinical patients in those scanners. Targeted imaging sequences at 3T such as F-GATIR, and other optimized inversion recovery sequences, have been presented which enhance contrast in a select group of these structures. In this work, we show that a series of atlases generated at 7T can be used to accurately segment these structures at 3T using a combination of standard and optimized imaging sequences, though no one approach provided the best result across all structures. In the thalamus and putamen, a median Dice coefficient over 0.88 and a mean surface distance less than 1.0mm was achieved using a combination of T1 and an optimized inversion recovery imaging sequences. In the internal and external globus pallidus a Dice over 0.75 and a mean surface distance less than 1.2mm was achieved using a combination of T1 and F-GATIR imaging sequences. In the substantia nigra and sub-thalamic nucleus a Dice coefficient of over 0.6 and a mean surface distance of less than 1.0mm was achieved using the optimized inversion recovery imaging sequence. On average, using T1 and optimized inversion recovery together produced significantly improved segmentation results than any individual modality (p<0.05 wilcox sign-rank test).
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Affiliation(s)
- Andrew J Plassard
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Pierre F D'Haese
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Srivatsan Pallavaram
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Allen T Newton
- Radiology, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Daniel O Claassen
- Neurology, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Benoit M Dawant
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235.,Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Bennett A Landman
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235.,Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235.,Radiology, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
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19
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Hogg E, Wertheimer J, Graner S, Tagliati M. Deep Brain Stimulation and Nonmotor Symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1045-1089. [DOI: 10.1016/bs.irn.2017.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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20
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Bick SKB, Folley BS, Mayer JS, Park S, Charles PD, Camalier CR, Pallavaram S, Konrad PE, Neimat JS. Subthalamic Nucleus Deep Brain Stimulation Alters Prefrontal Correlates of Emotion Induction. Neuromodulation 2016; 20:233-237. [PMID: 27730703 DOI: 10.1111/ner.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/08/2016] [Accepted: 09/13/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor symptoms in advanced Parkinson's disease. STN DBS may also affect emotion, possibly by impacting a parallel limbic cortico-striatal circuit. The objective of this study was to investigate changes in prefrontal cortical activity related to DBS during an emotion induction task. MATERIALS AND METHODS We used near infrared spectroscopy to monitor prefrontal cortex hemodynamic changes during an emotion induction task. Seven DBS patients were tested sequentially in the stimulation-on and stimulation-off states while on dopaminergic medication. Patients watched a series of positive, negative, and neutral videos. The general linear model was used to compare prefrontal oxygenated hemoglobin concentration between DBS states. RESULTS Deep brain stimulation was correlated with prefrontal oxygenated hemoglobin changes relative to the stimulation off state in response to both positive and negative videos. These changes were specific to emotional stimuli and were not seen during neutral stimuli. CONCLUSIONS These results suggest that STN stimulation influences the prefrontal cortical representation of positive and negative emotion induction.
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Affiliation(s)
- Sarah K B Bick
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bradley S Folley
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Norton Neuroscience Institute, Louisville, KY, USA
| | - Jutta S Mayer
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.,Department of Psychology, University of Frankfurt, Frankfurt, Germany
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - P David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Corrie R Camalier
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Srivatsan Pallavaram
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Peter E Konrad
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph S Neimat
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
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21
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Mayer JS, Neimat J, Folley BS, Bourne SK, Konrad PE, Charles D, Park S. Deep brain stimulation of the subthalamic nucleus alters frontal activity during spatial working memory maintenance of patients with Parkinson's disease. Neurocase 2016; 22:369-78. [PMID: 27337498 PMCID: PMC4980078 DOI: 10.1080/13554794.2016.1197951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves the motor symptoms of Parkinson's disease (PD). The STN may represent an important relay station not only in the motor but also the associative cortico-striato-thalamocortical pathway. Therefore, STN stimulation may alter cognitive functions, such as working memory (WM). We examined cortical effects of STN-DBS on WM in early PD patients using functional near-infrared spectroscopy. The effects of dopaminergic medication on WM were also examined. Lateral frontal activity during WM maintenance was greater when patients were taking dopaminergic medication. STN-DBS led to a trend-level worsening of WM performance, accompanied by increased lateral frontal activity during WM maintenance. These findings suggest that STN-DBS in PD might lead to functional modifications of the basal ganglia-thalamocortical pathway during WM maintenance.
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Affiliation(s)
- Jutta S Mayer
- a Department of Psychology , Vanderbilt University , Nashville , TN , USA.,b Department of Psychology , Goethe University , Frankfurt , Germany
| | - Joseph Neimat
- c Department of Neurological Surgery , Vanderbilt Medical Center , Nashville , TN , USA
| | | | - Sarah K Bourne
- c Department of Neurological Surgery , Vanderbilt Medical Center , Nashville , TN , USA
| | - Peter E Konrad
- c Department of Neurological Surgery , Vanderbilt Medical Center , Nashville , TN , USA
| | - David Charles
- e Department of Neurology , Vanderbilt Medical Center , Nashville , TN , USA
| | - Sohee Park
- a Department of Psychology , Vanderbilt University , Nashville , TN , USA
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22
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Hacker M, Charles D, Finder S. Deep brain stimulation in early stage Parkinson's disease may reduce the relative risk of symptom worsening. Parkinsonism Relat Disord 2016; 22:112-3. [DOI: 10.1016/j.parkreldis.2015.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 11/16/2022]
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23
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Herrington TM, Cheng JJ, Eskandar EN. Mechanisms of deep brain stimulation. J Neurophysiol 2015; 115:19-38. [PMID: 26510756 DOI: 10.1152/jn.00281.2015] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/22/2015] [Indexed: 12/31/2022] Open
Abstract
Deep brain stimulation (DBS) is widely used for the treatment of movement disorders including Parkinson's disease, essential tremor, and dystonia and, to a lesser extent, certain treatment-resistant neuropsychiatric disorders including obsessive-compulsive disorder. Rather than a single unifying mechanism, DBS likely acts via several, nonexclusive mechanisms including local and network-wide electrical and neurochemical effects of stimulation, modulation of oscillatory activity, synaptic plasticity, and, potentially, neuroprotection and neurogenesis. These different mechanisms vary in importance depending on the condition being treated and the target being stimulated. Here we review each of these in turn and illustrate how an understanding of these mechanisms is inspiring next-generation approaches to DBS.
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Affiliation(s)
- Todd M Herrington
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Jennifer J Cheng
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Emad N Eskandar
- Nayef Al-Rodhan Laboratories, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Hacker ML, Tonascia J, Turchan M, Currie A, Heusinkveld L, Konrad PE, Davis TL, Neimat JS, Phibbs FT, Hedera P, Wang L, Shi Y, Shade DM, Sternberg AL, Drye LT, Charles D. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease. Parkinsonism Relat Disord 2015; 21:1177-83. [PMID: 26306000 DOI: 10.1016/j.parkreldis.2015.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/09/2015] [Accepted: 08/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. METHODS A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. RESULTS DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p < 0.003), with no significant change in the DBS + ODT group. CONCLUSIONS DBS + ODT in early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD.
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Affiliation(s)
- Mallory L Hacker
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States.
| | - James Tonascia
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe St., Baltimore, MD, 21205, United States
| | - Maxim Turchan
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States
| | - Amanda Currie
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States
| | - Lauren Heusinkveld
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States
| | - Peter E Konrad
- Department of Neurosurgery, Vanderbilt University, 4340 Village at Vanderbilt, Nashville, TN, 37232-8618, United States
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States
| | - Joseph S Neimat
- Department of Neurosurgery, Vanderbilt University, 4340 Village at Vanderbilt, Nashville, TN, 37232-8618, United States
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States
| | - Peter Hedera
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States
| | - Lily Wang
- Department of Biostatistics, Vanderbilt University, 2525 West End Avenue, Suite 11000, Nashville, TN, 37212, United States
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University, 2525 West End Avenue, Suite 11000, Nashville, TN, 37212, United States
| | - David M Shade
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe St., Baltimore, MD, 21205, United States
| | - Alice L Sternberg
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe St., Baltimore, MD, 21205, United States
| | - Lea T Drye
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe St., Baltimore, MD, 21205, United States
| | - David Charles
- Department of Neurology, Vanderbilt University, 1611 21st Ave S., A-0118 Medical Center North, Nashville, TN, 37232-2551, United States
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High-Frequency Stimulation of the Rat Entopeduncular Nucleus Does Not Provide Functional or Morphological Neuroprotection from 6-Hydroxydopamine. PLoS One 2015. [PMID: 26222442 PMCID: PMC4519335 DOI: 10.1371/journal.pone.0133957] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Deep brain stimulation (DBS) is the most common neurosurgical treatment for Parkinson’s disease (PD). Whereas the globus pallidus interna (GPi) has been less commonly targeted than the subthalamic nucleus (STN), a recent clinical trial suggests that GPi DBS may provide better outcomes for patients with psychiatric comorbidities. Several laboratories have demonstrated that DBS of the STN provides neuroprotection of substantia nigra pars compacta (SNpc) dopamine neurons in preclinical neurotoxin models of PD and increases brain-derived neurotrophic factor (BDNF). However, whether DBS of the entopeduncular nucleus (EP), the homologous structure to the GPi in the rat, has similar neuroprotective potential in preclinical models has not been investigated. We investigated the impact of EP DBS on forelimb use asymmetry and SNpc degeneration induced by 6-hydroxydopamine (6-OHDA) and on BDNF levels. EP DBS in male rats received unilateral, intrastriatal 6-OHDA and ACTIVE or INACTIVE stimulation continuously for two weeks. Outcome measures included quantification of contralateral forelimb use, stereological assessment of SNpc neurons and BDNF levels. EP DBS 1) did not ameliorate forelimb impairments induced by 6-OHDA, 2) did not provide neuroprotection for SNpc neurons and 3) did not significantly increase BDNF levels in any of the structures examined. These results are in sharp contrast to the functional improvement, neuroprotection and BDNF-enhancing effects of STN DBS under identical experimental parameters in the rat. The lack of functional response to EP DBS suggests that stimulation of the rat EP may not represent an accurate model of clinical GPi stimulation.
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Gunduz A, Morita H, Rossi PJ, Allen WL, Alterman RL, Bronte-Stewart H, Butson CR, Charles D, Deckers S, de Hemptinne C, DeLong M, Dougherty D, Ellrich J, Foote KD, Giordano J, Goodman W, Greenberg BD, Greene D, Gross R, Judy JW, Karst E, Kent A, Kopell B, Lang A, Lozano A, Lungu C, Lyons KE, Machado A, Martens H, McIntyre C, Min HK, Neimat J, Ostrem J, Pannu S, Ponce F, Pouratian N, Reymers D, Schrock L, Sheth S, Shih L, Stanslaski S, Steinke GK, Stypulkowski P, Tröster AI, Verhagen L, Walker H, Okun MS. Proceedings of the Second Annual Deep Brain Stimulation Think Tank: What's in the Pipeline. Int J Neurosci 2015; 125:475-85. [PMID: 25526555 PMCID: PMC4743588 DOI: 10.3109/00207454.2014.999268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The proceedings of the 2nd Annual Deep Brain Stimulation Think Tank summarize the most contemporary clinical, electrophysiological, and computational work on DBS for the treatment of neurological and neuropsychiatric disease and represent the insights of a unique multidisciplinary ensemble of expert neurologists, neurosurgeons, neuropsychologists, psychiatrists, scientists, engineers and members of industry. Presentations and discussions covered a broad range of topics, including advocacy for DBS, improving clinical outcomes, innovations in computational models of DBS, understanding of the neurophysiology of Parkinson's disease (PD) and Tourette syndrome (TS) and evolving sensor and device technologies.
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McIntosh LG, Mannava S, Camalier CR, Folley BS, Albritton A, Konrad PE, Charles D, Park S, Neimat JS. Emotion recognition in early Parkinson's disease patients undergoing deep brain stimulation or dopaminergic therapy: a comparison to healthy participants. Front Aging Neurosci 2015; 6:349. [PMID: 25653616 PMCID: PMC4301000 DOI: 10.3389/fnagi.2014.00349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 12/28/2014] [Indexed: 01/24/2023] Open
Abstract
Parkinson's disease (PD) is traditionally regarded as a neurodegenerative movement disorder, however, nigrostriatal dopaminergic degeneration is also thought to disrupt non-motor loops connecting basal ganglia to areas in frontal cortex involved in cognition and emotion processing. PD patients are impaired on tests of emotion recognition, but it is difficult to disentangle this deficit from the more general cognitive dysfunction that frequently accompanies disease progression. Testing for emotion recognition deficits early in the disease course, prior to cognitive decline, better assesses the sensitivity of these non-motor corticobasal ganglia-thalamocortical loops involved in emotion processing to early degenerative change in basal ganglia circuits. In addition, contrasting this with a group of healthy aging individuals demonstrates changes in emotion processing specific to the degeneration of basal ganglia circuitry in PD. Early PD patients (EPD) were recruited from a randomized clinical trial testing the safety and tolerability of deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) in early-staged PD. EPD patients were previously randomized to receive optimal drug therapy only (ODT), or drug therapy plus STN-DBS (ODT + DBS). Matched healthy elderly controls (HEC) and young controls (HYC) also participated in this study. Participants completed two control tasks and three emotion recognition tests that varied in stimulus domain. EPD patients were impaired on all emotion recognition tasks compared to HEC. Neither therapy type (ODT or ODT + DBS) nor therapy state (ON/OFF) altered emotion recognition performance in this study. Finally, HEC were impaired on vocal emotion recognition relative to HYC, suggesting a decline related to healthy aging. This study supports the existence of impaired emotion recognition early in the PD course, implicating an early disruption of fronto-striatal loops mediating emotional function.
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Affiliation(s)
- Lindsey G McIntosh
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA ; Department of Psychology, Vanderbilt University Nashville, TN, USA
| | - Sishir Mannava
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | - Corrie R Camalier
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | | | - Aaron Albritton
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center Nashville, TN, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University Nashville, TN, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
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28
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Charles D, Tolleson C, Davis TL, Gill CE, Molinari AL, Bliton MJ, Tramontana MG, Salomon RM, Kao C, Wang L, Hedera P, Phibbs FT, Neimat JS, Konrad PE. Pilot study assessing the feasibility of applying bilateral subthalamic nucleus deep brain stimulation in very early stage Parkinson's disease: study design and rationale. JOURNAL OF PARKINSONS DISEASE 2014; 2:215-23. [PMID: 23938229 DOI: 10.3233/jpd-2012-012095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Deep brain stimulation provides significant symptomatic benefit for people with advanced Parkinson's disease whose symptoms are no longer adequately controlled with medication. Preliminary evidence suggests that subthalamic nucleus stimulation may also be efficacious in early Parkinson's disease, and results of animal studies suggest that it may spare dopaminergic neurons in the substantia nigra. OBJECTIVE We report the methodology and design of a novel Phase I clinical trial testing the safety and tolerability of deep brain stimulation in early Parkinson's disease and discuss previous failed attempts at neuroprotection. METHODS We recently conducted a prospective, randomized, parallel-group, single-blind pilot clinical trial of deep brain stimulation in early Parkinson's disease. Subjects were randomized to receive either optimal drug therapy or deep brain stimulation plus optimal drug therapy. Follow-up visits occurred every six months for a period of two years and included week-long therapy washouts. RESULTS Thirty subjects with Hoehn & Yahr Stage II idiopathic Parkinson's disease were enrolled over a period of 32 months. Twenty-nine subjects completed all follow-up visits; one patient in the optimal drug therapy group withdrew from the study after baseline. Baseline characteristics for all thirty patients were not significantly different. CONCLUSIONS This study demonstrates that it is possible to recruit and retain subjects in a clinical trial testing deep brain stimulation in early Parkinson's disease. The results of this trial will be used to support the design of a Phase III, multicenter trial investigating the efficacy of deep brain stimulation in early Parkinson's disease.
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Affiliation(s)
- David Charles
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Liu Y, Li W, Tan C, Liu X, Wang X, Gui Y, Qin L, Deng F, Hu C, Chen L. Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease. J Neurosurg 2014; 121:709-18. [PMID: 24905564 DOI: 10.3171/2014.4.jns131711] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECT Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). The globus pallidus internus (GPi) and the subthalamic nucleus (STN) are commonly targeted by this procedure. The purpose of this meta-analysis was to compare the efficacy of DBS in each region. METHODS MEDLINE/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library were searched for English-language studies published before April 2013. RESULTS of studies investigating the efficacy and clinical outcomes of DBS of the GPi and STN for PD were analyzed. RESULTS Six eligible trials containing a total of 563 patients were included in the analysis. Deep brain stimulation of the GPi or STN equally improved motor function, measured by the Unified Parkinson's Disease Rating Scale Section III (UPDRSIII) (motor section, for patients in on- and off-medication phases), within 1 year postsurgery. The change score for the on-medication phase was 0.68 (95% CI - 2.12 to 3.47, p > 0.05; 5 studies, 518 patients) and for the off-medication phase was 1.83 (95% CI - 3.12 to 6.77, p > 0.05; 5 studies, 518 patients). The UPDRS Section II (activities of daily living) scores for patients on medication improved equally in both DBS groups (p = 0.97). STN DBS allowed medication dosages to be reduced more than GPi DBS (95% CI 129.27-316.64, p < 0.00001; 5 studies, 540 patients). Psychiatric symptoms, measured by Beck Depression Inventory, 2nd edition scores, showed greater improvement from baseline after GPi DBS than after STN DBS (standardized mean difference -2.28, 95% CI -3.73 to -0.84, p = 0.002; 3 studies, 382 patients). CONCLUSIONS GPi and STN DBS improve motor function and activities of daily living for PD patients. Differences in therapeutic efficacy for PD were not observed between the 2 procedures. STN DBS allowed greater reduction in medication for patients, whereas GPi DBS provided greater relief from psychiatric symptoms. An understanding of other symptomatic aspects of targeting each region and long-term observations on therapeutic effects are needed.
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Affiliation(s)
- Yi Liu
- Department of Neurology, the Second Affiliated Hospital of Chong Qing Medical University, YuZhong, Chong Qing, China
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30
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Charles D, Konrad PE, Neimat JS, Molinari AL, Tramontana MG, Finder SG, Gill CE, Bliton MJ, Kao C, Phibbs FT, Hedera P, Salomon RM, Cannard KR, Wang L, Song Y, Davis TL. Subthalamic nucleus deep brain stimulation in early stage Parkinson's disease. Parkinsonism Relat Disord 2014; 20:731-7. [PMID: 24768120 DOI: 10.1016/j.parkreldis.2014.03.019] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/06/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective and approved therapy for advanced Parkinson's disease (PD), and a recent study suggests efficacy in mid-stage disease. This manuscript reports the results of a pilot trial investigating preliminary safety and tolerability of DBS in early PD. METHODS Thirty subjects with idiopathic PD (Hoehn & Yahr Stage II off medication), age 50-75, on medication ≥6 months but ≤4 years, and without motor fluctuations or dyskinesias were randomized to optimal drug therapy (ODT) (n = 15) or DBS + ODT (n = 15). Co-primary endpoints were the time to reach a 4-point worsening from baseline in the UPDRS-III off therapy and the change in levodopa equivalent daily dose from baseline to 24 months. RESULTS As hypothesized, the mean UPDRS total and part III scores were not significantly different on or off therapy at 24 months. Medication requirements in the DBS + ODT group were lower at all time points with a maximal difference at 18 months. With a few exceptions, differences in neuropsychological functioning were not significant. Two subjects in the DBS + ODT group suffered serious adverse events; remaining adverse events were mild or transient. CONCLUSIONS This study demonstrates that subjects with early stage PD will enroll in and complete trials testing invasive therapies and provides preliminary evidence that DBS is well tolerated in early PD. The results of this trial provide the data necessary to design a large, phase III, double-blind, multicenter trial investigating the safety and efficacy of DBS in early PD.
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Affiliation(s)
- David Charles
- Department of Neurology, Vanderbilt University Medical Center, USA.
| | - Peter E Konrad
- Department of Neurosurgery, Vanderbilt University Medical Center, USA
| | - Joseph S Neimat
- Department of Neurosurgery, Vanderbilt University Medical Center, USA
| | - Anna L Molinari
- Department of Neurology, Vanderbilt University Medical Center, USA
| | | | - Stuart G Finder
- Center for Healthcare Ethics, Cedars-Sinai Medical Center, USA
| | | | | | - Chris Kao
- Department of Neurosurgery, Vanderbilt University Medical Center, USA
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, USA
| | - Peter Hedera
- Department of Neurology, Vanderbilt University Medical Center, USA
| | - Ronald M Salomon
- Department of Psychiatry, Vanderbilt University Medical Center, USA
| | | | - Lily Wang
- Department of Biostatistics, Vanderbilt University Medical Center, USA
| | - Yanna Song
- Department of Biostatistics, Vanderbilt University Medical Center, USA
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University Medical Center, USA
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Camalier CR, Konrad PE, Gill CE, Kao C, Remple MR, Nasr HM, Davis TL, Hedera P, Phibbs FT, Molinari AL, Neimat JS, Charles D. Methods for Surgical Targeting of the STN in Early-Stage Parkinson's Disease. Front Neurol 2014; 5:25. [PMID: 24678307 PMCID: PMC3958735 DOI: 10.3389/fneur.2014.00025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 02/21/2014] [Indexed: 11/13/2022] Open
Abstract
Patients with Parkinson's disease (PD) experience progressive neurological decline, and future interventional therapies are thought to show most promise in early stages of the disease. There is much interest in therapies that target the subthalamic nucleus (STN) with surgical access. While locating STN in advanced disease patients (Hoehn-Yahr Stage III or IV) is well understood and routinely performed at many centers in the context of deep brain stimulation surgery, the ability to identify this nucleus in early-stage patients has not previously been explored in a sizeable cohort. We report surgical methods used to target the STN in 15 patients with early PD (Hoehn-Yahr Stage II), using a combination of image guided surgery, microelectrode recordings, and clinical responses to macrostimulation of the region surrounding the STN. Measures of electrophysiology (firing rates and root mean squared activity) have previously been found to be lower than in later-stage patients, however, the patterns of electrophysiology seen and dopamimetic macrostimulation effects are qualitatively similar to those seen in advanced stages. Our experience with surgical implantation of Parkinson's patients with minimal motor symptoms suggest that it remains possible to accurately target the STN in early-stage PD using traditional methods.
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Affiliation(s)
- Corrie R Camalier
- Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Peter E Konrad
- Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Chandler E Gill
- Stritch School of Medicine, Loyola University Chicago , Chicago, IL , USA
| | - Chris Kao
- Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Michael R Remple
- Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Hana M Nasr
- Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Thomas L Davis
- Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Peter Hedera
- Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Fenna T Phibbs
- Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Anna L Molinari
- Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA
| | - Joseph S Neimat
- Department of Neurosurgery, Vanderbilt University Medical Center , Nashville, TN , USA
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center , Nashville, TN , USA
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Calcium imaging of infrared-stimulated activity in rodent brain. Cell Calcium 2014; 55:183-90. [PMID: 24674600 DOI: 10.1016/j.ceca.2014.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 01/16/2014] [Accepted: 01/21/2014] [Indexed: 11/20/2022]
Abstract
Infrared neural stimulation (INS) is a promising neurostimulation technique that can activate neural tissue with high spatial precision and without the need for exogenous agents. However, little is understood about how infrared light interacts with neural tissue on a cellular level, particularly within the living brain. In this study, we use calcium sensitive dye imaging on macroscopic and microscopic scales to explore the spatiotemporal effects of INS on cortical calcium dynamics. The INS-evoked calcium signal that was observed exhibited a fast and slow component suggesting activation of multiple cellular mechanisms. The slow component of the evoked signal exhibited wave-like properties suggesting network activation, and was verified to originate from astrocytes through pharmacology and 2-photon imaging. We also provide evidence that the fast calcium signal may have been evoked through modulation of glutamate transients. This study demonstrates that pulsed infrared light can induce intracellular calcium modulations in both astrocytes and neurons, providing new insights into the mechanisms of action of INS in the brain.
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deSouza RM, Moro E, Lang AE, Schapira AHV. Timing of deep brain stimulation in Parkinson disease: a need for reappraisal? Ann Neurol 2013; 73:565-75. [PMID: 23483564 PMCID: PMC4065356 DOI: 10.1002/ana.23890] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 01/27/2023]
Abstract
We review the current application of deep brain stimulation (DBS) in Parkinson disease (PD) and consider the evidence that earlier use of DBS confers long-term symptomatic benefit for patients compared to best medical therapy. Electronic searches were performed of PubMed, Web of Knowledge, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials to identify all article types relating to the timing of DBS in PD. Current evidence suggests that DBS is typically performed in late stage PD, a mean of 14 to 15 years after diagnosis. Current guidelines recommend that PD patients who are resistant to medical therapies, have significant medication side effects and lengthening off periods, but are otherwise cognitively intact and medically fit for surgery be considered for DBS. If these criteria are rigidly interpreted, it may be that, by the time medical treatment options have been exhausted, the disease has progressed to the point that the patient may no longer be fit for neurosurgical intervention. From the evidence available, we conclude that surgical management of PD alone or in combination with medical therapy results in greater improvement of motor symptoms and quality of life than medical treatment alone. There is evidence to support the use of DBS in less advanced PD and that it may be appropriate for earlier stages of the disease than for which it is currently used. The improving short and long-term safety profile of DBS makes early application a realistic possibility.
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Affiliation(s)
- Ruth-Mary deSouza
- Department of Clinical Neurosciences, Institute of Neurology, University College London, London, United Kingdom
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Israeli-Korn SD, Hocherman S, Hassin-Baer S, Cohen OS, Inzelberg R. Subthalamic nucleus deep brain stimulation does not improve visuo-motor impairment in Parkinson's disease. PLoS One 2013; 8:e65270. [PMID: 23776460 PMCID: PMC3679151 DOI: 10.1371/journal.pone.0065270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/23/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate how bilateral subthalamic nucleus deep brain stimulation (STN-DBS) affects visuo-motor coordination (VMC) in patients with Parkinson's disease (PD). BACKGROUND VMC involves multi-sensory integration, motor planning, executive function and attention. VMC deficits are well-described in PD. STN-DBS conveys marked motor benefit in PD, but pyscho-cognitive complications are recognized and the effect on VMC is not known. METHODS Thirteen PD patients with bilateral STN-DBS underwent neurological, cognitive, and mood assessment before VMC testing with optimal DBS stimulation parameters ('on-stimulation') and then, on the same day without any medication changes, after DBS silencing and establishing motor function deterioration ('off-stimulation'). Twelve age-matched healthy controls performed 2 successive VMC testing sessions, with a break of similar duration to that of the PD group. The computer cursor was controlled with a dome-shaped 'mouse' hidden from view that minimized tremor effects. Movement duration, hand velocity, tracking continuity, directional control variables, and feedback utilization variables were measured. MANOVA was performed on (1) clinically measured motor function, (2) VMC performance and (3) mood and attention, looking for main and interaction effects of: (1) group (controls/PD), (2) test-order (controls: first/second, PD: on-stimulation/off-stimulation), (3) path (sine/square/circle) and (4) hand (dominant/non-dominant). RESULTS Unified PD Rating Scale (UPDRS) Part III worsened off-stimulation versus on-stimulation (mean: 42.3 versus 21.6, p = 0.02), as did finger tapping (p = 0.02), posture-gait (p = 0.01), upper limb function (p<0.001) and backwards digit span (p = 0.02). Stimulation state did not affect mood. PD patients performed worse in non-velocity related VMC variables than controls (F(5,18) = 8.5, p<0.001). In the control group there were significant main effects of hand (dominant/non-dominant), path (sine/square/circle) and test-order (Test_1/Test_2). In the PD group, hand and path effects, but no test-order (on-stimulation/off-stimulation), were found. CONCLUSIONS 'Low-level' clinically-measured motor function responds to STN-DBS but 'high-level' motor and cognitive functions relating to VMC may be unresponsive to STN-DBS.
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Affiliation(s)
- Simon D Israeli-Korn
- Parkinson's Disease and Movement Disorders Clinic, Sagol Neuroscience Center and Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.
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35
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Claassen DO, Wylie SA. Trends and issues in characterizing early cognitive changes in Parkinson's disease. Curr Neurol Neurosci Rep 2013; 12:695-702. [PMID: 22949166 DOI: 10.1007/s11910-012-0312-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this review, we first discuss trends and issues in measuring cognitive changes in PD, including recent efforts to define the diagnostic classification of "PD Mild Cognitive Impairment" (PD-MCI). After reviewing some limitations associated with this diagnosis, we discuss how measures derived from the neurocognitive sciences offer better precision in detecting early cognitive changes in PD. To support this idea, we highlight 2 influential lines of current investigation that are unveiling novel insights about specific cognitive processes that are vulnerable early in PD and of critical importance to clinicians involved in treating PD: action control and reward learning and decision making. We conclude by highlighting some extant issues and unresolved questions for future investigations.
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Affiliation(s)
- Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN 37232, USA.
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Abstract
Deep brain stimulation is one of the most effective treatments of Parkinson's disease (PD). This report summarizes the state of the art as at January 2013. Stimulation of the subthalamic nucleus is the most commonly used approach. It improves the core motor symptoms better than medication in patients with advanced disease. It also improves the majority of nonmotor symptoms, such as mood, impulse control disorders, sleep, and some autonomic dysfunctions. Quality of life (QoL) is improved significantly more than with medication. Long-term data show that the treatment is effective for up to 10 years, but the late appearance of l-dopa-resistant symptoms is seemingly not influenced. Internal globus pallidus (GPi) stimulation is less well studied but seems to have similar short-term efficacy. Importantly l-dopa use cannot be reduced with GPi DBS, which is a major disadvantage for patients suffering from medication side-effects, although gait may be influenced more positively. Although short-term QoL improvement seems to be similar to that for subthalamic nucleus (STN) DBS - gait and speech may be better improved - long-term data are rare for GPi DBS. Thalamic stimulation in the ventral intermediate nucleus (VIM) is applied only in tremor-dominant elderly patients. The treatment improves the dopa-sensitive symptoms and effectively reduces fluctuations leading to an overall QoL improvement. Although most of the controlled studies have been on advanced PD, the recently published EARLYSTIM study suggests that even patients with a very short duration of their fluctuations and dyskinesia are doing significantly better with neurostimulation in terms of QoL and all major motor outcome parameters.
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Mizuno Y. An update on the management of juvenile and young-onset Parkinson’s disease. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Early-onset Parkinson’s disease (PD) denotes onset of the disease below the age of 40 years. Patients tend to have a slower disease progression, an increased rate of dystonia, an increased rate of dyskinesias in response to L-3,4-dihydroxyphenylalanine and a lower rate of dementia compared with those in late-onset PD. Early-onset PD patients may experience more social and psychosocial conflict compared with late-onset patients and these factors would contribute to greater impairment of quality of life. Unemployment due to disability or early retirement may be causes for these conflicts. We have to take these factors into account whenever we institute drug therapy in early-onset PD. There is no randomized controlled study on early-onset PD; however, we may make a reasonable decision by considering the data on PD in general and clinical characteristics of early-onset patients. The management of motor and non-motor symptoms of early-onset PD patients is reviewed here.
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Affiliation(s)
- Yoshikuni Mizuno
- Department of Neuroregenerative Medicine, Kitasato University School of Medicine, Kanagawa & Department of Neurology, Juntendo University School of Medicine, Kanagawa 2-1-1 Asamizodai, Minamiku, Sagamihara, 252-0360 Kanagawa, Japan
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