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Ponce FA, Shill HA. What Is "Advanced" Parkinson's Disease? Defining What Determines Medicare Coverage for Deep Brain Stimulation in the USA. Stereotact Funct Neurosurg 2024:1-6. [PMID: 39236686 DOI: 10.1159/000540873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND The National Coverage Determination (NCD) by the Centers for Medicare and Medicaid Services (CMS) for deep brain stimulation requires that a patient have "advanced idiopathic Parkinson's disease (PD) as determined by Hoehn and Yahr (HY) stage or the Unified Parkinson's Disease Rating Scale part III motor subscale (UPDRS III)." How to apply the HY or UPDRS III scales to define "advanced" PD is unclear. SUMMARY There is an ongoing recovery audit by the CMS of deep brain stimulation cases that were covered by Medicare but are deemed not to have met the NCD requirements and therefore not to have been medically necessary. Whether a hospital is asked to refund Medicare often hinges upon whether medical documentation supports the diagnosis of advanced PD. However, neither the HY nor the UPDRS III scales use "advanced" to define or describe stages of PD. The NCD has an accompanying National Coverage Analysis that reviews the studies that inform the NCD. These studies use "advanced" as well as the HY and UPDRS III scales. This review identifies how the HY and UPDRS III scales were used to categorize advanced PD in the studies that were cited in the National Coverage Analysis. KEY MESSAGES In the studies used for the NCD for deep brain stimulation for PD, an HY score ≥3 or a UPDRS III score ≥30 was used to describe patient cohorts considered to have advanced PD.
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Affiliation(s)
- Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Holly A Shill
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Kim Y, Thompson A, Nip ISB. Effects of Deep-Brain Stimulation on Speech: Perceptual and Acoustic Data. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1090-1106. [PMID: 38498664 PMCID: PMC11005955 DOI: 10.1044/2024_jslhr-23-00511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE This study examined speech changes induced by deep-brain stimulation (DBS) in speakers with Parkinson's disease (PD) using a set of auditory-perceptual and acoustic measures. METHOD Speech recordings from nine speakers with PD and DBS were compared between DBS-On and DBS-Off conditions using auditory-perceptual and acoustic analyses. Auditory-perceptual ratings included voice quality, articulation precision, prosody, speech intelligibility, and listening effort obtained from 44 listeners. Acoustic measures were made for voicing proportion, second formant frequency slope, vowel dispersion, articulation rate, and range of fundamental frequency and intensity. RESULTS No significant changes were found between DBS-On and DBS-Off for the five perceptual ratings. Four of six acoustic measures revealed significant differences between the two conditions. While articulation rate and acoustic vowel dispersion increased, voicing proportion and intensity range decreased from the DBS-Off to DBS-On condition. However, a visual examination of the data indicated that the statistical significance was mostly driven by a small number of participants, while the majority did not show a consistent pattern of such changes. CONCLUSIONS Our data, in general, indicate no-to-minimal changes in speech production ensued from DBS stimulation. The findings are discussed with a focus on large interspeaker variability in PD in terms of their speech characteristics and the potential effects of DBS on speech.
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Affiliation(s)
- Yunjung Kim
- School of Communication Science and Disorders, Florida State University, Tallahassee
| | - Austin Thompson
- Department of Communication Sciences and Disorders, University of Houston, TX
| | - Ignatius S. B. Nip
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
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Baláž M, Filip P, Bočková M, Feitová V, Říha I, Hrabovský D, Chrastina J. Successful asymmetrical deep brain stimulation using right subthalamic and left pallidal electrodes in a patient with Parkinson's disease. Br J Neurosurg 2024; 38:356-360. [PMID: 33475016 DOI: 10.1080/02688697.2021.1876210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Despite the best efforts of neurologists, the results of pharmacotherapy in the late stages of Parkinson's disease are often disappointing and accompanied by debilitating side effects. Under these circumstances, deep brain stimulation is a viable treatment option. The aim of the meticulous pre-surgical planning is not only precise electrode implantation, but also the avoidance of intraoperative vascular conflicts potentially causing intracerebral bleeding. MATERIAL AND METHODS In this report, we present a patient with early-onset Parkinson's disease whose cerebral vascular anatomy precluded standard bilateral subthalamic nucleus electrode implantation. Initially, right subthalamic stimulation alone provided a very mild clinical benefit that was not reflected in the patient's quality of life. In this patient, an unusual configuration of intracerebral electrodes with right subthalamic and left pallidal stimulation electrodes was applied 15 months after the initial subthalamic electrode implantation. RESULTS The procedure has had a highly beneficial long-term effect without any significant complications. The greatest improvement was noted using the setting 1.8 V, 130 Hz, 90 μs at the right side (STN) and 3.7 V, 130 Hz, 120 μs at the left side (GPi). This allowed the patient to return to his daily life activities. CONCLUSIONS The reported case provides a new perspective of treatment possibilities in complex functional neurosurgical cases requiring exceptional individualisation of the treatment approach.
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Affiliation(s)
- Marek Baláž
- Medical Faculty, First Department of Neurology, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Pavel Filip
- Medical Faculty, First Department of Neurology, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Martina Bočková
- Medical Faculty, First Department of Neurology, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Věra Feitová
- Medical Faculty, Department of Imaging Techniques, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Ivo Říha
- Medical Faculty, Department of Neurosurgery, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Dušan Hrabovský
- Medical Faculty, Department of Neurosurgery, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Jan Chrastina
- Medical Faculty, Department of Neurosurgery, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
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Liang K, Li RP, Gao Y, Liu C, Wang Q, Gao DM, Wang HM, Zou LY, Zhang X, Han CL, Zhang JG, Meng FG. Emotional symptoms and cognitive function outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts and the volume of tissue activated. CNS Neurosci Ther 2023. [PMID: 36965028 DOI: 10.1111/cns.14187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD), that can improve patients' motor and non-motor symptoms. However, there are differences in the improvement of patients' emotional symptoms and cognitive function. OBJECTIVE To investigate the impact of active contact location and the volume of tissue activated (VTA) on patients' emotional symptoms and cognitive function in STN-DBS in PD. METHODS A total of 185 PD patients were included in this study. We evaluated them using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, Hamilton Anxiety Scale (HAM-A), Hamilton Depression Scale (HAM-D), Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE) scales at the preoperative, 1- and 12-month postoperative time points. Leads were positioned in standard space using the Lead-DBS toolbox, and VTA was calculated for analysis. RESULTS When the lead active contact was closer to the ventral side of the STN, the patients' HAM-A improvement rate was higher, and when the active contact was closer to the anterior and dorsal sides of the STN, the patients' MoCA improvement rate was higher. Stimulation of the sensorimotor zone was more favorable to the improvement of HAM-A and HAM-D in patients. And, the stimulation of the associative zone was more favorable to the improvement of MoCA in patients. CONCLUSION Our results provide evidence that the 12-month outcomes of cognitive function and emotional symptoms in PD patients with STN-DBS were closely related to the specific location of the active contacts in the STN and influenced by the VTA.
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Affiliation(s)
- Kun Liang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ren-Peng Li
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yuan Gao
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chong Liu
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Dong-Mei Gao
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hui-Min Wang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liang-Ying Zou
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Lei Han
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Chinese Institute for Brain Research, Beijing (CIBR), Beijing, China
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Avecillas-Chasin JM. Letter to the Editor. Dopaminergic transmission as the mechanism of action of STN-DBS. J Neurosurg 2023; 138:295-296. [PMID: 36115052 DOI: 10.3171/2022.7.jns221572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Tripoliti E, Ramig L. Elektrische Stimulation tiefer Hirnstrukturen: Auswirkungen auf das Sprechen. SPRACHE · STIMME · GEHÖR 2022. [DOI: 10.1055/a-1941-3588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Adam EM, Brown EN, Kopell N, McCarthy MM. Deep brain stimulation in the subthalamic nucleus for Parkinson's disease can restore dynamics of striatal networks. Proc Natl Acad Sci U S A 2022; 119:e2120808119. [PMID: 35500112 PMCID: PMC9171607 DOI: 10.1073/pnas.2120808119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly effective in alleviating movement disability in patients with Parkinson’s disease (PD). However, its therapeutic mechanism of action is unknown. The healthy striatum exhibits rich dynamics resulting from an interaction of beta, gamma, and theta oscillations. These rhythms are essential to selection and execution of motor programs, and their loss or exaggeration due to dopamine (DA) depletion in PD is a major source of behavioral deficits. Restoring the natural rhythms may then be instrumental in the therapeutic action of DBS. We develop a biophysical networked model of a BG pathway to study how abnormal beta oscillations can emerge throughout the BG in PD and how DBS can restore normal beta, gamma, and theta striatal rhythms. Our model incorporates STN projections to the striatum, long known but understudied, found to preferentially target fast-spiking interneurons (FSI). We find that DBS in STN can normalize striatal medium spiny neuron activity by recruiting FSI dynamics and restoring the inhibitory potency of FSIs observed in normal conditions. We also find that DBS allows the reexpression of gamma and theta rhythms, thought to be dependent on high DA levels and thus lost in PD, through cortical noise control. Our study highlights that DBS effects can go beyond regularizing BG output dynamics to restoring normal internal BG dynamics and the ability to regulate them. It also suggests how gamma and theta oscillations can be leveraged to supplement DBS treatment and enhance its effectiveness.
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Affiliation(s)
- Elie M. Adam
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Emery N. Brown
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114
| | - Nancy Kopell
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215
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Eisinger RS, Cagle JN, Alcantara JD, Opri E, Cernera S, Le A, Torres Ponce EM, Lanese J, Nelson B, Lopes J, Hundley C, Ravy T, Wu SS, Foote KD, Okun MS, Gunduz A. Distinct Roles of the Human Subthalamic Nucleus and Dorsal Pallidum in Parkinson's Disease Impulsivity. Biol Psychiatry 2022; 91:370-379. [PMID: 33993998 PMCID: PMC8419208 DOI: 10.1016/j.biopsych.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Impulsivity and impulse control disorders are common in Parkinson's disease and lead to increased morbidity and reduced quality of life. Impulsivity is thought to arise from aberrant reward processing and inhibitory control, but it is unclear why deep brain stimulation of either the subthalamic nucleus (STN) or globus pallidus internus (GPi) affects levels of impulsivity. Our aim was to assess the role of the STN and GPi in impulsivity using invasive local field potential (LFP) recordings from deep brain stimulation electrodes. METHODS We measured LFPs during a simple rewarding Go/NoGo paradigm in 39 female and male human patients with Parkinson's disease manifesting variable amounts of impulsivity who were undergoing unilateral deep brain stimulation of either the STN (18 nuclei) or GPi (28 nuclei). We identified reward-specific LFP event-related potentials and correlated them to impulsivity severity. RESULTS LFPs in both structures modulated during reward-specific Go and NoGo stimulus evaluation, reward feedback, and loss feedback. Motor and limbic functions were anatomically separable in the GPi but not in the STN. Across participants, LFP reward processing responses in the STN and GPi uniquely depended on the severity of impulsivity. CONCLUSIONS This study establishes LFP correlates of impulsivity within the STN and GPi regions. We propose a model for basal ganglia reward processing that includes the bottom-up role of the GPi in reward salience and the top-down role of the STN in cognitive control.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, Gainesville, Florida.
| | - Jackson N Cagle
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Jose D Alcantara
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Enrico Opri
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Stephanie Cernera
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Anh Le
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | | | - Joseph Lanese
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Brawn Nelson
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Janine Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | | | - Tasmeah Ravy
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - Michael S Okun
- Department of Neuroscience, University of Florida, Gainesville, Florida; Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida; Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, Florida; J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
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Voice handicap Index in Parkinson's patients: Subthalamic versus globus pallidus deep brain stimulation. J Clin Neurosci 2022; 98:83-88. [PMID: 35151061 DOI: 10.1016/j.jocn.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/22/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Subthalamic nucleus (STN) and globus pallidus interna (GPI) are the two most common sites for deep brain stimulation (DBS) in people with Parkinson's disease (PWP). Voice impairments are a common symptom of Parkinson's disease and information about voice outcomes with DBS is limited. Most studies in speech-language pathology have focused on STN-DBS and few have examined the effects of GPI-DBS. This was an initial effort to examine the impact of DBS location on Vocal Handicap Index (VHI) scores, which assess the impact of a voice disorder on an individual. METHOD Twenty-four gender-matched PWP (12 STN-DBS and 12 GPI-DBS) completed the VHI post-DBS implantation. Two-tailed independent samples t-tests were used to compare each VHI scale score (physical, functional, emotional, total) and patient factors between the two groups. RESULTS No significant differences in total or subscale VHI scores were identified between the two DBS groups. A trend toward greater impairment in PWP with GPI-DBS was noted. An association between higher VHI scores and DBS settings was found. CONCLUSIONS Studies directly comparing speech outcomes for different DBS targets are lacking. The current findings provide new insights concerning voice outcomes following DBS by adding to the limited literature directly comparing speech outcomes in multiple DBS targets. Limitations and directions for future research are discussed.
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McCarter SJ, Savica R. Autopallidotomy: From Colloquial Term to Scientific Theory. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2009-2013. [PMID: 36120793 PMCID: PMC9661314 DOI: 10.3233/jpd-223491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
Levodopa-induced dyskinesia (LID), a frequent complication of Parkinson's disease (PD), occurs in ∼30% of patients after five years' treatment with levodopa. In atypical parkinsonism, LID occurs less frequently than in PD. Lower frequency of LID in atypical parkinsonism has traditionally been attributed to lower amounts of levodopa used by these patients; however, recent studies have shown lower frequency of LID in atypical parkinsonism compared with PD when adjusting for levodopa dose. The mechanism of LID is complex but requires pulsatile levodopa stimulation, progressive presynaptic dopaminergic degeneration, and a relatively intact postsynaptic dopaminergic system. The globus pallidus internus (GPi), the main inhibitory nucleus of the basal ganglia, may play a major role in the development and treatment of LID. Surgical lesioning of the posteroventral GPi is directly antidyskinetic; animal models showing GPi-associated striatal neurons are directly responsible for the development of LID. However, other cortical areas, particularly the primary sensory and motor cortices may also play a role in LID. In some cases of atypical parkinsonism, particularly progressive supranuclear palsy and corticobasal degeneration, severe degeneration of the GPi, a so-called "autopallidotomy," may explain the absence of LID in these patients. In other atypical parkinsonisms, such as PD dementia and dementia with Lewy bodies, the lower incidence of LID may partly be attributed to more striatal degeneration but likely also relates to the degeneration of the motor cortex and resultant network dysfunction. Overall, atypical parkinsonism serves as a natural model that may ultimately reveal more effective therapies for LID.
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Affiliation(s)
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Lin Z, Zhang C, Li D, Sun B. Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review. Mov Disord Clin Pract 2021; 9:140-155. [PMID: 35146054 DOI: 10.1002/mdc3.13379] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
- Shanghai Research Center for Brain Science and Brain‐Inspired Intelligence Shanghai China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
- Center for Functional Neurosurgery Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Institute of Clinical Neuroscience Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine Shanghai China
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Au KLK, Wong JK, Tsuboi T, Eisinger RS, Moore K, Lemos Melo Lobo Jofili Lopes J, Holland MT, Holanda VM, Peng-Chen Z, Patterson A, Foote KD, Ramirez-Zamora A, Okun MS, Almeida L. Globus Pallidus Internus (GPi) Deep Brain Stimulation for Parkinson's Disease: Expert Review and Commentary. Neurol Ther 2021; 10:7-30. [PMID: 33140286 PMCID: PMC8140010 DOI: 10.1007/s40120-020-00220-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/08/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The globus pallidus internus (GPi) region has evolved as a potential target for deep brain stimulation (DBS) in Parkinson's disease (PD). DBS of the GPi (GPi DBS) is an established, safe and effective method for addressing many of the motor symptoms associated with advanced PD. It is important that clinicians fully understand this target when considering GPi DBS for individual patients. METHODS The literature on GPi DBS in PD has been comprehensively reviewed, including the anatomy, physiology and potential pitfalls that may be encountered during surgical targeting and post-operative management. Here, we review and address the implications of lead location on GPi DBS outcomes. Additionally, we provide a summary of randomized controlled clinical trials conducted on DBS in PD, together with expert commentary on potential applications of the GPi as target. Finally, we highlight future technologies that will likely impact GPi DBS, including closed-loop adaptive approaches (e.g. sensing-stimulating capabilities), advanced methods for image-based targeting and advances in DBS programming, including directional leads and pulse shaping. RESULTS There are important disease characteristics and factors to consider prior to selecting the GPi as the DBS target of PD surgery. Prior to and during implantation of the leads it is critical to consider the neuroanatomy, which can be defined through the combination of image-based targeting and intraoperative microelectrode recording strategies. There is an increasing body of literature on GPi DBS in patients with PD suggesting both short- and long-term benefits. Understanding the GPi target can be useful in choosing between the subthalamic (STN), GPi and ventralis intermedius nucleus as lead locations to address the motor symptoms and complications of PD. CONCLUSION GPi DBS can be effectively used in select cases of PD. As the ongoing DBS target debate continues (GPi vs. STN as DBS target), clinicians should keep in mind that GPi DBS has been shown to be an effective treatment strategy for a variety of symptoms, including bradykinesia, rigidity and tremor control. GPi DBS also has an important, direct anti-dyskinetic effect. GPi DBS is easier to program in the outpatient setting and will allow for more flexibility in medication adjustments (e.g. levodopa). Emerging technologies, including GPi closed-loop systems, advanced tractography-based targeting and enhanced programming strategies, will likely be future areas of GPi DBS expansion. We conclude that although the GPi as DBS target may not be appropriate for all PD patients, it has specific clinical advantages.
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Affiliation(s)
- Ka Loong Kelvin Au
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
| | - Joshua K Wong
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Takashi Tsuboi
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kathryn Moore
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | | | - Marshall T Holland
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Vanessa M Holanda
- Center of Neurology and Neurosurgery Associates (CENNA), Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Mayo Clinic Jackonsville, Jacksonville, FL, USA
| | - Zhongxing Peng-Chen
- Facultad de Medicina Clínica Alemana, Hospital Padre Hurtado-Universidad del Desarrollo, Santiago, Chile
| | - Addie Patterson
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Departments of Neurology and Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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Monteferrante NR, Wilhelmi BG, Lambert M, Ponce FA. Effects of implantation of a deep brain stimulation device on patient weight in Parkinson's disease and essential tremor. J Neurosurg 2021; 134:1624-1630. [PMID: 32442969 DOI: 10.3171/2020.2.jns192354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is a well-established therapy for treating neurological movement disorders. Some patients who have received DBS therapy have noticed significant weight gain. Further investigation into correlations between patient characteristics and weight gain following DBS device implantation, which the authors here have done, will provide physicians with useful clinical information. METHODS The authors performed a retrospective study of patients with Parkinson's disease (PD) and essential tremor (ET) who had received DBS therapy in the period from 2012 to 2017. Patient weights had been recorded preoperatively and at 3, 6, and 12 months postoperatively. These data were used to compare patient characteristics, including diagnosis, body mass index (BMI), sex, levodopa equivalent dose (LED), and change in Unified Parkinson's Disease Rating Scale (UPDRS) score. For PD patients, a quantile multivariate regression analysis was used to examine whether significant correlations existed between several of these patient characteristics, as well as age and weight gain following implantation. RESULTS PD patients had gained a significant amount of weight at 3 months (mean [SE] 2.66 [0.428] kg, p < 0.001), 6 months (3.64 [0.492] kg, p < 0.001), and 12 months (4.18 [0.540] kg, p < 0.001) after DBS placement. Patients who had undergone subthalamic nucleus (STN) DBS device placement gained, on average, more weight than the patients with globus pallidus internus (GPi) placement at both 6 months (mean 2.558 [1.020] kg, p = 0.01) and 12 months (2.358 [1.130] kg, p = 0.04). BMI in the STN cohort was greater than that in the GPi cohort at 6 months (mean difference [SE] 2.60 [1.127] kg/m2, p = 0.02) and at 12 months (2.36 [1.112] kg/m2, p = 0.04). A reduction in LED was negatively correlated with weight change at 6 months (r = -0.33, p < 0.001) and 12 months (r = -0.41, p < 0.001). There was no weight gain correlated with DBS therapy for ET. CONCLUSIONS PD patients experienced a significant change in weight over time after DBS therapy, whereas ET patients did not. PD patients with an STN target site experienced greater weight gain, on average, than those with a GPi target site. Furthermore, there was a significant increase in BMI at 6 and 12 months in patients with an STN target compared to that in patients with a GPi target. PD patients whose LED was reduced after DBS gained more weight at 6 and 12 months after surgery than the patients whose LED was kept at the same level or increased.
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Affiliation(s)
| | - Brian G Wilhelmi
- 2Department of Anesthesiology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center; and
| | - Margaret Lambert
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Francisco A Ponce
- 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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14
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Liu J, Ding H, Xu K, Liu R, Wang D, Ouyang J, Liu Z, Miao Z. Pallidal versus subthalamic deep-brain stimulation for meige syndrome: a retrospective study. Sci Rep 2021; 11:8742. [PMID: 33888857 PMCID: PMC8062505 DOI: 10.1038/s41598-021-88384-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/12/2021] [Indexed: 11/09/2022] Open
Abstract
Deep-brain stimulation (DBS) is an effective treatment for patients with Meige syndrome. The globus pallidus interna (GPi) and the subthalamic nucleus (STN) are accepted targets for this treatment. We compared 12-month outcomes for patients who had undergone bilateral stimulation of the GPi or STN. Forty-two Asian patients with primary Meige syndrome who underwent GPi or STN neurostimulation were recruited between September 2017 and September 2019 at the Department of Neurosurgery, Peking University People's Hospital. The primary outcome was the change in motor function, including the Burke-Fahn-Marsden Dystonia Rating Scale movement (BFMDRS-M) and disability subscale (BFMDRS-D) at 3 days before DBS (baseline) surgery and 1, 3, 6, and 12 months after surgery. Secondary outcomes included health-related quality of life, sleep quality status, depression severity, and anxiety severity at 3 days before and 12 months after DBS surgery. Adverse events during the 12 months were also recorded. Changes in BFMDRS-M and BFMDRS-D scores at 1, 3, 6, and 12 months with DBS and without medication did not significantly differ based on the stimulation target. There were also no significant differences in the changes in health-related quality of life (36-Item Short-Form General Health Survey) and sleep quality status (Pittsburgh Sleep Quality Index) at 12 months. However, there were larger improvements in the STN than the GPi group in mean score changes on the 17-item Hamilton depression rating scale (- 3.38 vs. - 0.33 points; P = 0.014) and 14-item Hamilton anxiety rating scale (- 3.43 vs. - 0.19 points; P < 0.001). There were no significant between-group differences in the frequency or type of serious adverse events. Patients with Meige syndrome had similar improvements in motor function, quality of life and sleep after either pallidal or subthalamic stimulation. Depression and anxiety factors may reasonably be included during the selection of DBS targets for Meige syndrome.
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Affiliation(s)
- Jiayu Liu
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China
| | - Hu Ding
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China
| | - Ke Xu
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China.
| | - Dongliang Wang
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China
| | - Jia Ouyang
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China
| | - Zhi Liu
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China
| | - Zeyu Miao
- Department of Neurosurgery, Peking University People's Hospital, 11th Xizhimen South St., Beijing, 100044, China
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15
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Movement disorder surgery Part I: historical background and principle of surgery. BJA Educ 2021; 21:133-139. [PMID: 33777411 DOI: 10.1016/j.bjae.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 11/22/2022] Open
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16
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Shen L, Jiang C, Hubbard CS, Ren J, He C, Wang D, Dahmani L, Guo Y, Liu Y, Xu S, Meng F, Zhang J, Liu H, Li L. Subthalamic Nucleus Deep Brain Stimulation Modulates 2 Distinct Neurocircuits. Ann Neurol 2020; 88:1178-1193. [PMID: 32951262 DOI: 10.1002/ana.25906] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Current understanding of the neuromodulatory effects of deep brain stimulation (DBS) on large-scale brain networks remains elusive, largely due to the lack of techniques that can reveal DBS-induced activity at the whole-brain level. Using a novel 3T magnetic resonance imaging (MRI)-compatible stimulator, we investigated whole-brain effects of subthalamic nucleus (STN) stimulation in patients with Parkinson disease. METHODS Fourteen patients received STN-DBS treatment and participated in a block-design functional MRI (fMRI) experiment, wherein stimulations were delivered during "ON" blocks interleaved with "OFF" blocks. fMRI responses to low-frequency (60Hz) and high-frequency(130Hz) STN-DBS were measured 1, 3, 6, and 12 months postsurgery. To ensure reliability, multiple runs (48 minutes) of fMRI data were acquired at each postsurgical visit. Presurgical resting-state fMRI (30 minutes) data were also acquired. RESULTS Two neurocircuits showed highly replicable, but distinct responses to STN-DBS. A circuit involving the globus pallidus internus (GPi), thalamus, and deep cerebellar nuclei was significantly activated, whereas another circuit involving the primary motor cortex (M1), putamen, and cerebellum showed DBS-induced deactivation. These 2 circuits were dissociable in terms of their DBS-induced responses and resting-state functional connectivity. The GPi circuit was frequency-dependent, selectively responding to high-frequency stimulation, whereas the M1 circuit was responsive in a time-dependent manner, showing enhanced deactivation over time. Finally, activation of the GPi circuit was associated with overall motor improvement, whereas M1 circuit deactivation was related to reduced bradykinesia. INTERPRETATION Concurrent DBS-fMRI using 3T revealed 2 distinct circuits that responded differentially to STN-DBS and were related to divergent symptoms, a finding that may provide novel insights into the neural mechanisms underlying DBS. ANN NEUROL 2020;88:1178-1193.
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Affiliation(s)
- Lunhao Shen
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Changqing Jiang
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Catherine S Hubbard
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Jianxun Ren
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Changgeng He
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Danhong Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Louisa Dahmani
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Yi Guo
- Peking Union Medical College Hospital, Beijing, China
| | - Yiming Liu
- Qilu Hospital of Shandong University, Jinan, China
| | - Shujun Xu
- Qilu Hospital of Shandong University, Jinan, China
| | - Fangang Meng
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.,Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China.,Precision Medicine & Healthcare Research Center, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, China.,IDG(International Data Group)/McGovern Institute for Brain Research at Tsinghua University, Beijing, China.,Institute of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
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17
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Eisinger RS, Scott BM, Le A, Ponce EMT, Lanese J, Hundley C, Nelson B, Ravy T, Lopes J, Thompson S, Sathish S, O'Connell RL, Okun MS, Bowers D, Gunduz A. Pavlovian bias in Parkinson's disease: an objective marker of impulsivity that modulates with deep brain stimulation. Sci Rep 2020; 10:13448. [PMID: 32778775 PMCID: PMC7417529 DOI: 10.1038/s41598-020-69760-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
Impulsivity is a common symptom in Parkinson's disease (PD). Adaptive behavior is influenced by prepotent action-reward and inaction-avoid loss Pavlovian biases. We aimed to assess the hypothesis that impulsivity in PD is associated with Pavlovian bias, and to assess whether dopaminergic medications and deep brain stimulation (DBS) influence Pavlovian bias. A PD DBS cohort (N = 37) completed a reward-based Go/No-Go task and bias measures were calculated. This DBS cohort completed the task under three conditions: on-med/pre-DBS, off-med/off-DBS, and on-med/on-DBS. Participants also completed self-reported measures of impulsivity. Dopaminergic medication was associated with lower action-reward bias while DBS was associated with higher action-reward bias. Impulsivity was associated with higher action-reward bias but not inaction-avoid loss bias. We furthermore replicated this association in an independent, non-DBS PD cohort (N = 88). Overall we establish an objective behavioral marker of impulsivity and show that DBS affects impulsivity by amplifying automated responding. Our results point to the importance of reward rather than punishment avoidance in driving impulsive behaviors. This work provides insight into the pathophysiological underpinnings of impulsivity and especially medication and DBS-associated impulsivity in PD.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA.
| | - Bonnie M Scott
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Anh Le
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Elena M Torres Ponce
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Joseph Lanese
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Christopher Hundley
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Brawn Nelson
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Tasmeah Ravy
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
| | - Janine Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Sable Thompson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sneha Sathish
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rebecca L O'Connell
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, 1275 Center Drive, Gainesville, FL, 32611, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
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18
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Tsuboi T, Lemos Melo Lobo Jofili Lopes J, Patel B, Legacy J, Moore K, Eisinger RS, Almeida L, Foote KD, Okun MS, Ramirez-Zamora A. Parkinson's disease motor subtypes and bilateral GPi deep brain stimulation: One-year outcomes. Parkinsonism Relat Disord 2020; 75:7-13. [PMID: 32428801 DOI: 10.1016/j.parkreldis.2020.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We aimed to explore the differences in motor symptoms and quality of life (QOL) outcomes following bilateral globus pallidus internus deep brain stimulation (GPi DBS), across well-defined motor subtypes of Parkinson's disease (PD), to improve clinical decision making. METHODS This single-center retrospective study investigated bilateral GPi DBS outcomes in 65 PD patients. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS) and Parkinson's Disease Questionnaire (PDQ-39) before and one year after surgery. Outcomes were compared between the tremor-dominant (TD) and postural instability and gait difficulty (PIGD) subtypes and between the TD and akinetic-rigid (AR) subtypes. RESULTS For the entire cohort, motor function (UPDRS III) in the Off-medication state, motor complications (UPDRS IV), activities of daily living (ADL, UPDRS II), and the ADL and discomfort domains of PDQ-39 significantly improved one year following GPi implantation compared to baseline (effect size = 1.32, 1.15, 0.25, 0.45, and 0.34, respectively). GPi DBS improved the Off-medication UPDRS III scores regardless of the motor subtypes. However, compared to the PIGD and AR patients, the TD patients showed greater improvement in overall UPDRS III postoperatively primarily due to greater tremor improvement in the Off-medication state. The outcomes in akinesia, rigidity, axial symptoms and QOL were similar among all subtypes. CONCLUSION Bilateral GPi DBS was effective for advanced PD patients regardless of motor subtypes. Greater tremor improvement in the TD patients accounted for greater Off-medication motor improvement. Longer-term GPi DBS outcomes across different motor subtypes and brain targets should be further studied.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | | | - Bhavana Patel
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Joseph Legacy
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kathryn Moore
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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19
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Muller J, Alizadeh M, Mohamed FB, Riley J, Pearce JJ, Trieu B, Liang TW, Romo V, Sharan A, Wu C. Clinically applicable delineation of the pallidal sensorimotor region in patients with advanced Parkinson's disease: study of probabilistic and deterministic tractography. J Neurosurg 2019; 131:1520-1531. [PMID: 30554176 DOI: 10.3171/2018.7.jns18541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/16/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective procedure in improving motor symptoms for patients with advanced Parkinson's disease (PD) through the use of high-frequency stimulation. Although one of the most commonly used target sites for DBS, sensorimotor regions of the globus pallidus interna (GPi) have yet to be thoroughly described with advanced neuroimaging analysis in vivo for human subjects. Furthermore, many imaging studies to date have been performed in a research setting and bring into question the feasibility of their applications in a clinical setting, such as for surgical planning. This study compares two different tractography methods applied to clinically feasible acquisition sequences in identifying sensorimotor regions of the GPi and the subthalamic nucleus (STN) in patients with advanced PD selected to undergo DBS. METHODS Seven patients with refractory PD selected for DBS were examined by MRI. Diffusion images were acquired with an average acquisition time of 15 minutes. Probabilistic and deterministic tractography methods were applied to each diffusion-weighted data set using FSL and MRtrix, respectively. Fiber assignment was performed using combined sensorimotor areas as initiation seeds and the STN and GPi, separately, as inclusion masks. Corticospinal tracts were excluded by setting the cerebral peduncles as exclusion masks. Variability between proposed techniques was shown using center of gravity (CoG) coordinates. RESULTS Deterministic and probabilistic corticopallidal and corticosubthalamic pathways were successfully reconstructed for all subjects across all target sites (bilaterally). Both techniques displayed large connections between the sensorimotor cortex with the posterolateral aspect of the ipsilateral GPi and the posterosuperolateral aspect of the ipsilateral STN. The average variability was 2.67 mm, with the probabilistic method identifying the CoG consistently more posterior and more lateral than the deterministic method. CONCLUSIONS Successful delineation of the sensorimotor regions in both the GPi and STN is achievable within a clinically reasonable timeframe. The techniques described in this paper may enhance presurgical planning with increased accuracy and improvement of patient outcomes in patients undergoing DBS. The variability found between tracking techniques warrants the use of the probabilistic tractography method over the deterministic method for presurgical planning. Probabilistic tractography was found to have an advantage over deterministic tractography in its sensitivity, in accurately describing previously described tracts, and in its ability to detect a larger number of fibers.
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Affiliation(s)
| | | | | | | | | | - Benjamin Trieu
- 4College of Liberal Arts, Temple University, Philadelphia, Pennsylvania
| | | | - Victor Romo
- 6Anesthesiology, Thomas Jefferson University; and
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20
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Rughani A, Schwalb JM, Sidiropoulos C, Pilitsis J, Ramirez-Zamora A, Sweet JA, Mittal S, Espay AJ, Martinez JG, Abosch A, Eskandar E, Gross R, Alterman R, Hamani C. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation for the Treatment of Patients With Parkinson's Disease: Executive Summary. Neurosurgery 2019. [PMID: 29538685 DOI: 10.1093/neuros/nyy037] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
QUESTION 1 Is bilateral subthalamic nucleus deep brain stimulation (STN DBS) more, less, or as effective as bilateral globus pallidus internus deep brain stimulation (GPi DBS) in treating motor symptoms of Parkinson's disease, as measured by improvements in Unified Parkinson's Disease Rating Scale, part III (UPDRS-III) scores? RECOMMENDATION Given that bilateral STN DBS is at least as effective as bilateral GPi DBS in treating motor symptoms of Parkinson's disease (as measured by improvements in UPDRS-III scores), consideration can be given to the selection of either target in patients undergoing surgery to treat motor symptoms. (Level I). QUESTION 2 Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in allowing reduction of dopaminergic medication in Parkinson's disease? RECOMMENDATION When the main goal of surgery is reduction of dopaminergic medications in a patient with Parkinson's disease, then bilateral STN DBS should be performed instead of GPi DBS. (Level I). QUESTION 3 Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in treating dyskinesias associated with Parkinson's disease? RECOMMENDATION There is insufficient evidence to make a generalizable recommendation regarding the target selection for reduction of dyskinesias. However, when the reduction of medication is not anticipated and there is a goal to reduce the severity of "on" medication dyskinesias, the GPi should be targeted. (Level I). QUESTION 4 Is bilateral STN DBS more, less, or as effective as bilateral GPi DBS in improving quality of life measures in Parkinson's disease? RECOMMENDATION When considering improvements in quality of life in a patient undergoing DBS for Parkinson's disease, there is no basis to recommend bilateral DBS in 1 target over the other. (Level I). QUESTION 5 Is bilateral STN DBS associated with greater, lesser, or a similar impact on neurocognitive function than bilateral GPi DBS in Parkinson disease? RECOMMENDATION If there is significant concern about cognitive decline, particularly in regards to processing speed and working memory in a patient undergoing DBS, then the clinician should consider using GPi DBS rather than STN DBS, while taking into consideration other goals of surgery. (Level I). QUESTION 6 Is bilateral STN DBS associated with a higher, lower, or similar risk of mood disturbance than GPi DBS in Parkinson's disease? RECOMMENDATION If there is significant concern about the risk of depression in a patient undergoing DBS, then the clinician should consider using pallidal rather than STN stimulation, while taking into consideration other goals of surgery. (Level I). QUESTION 7 Is bilateral STN DBS associated with a higher, lower, or similar risk of adverse events compared to GPi DBS in Parkinson's disease? RECOMMENDATION There is insufficient evidence to recommend bilateral DBS in 1 target over the other in order to minimize the risk of surgical adverse events. The full guideline can be found at: https://www.cns.org/guidelines/deep-brain-stimulation-parkinsons-disease.
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Affiliation(s)
- Anand Rughani
- Neuroscience Institute, Maine Medical Center, Portland, Maine
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Gr-oup, West Bloomfield, Michigan
| | | | - Julie Pilitsis
- Departments of Neuroscience and Experimental Therapeutics and of Neurosurgery, Albany Medical College, Albany, New York
| | | | - Jennifer A Sweet
- Department of Neuro-surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sandeep Mittal
- De-partment of Neurosurgery, Wayne State University, Detroit, Michigan
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio
| | | | - Aviva Abosch
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Emad Eskandar
- Department of Neurological Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert Gross
- Department of Neu-rosurgery, Emory University, Atlanta, Georgia
| | - Ron Alterman
- Division of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massa-chusetts
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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21
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Changes in Personality Associated with Deep Brain Stimulation: a Qualitative Evaluation of Clinician Perspectives. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09419-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Lachenmayer M, Bettschen C, Bernasconi C, Petermann K, Debove I, Muellner J, Michelis J, Burgunder J, Krauss J, Oertel M, Pollo C, Kaelin-Lang A, Schüpbach M. Stimulation of the globus pallidus internus in the treatment of Parkinson's disease: Long-term results of a monocentric cohort. Parkinsonism Relat Disord 2019; 64:118-123. [DOI: 10.1016/j.parkreldis.2019.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
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Eisinger RS, Ramirez-Zamora A, Carbunaru S, Ptak B, Peng-Chen Z, Okun MS, Gunduz A. Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease. Front Neurol 2019; 10:86. [PMID: 30863353 PMCID: PMC6399407 DOI: 10.3389/fneur.2019.00086] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) have a high cumulative incidence and negatively impact quality of life. ICDs are influenced by a complex interaction of multiple factors. Although it is now well-recognized that dopaminergic treatments and especially dopamine agonists underpin many ICDs, medications alone are not the sole cause. Susceptibility to ICD is increased in the setting of PD. While causality can be challenging to ascertain, a wide range of modifiable and non-modifiable risk factors have been linked to ICDs. Common characteristics of PD patients with ICDs have been consistently identified across many studies; for example, males with an early age of PD onset and dopamine agonist use have a higher risk of ICD. However, not all cases of ICDs in PD can be directly attributable to dopamine, and studies have concluded that additional factors such as genetics, smoking, and/or depression may be more predictive. Beyond dopamine, other ICD associations have been described but remain difficult to explain, including deep brain stimulation surgery, especially in the setting of a reduction in dopaminergic medication use. In this review, we will summarize the demographic, genetic, behavioral, and clinical contributions potentially influencing ICD onset in PD. These associations may inspire future preventative or therapeutic strategies.
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Affiliation(s)
- Robert S. Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Samuel Carbunaru
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Brandon Ptak
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Zhongxing Peng-Chen
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Michael S. Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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Chang AY, Dutta G, Siddiqui S, Arumugam PU. Surface Fouling of Ultrananocrystalline Diamond Microelectrodes during Dopamine Detection: Improving Lifetime via Electrochemical Cycling. ACS Chem Neurosci 2019; 10:313-322. [PMID: 30285418 DOI: 10.1021/acschemneuro.8b00257] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In this work, we report the electrochemical response of a boron-doped ultrananocrystalline diamond (BDUNCD) microelectrode during long-term dopamine (DA) detection. Specifically, changes to its electrochemical activity and electroactive area due to DA byproducts and surface oxidation are studied via scanning electron microscopy, energy dispersive spectroscopy, electrochemical impedance spectroscopy, and silver deposition imaging (SDI). The fouling studies with amperometry (AM) and fast scan cyclic voltammetry (FSCV) methods suggest that the microelectrodes are heavily fouled due to poor DA-dopamine- o-quinone cyclization rates followed by a combination of polymer formation and major changes in their surface chemistry. SDI data confirms the presence of the insulating polymer with sparsely distributed tiny electroactive regions. This resulted in severely distorted DA signals and a 90% loss in signal starting as early as 3 h for AM and a 56% loss at 6.5 h for FSCV. This underscores the need for cleaning of the fouled microelectrodes if they have to be used long-term. Out of the three in vivo suitable electrochemical cycling cleaning waveforms investigated, the standard waveform (-0.4 V to +1.0 V) provides the best cleaned surface with a fully retained voltammogram shape, no hysteresis, no DA signal loss (a 90 ± 0.72 nA increase), and the smallest charge transfer resistance value of 0.4 ± 0.02 MΩ even after 6.5 h of monitoring. Most importantly, this is the same waveform that is widely used for in vivo detection with carbon fiber microelectrodes. Future work to test these microelectrodes for more than 24 h of DA detection is anticipated.
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Affiliation(s)
- An-Yi Chang
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
| | - Gaurab Dutta
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
| | - Shabnam Siddiqui
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
| | - Prabhu U. Arumugam
- Institute for Micromanufacturing, Louisiana Tech University, 911 Hergot Avenue, Ruston, Louisiana 71272, United States
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Doshi P, Chamankar N. Globus Pallidus Internal Deep-Brain Stimulation in a Patient with Neuroacanthocytosis with Drug-Induced Parkinsonism. Stereotact Funct Neurosurg 2018; 96:276. [PMID: 30153676 DOI: 10.1159/000492234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/18/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Paresh Doshi
- Department of Neurosurgery and Stereotactic and Functional Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, India
| | - Nikhil Chamankar
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, India
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Negida A, Elminawy M, El Ashal G, Essam A, Eysa A, Abd Elalem Aziz M. Subthalamic and Pallidal Deep Brain Stimulation for Parkinson's Disease. Cureus 2018; 10:e2232. [PMID: 29713577 PMCID: PMC5919761 DOI: 10.7759/cureus.2232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 02/26/2018] [Indexed: 01/21/2023] Open
Abstract
Deep brain stimulation (DBS) is a surgical treatment in which stimulation electrodes are permanently implanted in basal ganglia to treat motor fluctuations and symptoms of Parkinson's disease (PD). Subthalamic nucleus (STN) and globus pallidus internus (GPi) are the commonly used targets for DBS in PD. Many studies have compared motor and non-motor outcomes of DBS in both targets. However, the selection of PD patients for DBS targets is still poorly studied. Therefore, we performed this narrative review to summarize published studies comparing STN DBS and GPi DBS. GPi DBS is better for patients with problems in speech, mood, or cognition while STN DBS is better from an economic point of view as it allows much reduction in antiparkinson medications and less battery consumption.
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Affiliation(s)
- Ahmed Negida
- Faculty of Medicine, Zagazig University, Egypt, Zagazig University, Egypt
| | - Mohamed Elminawy
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Athar Eysa
- Faculty of Medicine, Menoufia University
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Cordon I, Nicolás MJ, Arrieta S, Alegre M, Artieda J, Valencia M. Theta-phase closed-loop stimulation induces motor paradoxical responses in the rat model of Parkinson disease. Brain Stimul 2017; 11:231-238. [PMID: 29051091 DOI: 10.1016/j.brs.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/04/2017] [Accepted: 10/05/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND High-frequency deep brain stimulation (DBS) has become a widespread therapy used in the treatment of Parkinson's Disease (PD) and other diseases. Although it has proved beneficial, much recent attention has been centered around the potential of new closed-loop DBS implementations. OBJECTIVE Here we present a new closed-loop DBS scheme based on the phase of the theta activity recorded from the motor cortex. By testing the implementation on freely moving 6-OHDA lesioned and control rats, we assessed the behavioral and neurophysiologic effects of this implementation and compared it against the classical high-frequency DBS. RESULTS Results show that both stimulation modalities produce significant and opposite changes on the movement and neurophysiological activity. Close-loop stimulation, far from improving the animals' behavior, exert contrary effects to those of high-frequency DBS which reverts the parkinsonian symptoms. Motor improvement during open-loop, high-frequency DBS was accompanied by a reduction in the amount of cortical beta oscillations while akinetic and disturbed behavior during close-loop stimulation coincided with an increase in the amplitude of beta activity. CONCLUSION Cortical-phase-dependent close-loop stimulation of the STN exerts significant behavioral and oscillatory changes in the rat model of PD. Open-loop and close-loop stimulation outcomes differed dramatically, thus suggesting that the scheme of stimulation determines the output of the modulation even if the target structure is maintained. The current framework could be extended in future studies to identify the correct parameters that would provide a suitable control signal to the system. It may well be that with other stimulation parameters, this sort of DBS could be beneficial.
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Affiliation(s)
- Ivan Cordon
- Neuroscience Program, Center for Applied Medical Research, University of Navarra, 31008 Pamplona, Spain; Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - María Jesús Nicolás
- Neuroscience Program, Center for Applied Medical Research, University of Navarra, 31008 Pamplona, Spain; Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Sandra Arrieta
- Neuroscience Program, Center for Applied Medical Research, University of Navarra, 31008 Pamplona, Spain; Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Manuel Alegre
- Neuroscience Program, Center for Applied Medical Research, University of Navarra, 31008 Pamplona, Spain; Navarra Institute for Health Research, 31008 Pamplona, Spain; Neurophysiology Service, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Spain
| | - Julio Artieda
- Neuroscience Program, Center for Applied Medical Research, University of Navarra, 31008 Pamplona, Spain; Navarra Institute for Health Research, 31008 Pamplona, Spain; Neurophysiology Service, Clínica Universidad de Navarra, University of Navarra, 31008 Pamplona, Spain.
| | - Miguel Valencia
- Neuroscience Program, Center for Applied Medical Research, University of Navarra, 31008 Pamplona, Spain; Navarra Institute for Health Research, 31008 Pamplona, Spain.
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Shah VV, Goyal S, Palanthandalam-Madapusi HJ. A Possible Explanation of How High-Frequency Deep Brain Stimulation Suppresses Low-Frequency Tremors in Parkinson's Disease. IEEE Trans Neural Syst Rehabil Eng 2017; 25:2498-2508. [PMID: 28866595 DOI: 10.1109/tnsre.2017.2746623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder of the central nervous system and one of its key symptoms is rest tremor. Deep brain stimulation (DBS) effectively suppresses rest tremor in Parkinson's disease. Despite being a successful treatment option, its underlying principle and the mechanism by which it attenuates tremors is not yet fully understood. Since existing methods for tuning DBS parameters are largely trial and error, understanding how DBS works can help to reduce time and costs, and could also ultimately lead to better treatment strategies for PD. In this paper, we set out to analyze how a high-frequency stimulation applied through DBS can help reduce the low-frequency rest tremors observed in PD patients. We identify key elements in the sensorimotor loop (the feedback loop consisting of sensory feedbacks and motor responses) that play a role in the interaction of high-frequency DBS signal and the low-frequency tremor. Based on the analysis of these elements, we draw insights about the working of DBS and the role of frequency and the nature of stimulation. We verify these observations with numerical examples and a bench top experimental example.
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Saenger VM, Kahan J, Foltynie T, Friston K, Aziz TZ, Green AL, van Hartevelt TJ, Cabral J, Stevner ABA, Fernandes HM, Mancini L, Thornton J, Yousry T, Limousin P, Zrinzo L, Hariz M, Marques P, Sousa N, Kringelbach ML, Deco G. Uncovering the underlying mechanisms and whole-brain dynamics of deep brain stimulation for Parkinson's disease. Sci Rep 2017; 7:9882. [PMID: 28851996 PMCID: PMC5574998 DOI: 10.1038/s41598-017-10003-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/28/2017] [Indexed: 12/01/2022] Open
Abstract
Deep brain stimulation (DBS) for Parkinson's disease is a highly effective treatment in controlling otherwise debilitating symptoms. Yet the underlying brain mechanisms are currently not well understood. Whole-brain computational modeling was used to disclose the effects of DBS during resting-state functional Magnetic Resonance Imaging in ten patients with Parkinson's disease. Specifically, we explored the local and global impact that DBS has in creating asynchronous, stable or critical oscillatory conditions using a supercritical bifurcation model. We found that DBS shifts global brain dynamics of patients towards a Healthy regime. This effect was more pronounced in very specific brain areas such as the thalamus, globus pallidus and orbitofrontal regions of the right hemisphere (with the left hemisphere not analyzed given artifacts arising from the electrode lead). Global aspects of integration and synchronization were also rebalanced. Empirically, we found higher communicability and coherence brain measures during DBS-ON compared to DBS-OFF. Finally, using our model as a framework, artificial in silico DBS was applied to find potential alternative target areas for stimulation and whole-brain rebalancing. These results offer important insights into the underlying large-scale effects of DBS as well as in finding novel stimulation targets, which may offer a route to more efficacious treatments.
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Affiliation(s)
- Victor M Saenger
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Joshua Kahan
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Tim J van Hartevelt
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Joana Cabral
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
| | - Angus B A Stevner
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Henrique M Fernandes
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - John Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Paulo Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga, Portugal
- Clinical Academic Center, 4710-057, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga, Portugal
- Clinical Academic Center, 4710-057, Braga, Portugal
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom.
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark.
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- Instituci Catalana de la Recerca i Estudis Avanats (ICREA), Universitat Pompeu Fabra, Barcelona, 08010, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103, Leipzig, Germany
- School of Psychological Sciences, Monash University, Clayton VIC, 3800, Melbourne, Australia
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Thompson JA, Yin D, Ojemann SG, Abosch A. Use of the Putamen as a Surrogate Anatomical Marker for the Internal Segment of the Globus Pallidus in Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2017; 95:229-235. [DOI: 10.1159/000478105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 06/08/2017] [Indexed: 12/25/2022]
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Xu H, Zheng F, Krischek B, Ding W, Xiong C, Wang X, Niu C. Subthalamic nucleus and globus pallidus internus stimulation for the treatment of Parkinson's disease: A systematic review. J Int Med Res 2017; 45:1602-1612. [PMID: 28701061 PMCID: PMC5718722 DOI: 10.1177/0300060517708102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Deep brain stimulation (DBS) for treatment of advanced Parkinson’s disease (PD) has two anatomical targets: the subthalamic nucleus (STN) and the globus pallidus internus (GPI). The clinical effectiveness of these two stimulation targets was compared in the present study. Methods A systematic review and meta-analysis was performed to evaluated the postoperative changes in the United Parkinson’s Disease Rating Scale (UPDRS) on- and off-phase, on-stimulation motor scores; activities of daily living score (ADLS); and levodopa equivalent dose (LED) after STN and GPI stimulation. Randomized and nonrandomized controlled trials of PD treated by STN and GPI stimulation were considered for inclusion. Results Eight published reports of eligible studies involving 599 patients met the inclusion criteria. No significant differences were observed between the STN and GPI groups in the on-medication, on-stimulation UPDRS motor score [mean difference, 2.15; 95% confidence interval (CI), −0.96–5.27] or ADLS (mean difference, 3.40; 95% CI, 0.95–7.76). Significant differences in favor of STN stimulation were noted in the off-medication, on-stimulation UPDRS motor score (mean difference, 1.67; 95% CI, 0.98–2.37) and LED (mean difference, 130.24; 95% CI, 28.82–231.65). Conclusion The STN may be the preferred target for DBS in consideration of medication reduction, economic efficiency, and motor function improvement in the off phase. However, treatment decisions should be made according to the individual patient’s symptoms and expectations.
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Affiliation(s)
- Hao Xu
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.,2 Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Zheng
- 3 Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China.,4 Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Boris Krischek
- 4 Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - Wanhai Ding
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Chi Xiong
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xin Wang
- 5 Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Chaoshi Niu
- 1 Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
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Dall AM, Danielsen EH, Sørensen JC, Andersen F, Møller A, Zimmer J, Gjedde AH, Cumming P, Zimmer J, Brevig T, Dall AM, Meyer M, Pedersen EB, Gjedde A, Danielsen EH, Cumming P, Andersen F, Bender D, Falborg L, Gee A, Gillings NM, Hansen SB, Hermansen F, Jørgensen HA, Munk O, Poulsen PH, Rodell AB, Sakoh M, Simonsen CZ, Smith DF, Sørensen JC, Østergård L, Moller A, Johansen TE. Quantitative [18F]Fluorodopa/PET and Histology of Fetal Mesencephalic Dopaminergic Grafts to the Striatum of MPTP-Poisoned Minipigs. Cell Transplant 2017. [DOI: 10.3727/000000002783985314] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The functional restoration of the dopamine innervation of striatum in MPTP-poisoned Göttingen minipigs was assessed for 6 months following grafting of fetal pig mesencephalic neurons. Pigs were assigned to a normal control group and a MPTP-poisoned group, members of which received no further treatment, or which received bilateral grafts to the striatum of tissue blocks harvested from E28 fetal pig mesencephalon with and without immunosuppressive treatment after grafting, or with additional co-grafting with immortalized rat neural cells transfected to produce GDNF. In the baseline condition, and again at 3 and 6 months postsurgery, all animals were subjected to quantitative [18F]fluorodopa PET scans and testing for motor impairment. At the end of 6 months, tyrosine hydroxylase (TH)-containing neurons were counted in the grafts by stereological methods. The MPTP poisoning persistently reduced the magnitude of k3D, the relative activity of DOPA decarboxylase in striatum, by 60%. Grafting restored the rate of [18F]fluorodopa decarboxylation to the normal range, and normalized the scores in motor function. The biochemical and functional recovery was associated with survival of approximately 100,000 TH-positive graft neurons in each hemisphere. Immunosuppression did not impart a greater recovery of [18F]fluorodopa uptake, nor were the number of TH-positive graft neurons or the volumes of the grafts increased in the immunosuppressed group. Contrary to expectation, co-grafting of transfected GDNF-expressing HiB5 cells, a rat-derived neural cell line, tended to impair the survival of the grafts with the lowest values for graft volumes, TH-positive cell numbers, behavioral scores, and relative DOPA decarboxylase activity. From the results we conclude that pig ventral mesencephalic allografts can restore functional dopamine innervation in adult MPTP-lesioned minipigs.
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Affiliation(s)
- Annette Møller Dall
- Department of Anatomy and Neurobiology, University of Southern Denmark, 5000 Odense C, Denmark
| | | | | | | | | | - Jens Zimmer
- Department of Anatomy and Neurobiology, University of Southern Denmark, 5000 Odense C, Denmark
| | - Albert H. Gjedde
- Department of Anatomy and Neurobiology, University of Southern Denmark, 5000 Odense C, Denmark
- McGill University, Montreal, Quebec, Canada
| | - Paul Cumming
- PET Centre, Aarhus General Hospital, 8000 Aarhus C, Denmark
| | - J. Zimmer
- Department of Anatomy and Neurobiology, SDU Odense University
| | - T. Brevig
- Department of Anatomy and Neurobiology, SDU Odense University
| | - A. M. Dall
- Department of Anatomy and Neurobiology, SDU Odense University
| | - M. Meyer
- Department of Anatomy and Neurobiology, SDU Odense University
| | - E. B. Pedersen
- Department of Anatomy and Neurobiology, SDU Odense University
| | - A. Gjedde
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - E. H. Danielsen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - P. Cumming
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - F. Andersen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - D. Bender
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - L. Falborg
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - A. Gee
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - N. M. Gillings
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - S. B. Hansen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - F. Hermansen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - H. A. Jørgensen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - O. Munk
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - P. H. Poulsen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - A. B. Rodell
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - M. Sakoh
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - C. Z. Simonsen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - D. F. Smith
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - J. C. Sørensen
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
| | - L. Østergård
- PET-Center and Departments of Neuroradiology, Neurosurgery, Neuroanaesthesia, and Biological Psychiatry, Aarhus University Hospital
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Ryu HS, Kim MS, You S, Kim MJ, Kim YJ, Kim J, Kim K, Chung SJ. Comparison of Pallidal and Subthalamic Deep Brain Stimulation in Parkinson's Disease: Therapeutic and Adverse Effects. J Mov Disord 2017; 10:80-86. [PMID: 28479586 PMCID: PMC5435836 DOI: 10.14802/jmd.17001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/07/2017] [Accepted: 03/13/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the therapeutic and adverse effects of globus pallidus interna (GPi) and subthalamic nucleus (STN) deep brain stimulation (DBS) for the treatment of advanced Parkinson's disease (PD). METHODS We retrospectively analyzed the clinical data of patients with PD who underwent GPi (n = 14) or STN (n = 28) DBS surgery between April 2002 and May 2014. The subjects were matched for age at surgery and disease duration. The Unified Parkinson's Disease Rating Scale (UPDRS) scores and levodopa equivalent dose (LED) at baseline and 12 months after surgery were used to assess the therapeutic effects of DBS. Adverse effects were also compared between the two groups. RESULTS At 12 months, the mean changes in the UPDRS total and part I-IV scores did not differ significantly between the two groups. However, the subscores for gait disturbance/postural instability and dyskinesia were significantly more improved after GPi DBS than those after STN DBS (p = 0.024 and 0.016, respectively). The LED was significantly more reduced in patients after STN DBS than that after GPi DBS (p = 0.004). Serious adverse effects did not differ between the two groups (p = 0.697). CONCLUSION The patients with PD showed greater improvement in gait disturbance/postural instability and dyskinesia after GPi DBS compared with those after STN DBS, although the patients had a greater reduction in LED after STN DBS. These results may provide useful information for optimal target selection for DBS in PD.
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Affiliation(s)
- Ho-Sung Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi-Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sooyeoun You
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Mi-Jung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Neurology, Best Heals Hospital, Ansan, Korea
| | - Juyeon Kim
- Department of Neurology, Metro Hospital, Anyang, Korea
| | - Kiju Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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de Haan S, Rietveld E, Stokhof M, Denys D. Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations. PLoS One 2017; 12:e0175748. [PMID: 28426824 PMCID: PMC5398533 DOI: 10.1371/journal.pone.0175748] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/30/2017] [Indexed: 11/19/2022] Open
Abstract
Does DBS change a patient's personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson's disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.
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Affiliation(s)
- Sanneke de Haan
- The Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Faculty of Philosophy, Theology and Religious Studies, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Erik Rietveld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin Stokhof
- Institute for Logic, Language and Computation, Department of Philosophy, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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Park SC, Lee CS, Kim SM, Choi EJ, Lee JK. Comparison of the Stereotactic Accuracies of Function-Guided Deep Brain Stimulation, Calculated Using Multitrack Target Locations Geometrically Inferred from Three-Dimensional Trajectory Rotations, and of Magnetic Resonance Imaging-Guided Deep Brain Stimulation and Outcomes. World Neurosurg 2017; 98:734-749.e7. [DOI: 10.1016/j.wneu.2016.11.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
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Kasemsuk C, Oyama G, Hattori N. Management of impulse control disorders with deep brain stimulation: A double-edged sword. J Neurol Sci 2017; 374:63-68. [PMID: 28126343 DOI: 10.1016/j.jns.2017.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/06/2017] [Indexed: 12/29/2022]
Abstract
Deep brain stimulation (DBS) is a surgical option for advanced Parkinson's disease. Although DBS is used to treat motor fluctuation, DBS may affect non-motor symptoms including mood disorders, cognitive dysfunction, and behavior problems. Impulse control disorders (ICDs) are abnormal behaviors with various manifestations such as pathological gambling, hypersexuality, compulsive shopping, and binge eating, which can affect the quality of life in patients with Parkinson's disease. The effect of DBS on ICD is controversial. Reducing medication by DBS may improve ICDs, however, worsening or even developing new ICDs after DBS can occur. We will review the impact of DBS on ICDs and reveal factors associated with a good response to DBS as well as risk factors for developing ICDs after DBS. We also propose a strategy to manage preexisting ICD and prevent postoperative de novo ICDs.
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Affiliation(s)
- Chayut Kasemsuk
- Department of Neurology, Juntendo University, Faculty of Medicine, Tokyo, Japan; Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
| | - Genko Oyama
- Department of Neurology, Juntendo University, Faculty of Medicine, Tokyo, Japan.
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University, Faculty of Medicine, Tokyo, Japan
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Bonenfant J, Drapier S, Houvenaghel JF, Naudet F, Haegelen C, Sauleau P, Vérin M. Pallidal stimulation in Parkinson's patients with contraindications to subthalamic target: A 3 years follow-up. Parkinsonism Relat Disord 2016; 34:20-25. [PMID: 27751649 DOI: 10.1016/j.parkreldis.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Over a 3-year period, we monitored the efficacy and safety of deep-brain stimulation of the globus pallidus pars interna in patients with advanced Parkinson's disease whose cognitive, psychiatric impairment and/or dopa-resistant axial motor signs made them ineligible for surgery targeting the subthalamic nucleus. METHODS A total of 25 patients were assessed before surgery, 1 year and 3 years after surgery, on the UPDRS and a neuropsychological battery. RESULTS We noted a significant improvement of 65.9% in the Clinical global self-perceived Improvement by Visual Analog Scale and an improvement of 20.6% in the total UPDRS-III motor score at 3 years in the off-dopa condition compared to before surgery. There was an improvement in the treatment's motor complications, as measured by the UPDRS-IV, with a particularly marked reduction of 50% in the Dyskinesia subscore. Cognitive performances remained stable at 1 year but had fallen by the third year. We interpreted this deterioration as due to disease progression. CONCLUSION Bilateral pallidal stimulation in patients with contraindications to subthalamic surgery therefore seems to be effective over the long term in treating motor symptoms, especially dyskinesias, with good neuropsychological safety.
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Affiliation(s)
- Julien Bonenfant
- Department of Neurology, University Hospital of Rennes, 35043 Rennes, France.
| | - Sophie Drapier
- Department of Neurology, University Hospital of Rennes, 35043 Rennes, France; "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France
| | - Jean François Houvenaghel
- Department of Neurology, University Hospital of Rennes, 35043 Rennes, France; "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France
| | - Florian Naudet
- Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Rennes University Hospital, 35033 Rennes, France
| | - Claire Haegelen
- Department of Neurosurgery, Rennes University Hospital, 35033 Rennes, France; "MediCIS" Laboratory (UMR 1099 LTSI), INSERM/University of Rennes 1, Rennes, France
| | - Paul Sauleau
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France; Department of Neurophysiology, Rennes University Hospital, F-35033 Rennes, France
| | - Marc Vérin
- Department of Neurology, University Hospital of Rennes, 35043 Rennes, France; "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, 35043 Rennes, France.
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Towards a Better Treatment Option for Parkinson’s Disease: A Review of Adult Neurogenesis. Neurochem Res 2016; 41:3161-3170. [DOI: 10.1007/s11064-016-2053-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 02/04/2023]
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Shenai MB, Romeo A, Walker HC, Guthrie S, Watts RL, Guthrie BL. Spatial topographies of unilateral subthalamic nucleus deep brain stimulation efficacy for ipsilateral, contralateral, midline, and total Parkinson disease motor symptoms. Neurosurgery 2015; 11 Suppl 2:80-8; discussion 88. [PMID: 25599197 DOI: 10.1227/neu.0000000000000613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation is a successful intervention for medically refractory Parkinson disease, although its efficacy depends on optimal electrode placement. Even though the predominant effect is observed contralaterally, modest improvements in ipsilateral and midline symptoms are also observed. OBJECTIVE To elucidate the role of contact location of unilateral deep brain stimulation on contralateral, ipsilateral, and axial subscores of Parkinson disease motor symptoms. METHODS Eighty-six patients receiving first deep brain stimulation STN electrode placements were identified, yielding 73 patients with 3-month follow-up. Total preoperative and postoperative Unified Parkinson Disease Rating Scale Part III scores were obtained and divided into contralateral, ipsilateral, and midline subscores. Contact location was determined on immediate postoperative magnetic resonance imaging. A 3-dimensional ordinary "kriging" algorithm generated spatial interpolations for total, ipsilateral, contralateral, and midline symptom categories. Interpolative reconstructions were performed in the axial planes (z = -0.5, -1.0, -1.5, -3.5, -4.5, -6.0) and a sagittal plane (x = 12.0). Interpolation error and significance were quantified by use of a cross-validation technique and quantile-quantile analysis. RESULTS There was an overall reduction in Unified Parkinson Disease Rating Scale Part III symptoms: total = 37.0 ± 24.11% (P < .05), ipsilateral = 15.9 ± 51.8%, contralateral = 56.2 ± 26.8% (P < .05), and midline = 26.5 ± 34.7%. Kriging interpolation was performed and cross-validated with quantile-quantile analysis with high correlation (R2 > 0.92) and demonstrated regions of efficacy for each symptom category. Contralateral symptoms demonstrated broad regions of efficacy across the peri-STN area. The ipsilateral and midline regions of efficacy were constrained and located along the dorsal STN and caudal zona incerta. CONCLUSION We provide evidence for a unique functional topographic window in which contralateral, ipsilateral, and midline structures may achieve the best efficacy. Although there are overlapping regions, laterality demonstrates distinct topographies. Surgical optimization should target the intersection of optimal regions for these symptom categories.
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Affiliation(s)
- Mahesh B Shenai
- *Department of Neuroscience, Inova Health System, Falls Church, Virginia, ‡Department of Neurosurgery, and §Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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Angeli A, Akram H, Zacharia A, Limousin P, Hariz M, Zrinzo L, Foltynie T. Varying time-course of effects of high frequency stimulation of sub-regions of the globus pallidus in patients with parkinson's disease. Parkinsonism Relat Disord 2015; 21:597-602. [DOI: 10.1016/j.parkreldis.2015.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 11/28/2022]
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Katz M, Luciano MS, Carlson K, Luo P, Marks WJ, Larson PS, Starr PA, Follett KA, Weaver FM, Stern MB, Reda DJ, Ostrem JL. Differential effects of deep brain stimulation target on motor subtypes in Parkinson's disease. Ann Neurol 2015; 77:710-9. [DOI: 10.1002/ana.24374] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Maya Katz
- Department of Neurology; University of California; San Francisco and Parkinson's Disease Research; Education, and Clinical Center, San Francisco Veterans Affairs Medical Center; San Francisco CA
| | - Marta San Luciano
- Department of Neurology; University of California; San Francisco and Parkinson's Disease Research; Education, and Clinical Center, San Francisco Veterans Affairs Medical Center; San Francisco CA
| | - Kimberly Carlson
- Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development; Washington DC
| | - Ping Luo
- Domenic Reda and Kimberly Carlson Hines VA Cooperative Studies Program Coordinating Center; Hines; IL USA
| | - William J. Marks
- Department of Neurology; University of California; San Francisco and Parkinson's Disease Research; Education, and Clinical Center, San Francisco Veterans Affairs Medical Center; San Francisco CA
| | - Paul S. Larson
- Department of Neurological Surgery; University of California; San Francisco San Francisco CA
| | - Philip A. Starr
- Department of Neurological Surgery; University of California; San Francisco San Francisco CA
| | - Kenneth A. Follett
- Department of Neurosurgery; University of Nebraska Medical Center; Omaha NE
| | - Frances M. Weaver
- Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, Hines, IL, USA Stritch School of Medicine; Loyola University; Maywood IL, USA
| | - Matthew B. Stern
- Department of Neurology; University of Pennsylvania School of Medicine; Philadelphia PA
| | - Domenic J. Reda
- Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development; Washington DC
| | - Jill L. Ostrem
- Department of Neurology; University of California; San Francisco and Parkinson's Disease Research; Education, and Clinical Center, San Francisco Veterans Affairs Medical Center; San Francisco CA
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Galvan A, Devergnas A, Wichmann T. Alterations in neuronal activity in basal ganglia-thalamocortical circuits in the parkinsonian state. Front Neuroanat 2015; 9:5. [PMID: 25698937 PMCID: PMC4318426 DOI: 10.3389/fnana.2015.00005] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/10/2015] [Indexed: 12/15/2022] Open
Abstract
In patients with Parkinson’s disease and in animal models of this disorder, neurons in the basal ganglia and related regions in thalamus and cortex show changes that can be recorded by using electrophysiologic single-cell recording techniques, including altered firing rates and patterns, pathologic oscillatory activity and increased inter-neuronal synchronization. In addition, changes in synaptic potentials or in the joint spiking activities of populations of neurons can be monitored as alterations in local field potentials (LFPs), electroencephalograms (EEGs) or electrocorticograms (ECoGs). Most of the mentioned electrophysiologic changes are probably related to the degeneration of diencephalic dopaminergic neurons, leading to dopamine loss in the striatum and other basal ganglia nuclei, although degeneration of non-dopaminergic cell groups may also have a role. The altered electrical activity of the basal ganglia and associated nuclei may contribute to some of the motor signs of the disease. We here review the current knowledge of the electrophysiologic changes at the single cell level, the level of local populations of neural elements, and the level of the entire basal ganglia-thalamocortical network in parkinsonism, and discuss the possible use of this information to optimize treatment approaches to Parkinson’s disease, such as deep brain stimulation (DBS) therapy.
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Affiliation(s)
- Adriana Galvan
- Yerkes National Primate Research Center, Emory University Atlanta, GA, USA ; Department of Neurology, School of Medicine, Emory University Atlanta, GA, USA ; Udall Center of Excellence for Parkinson's Disease Research, Emory University Atlanta, GA, USA
| | - Annaelle Devergnas
- Yerkes National Primate Research Center, Emory University Atlanta, GA, USA ; Udall Center of Excellence for Parkinson's Disease Research, Emory University Atlanta, GA, USA
| | - Thomas Wichmann
- Yerkes National Primate Research Center, Emory University Atlanta, GA, USA ; Department of Neurology, School of Medicine, Emory University Atlanta, GA, USA ; Udall Center of Excellence for Parkinson's Disease Research, Emory University Atlanta, GA, USA
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Intranasal delivery of stem cells as therapy for central nervous system disease. Exp Mol Pathol 2015; 98:145-51. [PMID: 25645932 DOI: 10.1016/j.yexmp.2015.01.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/29/2015] [Indexed: 12/13/2022]
Abstract
Stem cells, upon entering the CNS, can preferentially migrate into disease foci, where they exert therapeutic effects that compensate for lost tissue, reconstructing damaged neuronal circuitry and establishing in the brain a new microenvironment suitable for cell survival. However, the route of stem cell delivery into the CNS remains a challenge: with systemic administration (e.g., intravenous injection), a fraction of cells may be trapped in other organs than the CNS, while direct CNS injections, e.g., intracerebroventricular or transcranial, are invasive. Intranasal (i.n.) delivery of stem cells, in contrast, can effectively bypass the blood-brain barrier, rapidly enter the CNS, and minimize systemic distribution. I.n. delivery of stem cells may therefore be a safe and non-invasive way of targeting the CNS and would thus be a promising therapeutic option for CNS disease. In this review we discuss the i.n. route for stem cell delivery into the CNS, and the perspectives of i.n. stem cell-based therapy in CNS disease.
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Abstract
Objective:To examine predictive factors associated with onset of depression among individuals diagnosed with Parkinson's disease (PD).Background:Depression may precede or follow symptomatic parkinsonism in PD. It is frequently treatable but often overlooked.Methods:The clinical series comprised 685 individuals who were diagnosed with PD and followed by one neurologist (RJU) from 1994 to 2007. The primary outcome was time to depression following the onset of PD. Diagnosis of depression was based on clinical assessment of depressive symptoms from patients (and spouse/family/caregiver) and antidepressant usage. A number of demographic, historical and clinical predictive factors were examined, including gender, age at symptomatic onset, disease duration, onset characteristics, clinical ratings, antiparkinsonian medications, cognitive status, depression history, and familial history of PD and other neurodegenerative disorders.Results:Seventy-two percent of patients developed depression within ten years of symptomatic PD onset, and the mean time to depression was 7.9 years (median: 5.7 years). Factors associated with depression included longer PD duration, greater impairment in activities of daily living, and positive family history of motor neuron disease (MND).Conclusions:A high rate of individuals with PD develop depressive symptoms during the course of the disease. Based on first clinic visit characteristics, most factors examined were not helpful in identifying individuals with an increased risk of depression. However, disease duration, functional limitations and family history of MND should lead clinicians to an increased vigilance for identifying depression.
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Fluchere F, Witjas T, Eusebio A, Bruder N, Giorgi R, Leveque M, Peragut JC, Azulay JP, Regis J. Controlled general anaesthesia for subthalamic nucleus stimulation in Parkinson's disease. J Neurol Neurosurg Psychiatry 2014; 85:1167-73. [PMID: 24249783 DOI: 10.1136/jnnp-2013-305323] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the short-term (1 year) and long-term (5 years) outcome of patients with Parkinson's disease (PD) with subthalamic nucleus (STN) stimulation operated upon under controlled general anaesthesia (GA). METHODS 213 consecutive patients with PD were included between January 2000 and March 2009 and operated upon under a particular type of GA with close control of the level of sedation allowing intraoperative recordings. 188 patients were assessed 1 year postoperatively. 65 patients also completed the long-term observation period and were evaluated 5 years postoperatively. RESULTS The Unified PD Rating Scale III score in the 'Off drug--On stim' condition was improved at 1 year and 5 years by 61% and 37%, respectively, (p<0.001). Motor complications decreased at short-term and long-term by 68% and 65%, respectively, for dyskinesia and by 52% and 48%, respectively, for fluctuations, (p<0.001). Dopaminergic treatment could also be reduced at short-term and long-term by 46% and 49%, respectively (p<0.001). There was no significant modification of mood and cognition assessments (Mattis scale and Beck depression inventory) at 1 year and 5 years. Concerning the main adverse events related to the surgery, we report four haematomas (1.9%) with two deaths (0.9%), eight cases of transient confusion (3.7%) and no epileptic seizure. CONCLUSIONS Our results confirm that STN stimulation performed under controlled GA is efficient and has similar short-term and long-term motor effects than intervention under local anaesthesia. Furthermore, this specific procedure is not associated with more adverse events. The success of such an intervention requires strict anaesthetic monitoring and accurate STN identification.
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Affiliation(s)
- F Fluchere
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
| | - T Witjas
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Univ, CNRS, Marseille, Cedex, France
| | - A Eusebio
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Univ, CNRS, Marseille, Cedex, France
| | - N Bruder
- Department of Anesthesiology, APHM, La Timone, Aix-Marseille Univ, Marseille, Cedex, France
| | - R Giorgi
- Service de Santé Publique et d'Information Médicale and LERTIM, APHM, La Timone, Aix-Marseille Univ, Marseille, Cedex, France
| | - M Leveque
- Department of Stereotactic and Functional Neurosurgery, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
| | - J-C Peragut
- Department of Stereotactic and Functional Neurosurgery, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
| | - J-P Azulay
- Department of Neurology and Movement Disorders, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France Institut de Neurosciences de la Timone UMR 7289 Aix Marseille Univ, CNRS, Marseille, Cedex, France
| | - J Regis
- Department of Stereotactic and Functional Neurosurgery, APHM, La Timone, Pôle de Neurosciences cliniques, Aix-Marseille Univ, Marseille, Cedex, France
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Clinical experience in the Hospital Central Militar with bilateral deep brain stimulation of ventro-medial globus pallidus in patients with Parkinson's disease. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2014. [DOI: 10.1016/j.hgmx.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Subjective visual vertical in Pisa syndrome. Parkinsonism Relat Disord 2014; 20:878-83. [DOI: 10.1016/j.parkreldis.2014.04.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/21/2014] [Accepted: 04/28/2014] [Indexed: 11/18/2022]
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Choi CW, Kim PS, Shin SA, Yang JY, Yang YS. Lateral geniculate body evoked potentials elicited by visual and electrical stimulation. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:337-42. [PMID: 25120343 PMCID: PMC4120355 DOI: 10.3341/kjo.2014.28.4.337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/12/2013] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Blind individuals who have photoreceptor loss are known to perceive phosphenes with electrical stimulation of their remaining retinal ganglion cells. We proposed that implantable lateral geniculate body (LGB) stimulus electrode arrays could be used to generate phosphene vision. We attempted to refine the basic reference of the electrical evoked potentials (EEPs) elicited by microelectrical stimulations of the optic nerve, optic tract and LGB of a domestic pig, and then compared it to visual evoked potentials (VEPs) elicited by short-flash stimuli. METHODS For visual function measurement, VEPs in response to short-flash stimuli on the left eye of the domestic pig were assessed over the visual cortex at position Oz with the reference electrode at Fz. After anesthesia, linearly configured platinum wire electrodes were inserted into the optic nerve, optic track and LGB. To determine the optimal stimulus current, EEPs were recorded repeatedly with controlling the pulse and power. The threshold of current and charge density to elicit EEPs at 0.3 ms pulse duration was about ±10 µA. RESULTS Our experimental results showed that visual cortex activity can be effectively evoked by stimulation of the optic nerve, optic tract and LGB using penetrating electrodes. The latency of P1 was more shortened as the electrical stimulation was closer to LGB. The EEPs of two-channel in the visual cortex demonstrated a similar pattern with stimulation of different spots of the stimulating electrodes. We found that the LGB-stimulated EEP pattern was very similar to the simultaneously generated VEP on the control side, although implicit time deferred. CONCLUSIONS EEPs and VEPs derived from visual-system stimulation were compared. The LGB-stimulated EEP wave demonstrated a similar pattern to the VEP waveform except implicit time, indicating prosthetic-based electrical stimulation of the LGB could be utilized for the blind to perceive vision of phosphenes.
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Affiliation(s)
- Chang Wook Choi
- Department of Ophthalmology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Pan Sang Kim
- Department of Ophthalmology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Sun Ae Shin
- Department of Ophthalmology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Ji Yeon Yang
- Hanson Institute, University of Adelaide, Adelaide, Australia
| | - Yun Sik Yang
- Department of Ophthalmology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Müller S, Walter H, Christen M. When benefitting a patient increases the risk for harm for third persons - the case of treating pedophilic Parkinsonian patients with deep brain stimulation. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2014; 37:295-303. [PMID: 24289863 DOI: 10.1016/j.ijlp.2013.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation - given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.
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Affiliation(s)
- Sabine Müller
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Charitéplatz 1, 10117 Berlin, Germany.
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Charitéplatz 1, 10117 Berlin, Germany
| | - Markus Christen
- Institute of Biomedical Ethics, Pestalozzistrasse 24, 8032 Zurich, Switzerland
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Kenney C, Fernandez HH, Okun MS. Role of deep brain stimulation targeted to the pedunculopontine nucleus in Parkinson’s disease. Expert Rev Neurother 2014; 7:585-9. [PMID: 17563240 DOI: 10.1586/14737175.7.6.585] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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