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Giménez S, Millan A, Mora-Morell A, Ayuso N, Gastaldo-Jordán I, Pardo M. Advances in Brain Stimulation, Nanomedicine and the Use of Magnetoelectric Nanoparticles: Dopaminergic Alterations and Their Role in Neurodegeneration and Drug Addiction. Molecules 2024; 29:3580. [PMID: 39124985 PMCID: PMC11314096 DOI: 10.3390/molecules29153580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
Recent advancements in brain stimulation and nanomedicine have ushered in a new era of therapeutic interventions for psychiatric and neurodegenerative disorders. This review explores the cutting-edge innovations in brain stimulation techniques, including their applications in alleviating symptoms of main neurodegenerative disorders and addiction. Deep Brain Stimulation (DBS) is an FDA-approved treatment for specific neurodegenerative disorders, including Parkinson's Disease (PD), and is currently under evaluation for other conditions, such as Alzheimer's Disease. This technique has facilitated significant advancements in understanding brain electrical circuitry by enabling targeted brain stimulation and providing insights into neural network function and dysfunction. In reviewing DBS studies, this review places particular emphasis on the underlying main neurotransmitter modifications and their specific brain area location, particularly focusing on the dopaminergic system, which plays a critical role in these conditions. Furthermore, this review delves into the groundbreaking developments in nanomedicine, highlighting how nanotechnology can be utilized to target aberrant signaling in neurodegenerative diseases, with a specific focus on the dopaminergic system. The discussion extends to emerging technologies such as magnetoelectric nanoparticles (MENPs), which represent a novel intersection between nanoformulation and brain stimulation approaches. These innovative technologies offer promising avenues for enhancing the precision and effectiveness of treatments by enabling the non-invasive, targeted delivery of therapeutic agents as well as on-site, on-demand stimulation. By integrating insights from recent research and technological advances, this review aims to provide a comprehensive understanding of how brain stimulation and nanomedicine can be synergistically applied to address complex neuropsychiatric and neurodegenerative disorders, paving the way for future therapeutic strategies.
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Affiliation(s)
- Silvia Giménez
- Department of Psychobiology, Universidad de Valencia, 46010 Valencia, Spain; (S.G.); (N.A.)
| | - Alexandra Millan
- Department of Neurobiology and Neurophysiology, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Spain;
| | - Alba Mora-Morell
- Faculty of Biological Sciences, Universidad de Valencia, 46100 Valencia, Spain;
| | - Noa Ayuso
- Department of Psychobiology, Universidad de Valencia, 46010 Valencia, Spain; (S.G.); (N.A.)
| | - Isis Gastaldo-Jordán
- Psychiatry Service, Doctor Peset University Hospital, FISABIO, 46017 Valencia, Spain;
| | - Marta Pardo
- Department of Psychobiology, Universidad de Valencia, 46010 Valencia, Spain; (S.G.); (N.A.)
- Interuniversity Research Institute for Molecular Recognition and Technological Development (IDM), 46022 Valencia, Spain
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Artusi CA, Rinaldi D, Balestrino R, Lopiano L. Deep brain stimulation for atypical parkinsonism: A systematic review on efficacy and safety. Parkinsonism Relat Disord 2022; 96:109-118. [PMID: 35288028 DOI: 10.1016/j.parkreldis.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atypical Parkinsonisms (APs) -including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB)- are neurodegenerative diseases lacking satisfying symptomatic therapies. Deep Brain Stimulation (DBS) is an established neurosurgical option for advanced Parkinson disease (PD). Although DBS effectiveness in PD fed expectations for the treatment of APs, DBS is still not recommended for APs on the basis of expert consensus and lack of clinical trials. OBJECTIVE In this systematic review, we sought to analyze current evidence on the safety and efficacy of DBS in APs, discussing clinical indications, anatomical targets, and ethical issues. METHODS Following the PRISMA guidelines, we systematically searched PubMed for studies reporting the outcome of patients with APs treated with DBS. RESULTS We identified 25 eligible studies for a total of 66 patients with APs treated with DBS: 31 PSP, 22 MSA, 12 DLB, 1 unspecified parkinsonism with tongue tremor. Targeted nuclei were subthalamic nucleus (STN), globus pallidus pars-interna (GPi), pedunculopontine nucleus (PPN), and nucleus basalis of Meynert (nbM). Only 3/25 studies were randomized controlled trials, and most studies showed a high risk of bias. CONCLUSION Taking into account study biases and confounding factors, current evidence does not support the use of DBS in APs. However, some interesting insights arise from the literature, such as the high frequency of cognitive/neurobehavioral issues in MSA patients treated with STN-DBS, the low frequency of complications in trials of nbM-DBS for DLB, and the possible good response of dystonic symptoms in PSP with GPi DBS.
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Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Torino, Italy; Neurology 2 Unit, A.O.U, Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy.
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa, 1035-00189, Rome, Italy
| | - Roberta Balestrino
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Torino, Italy; Neurology 2 Unit, A.O.U, Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
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Bluett B, Pantelyat AY, Litvan I, Ali F, Apetauerova D, Bega D, Bloom L, Bower J, Boxer AL, Dale ML, Dhall R, Duquette A, Fernandez HH, Fleisher JE, Grossman M, Howell M, Kerwin DR, Leegwater-Kim J, Lepage C, Ljubenkov PA, Mancini M, McFarland NR, Moretti P, Myrick E, Patel P, Plummer LS, Rodriguez-Porcel F, Rojas J, Sidiropoulos C, Sklerov M, Sokol LL, Tuite PJ, VandeVrede L, Wilhelm J, Wills AMA, Xie T, Golbe LI. Best Practices in the Clinical Management of Progressive Supranuclear Palsy and Corticobasal Syndrome: A Consensus Statement of the CurePSP Centers of Care. Front Neurol 2021; 12:694872. [PMID: 34276544 PMCID: PMC8284317 DOI: 10.3389/fneur.2021.694872] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS; the most common phenotype of corticobasal degeneration) are tauopathies with a relentless course, usually starting in the mid-60s and leading to death after an average of 7 years. There is as yet no specific or disease-modifying treatment. Clinical deficits in PSP are numerous, involve the entire neuraxis, and present as several discrete phenotypes. They center on rigidity, bradykinesia, postural instability, gait freezing, supranuclear ocular motor impairment, dysarthria, dysphagia, incontinence, sleep disorders, frontal cognitive dysfunction, and a variety of behavioral changes. CBS presents with prominent and usually asymmetric dystonia, apraxia, myoclonus, pyramidal signs, and cortical sensory loss. The symptoms and deficits of PSP and CBS are amenable to a variety of treatment strategies but most physicians, including many neurologists, are reluctant to care for patients with these conditions because of unfamiliarity with their multiplicity of interacting symptoms and deficits. CurePSP, the organization devoted to support, research, and education for PSP and CBS, created its CurePSP Centers of Care network in North America in 2017 to improve patient access to clinical expertise and develop collaborations. The directors of the 25 centers have created this consensus document outlining best practices in the management of PSP and CBS. They formed a writing committee for each of 12 sub-topics. A 4-member Steering Committee collated and edited the contributions. The result was returned to the entire cohort of authors for further comments, which were considered for incorporation by the Steering Committee. The authors hope that this publication will serve as a convenient guide for all clinicians caring for patients with PSP and CBS and that it will improve care for patients with these devastating but manageable disorders.
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Affiliation(s)
- Brent Bluett
- Neurology, Pacific Central Coast Health Center, Dignity Health, San Luis Obispo, CA, United States
- Neurology, Stanford University, Stanford, CA, United States
| | - Alexander Y. Pantelyat
- Neurology, The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Irene Litvan
- Neurology, University of California, San Diego, San Diego, CA, United States
| | - Farwa Ali
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Diana Apetauerova
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Danny Bega
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lisa Bloom
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - James Bower
- Neurology, Mayo Clinic, Rochester, MN, United States
| | - Adam L. Boxer
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Marian L. Dale
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Rohit Dhall
- Neurology, University of Arkansas for Medical Sciences, Little Rock, AK, United States
| | - Antoine Duquette
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Hubert H. Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jori E. Fleisher
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Murray Grossman
- Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael Howell
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Diana R. Kerwin
- Geriatrics, Presbyterian Hospital of Dallas, Dallas, TX, United States
| | | | - Christiane Lepage
- Service de Neurologie, Département de Médecine, Unité de Troubles du Mouvement André-Barbeau, Centre Hospitalier de l'Université de Service de Neurologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Martina Mancini
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Nikolaus R. McFarland
- Neurology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Paolo Moretti
- Neurology, The University of Utah, Salt Lake City, UT, United States
| | - Erica Myrick
- Neurological Sciences, Rush Medical College, Rush University, Chicago, IL, United States
| | - Pritika Patel
- Neurology, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Laura S. Plummer
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Julio Rojas
- Neurology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Miriam Sklerov
- Neurology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Leonard L. Sokol
- Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Paul J. Tuite
- Neurology, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Lawren VandeVrede
- Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jennifer Wilhelm
- Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Anne-Marie A. Wills
- Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Tao Xie
- Neurology, Surgery, University of Chicago, Chicago, IL, United States
| | - Lawrence I. Golbe
- Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Doshi PK, Das D. Deep Brain Stimulation for Parkinson's Disease: Currents Status and Emerging Concepts. Neurol India 2021; 68:S179-S186. [PMID: 33318348 DOI: 10.4103/0028-3886.302466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The clinical application of DBS has become manifold and there has been a tremendous growth in DBS technology in the last few decades making it safer and user friendly. The earlier concept of its delayed application in motor fluctuations of Parkinson's disease has been replaced by Class-I evidence of EARLY-STIM trial in 2013, leading to its FDA approval to be used in early-stage despite criticism. Various studies have provided evidence of beneficial effects of bilateral STN-DBS on both motor as well as nonmotor symptoms and different new targets such as the pedunculopontine nucleus, posterior subthalamic area or caudal zona incerta, centromedian-parafascicular complex, and substantia nigra pars reticulata have now become a new area of interest in addition to the subthalamic nucleus and globus pallidus internus for the alleviation of both motor and nonmotor symptoms of Parkinson's disease. New data has confirmed that the DBS is clinically as effective and safe in elderly patients as it is in younger ones. Technological advances like current steering, directional leads, and closed-loop DBS are directed towards reducing the stimulation-induced adverse effects and preservation of the battery life for a longer period. Results of the long-term efficacy of DBS on Parkinson's disease are now available. These have shown that as the motor benefit continues, the clinical progression of Parkinson's disease also continues. We plan to discuss all these in this paper.
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Affiliation(s)
- Paresh K Doshi
- Jaslok Hospital and Research Center, 15 Dr. G. Deshmukh Marg, Mumbai, Maharashtra, India
| | - Deepak Das
- Jaslok Hospital and Research Center, 15 Dr. G. Deshmukh Marg, Mumbai, Maharashtra, India
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Molina R, Hass CJ, Cernera S, Sowalsky K, Schmitt AC, Roper JA, Martinez-Ramirez D, Opri E, Hess CW, Eisinger RS, Foote KD, Gunduz A, Okun MS. Closed-Loop Deep Brain Stimulation to Treat Medication-Refractory Freezing of Gait in Parkinson's Disease. Front Hum Neurosci 2021; 15:633655. [PMID: 33732122 PMCID: PMC7959768 DOI: 10.3389/fnhum.2021.633655] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Treating medication-refractory freezing of gait (FoG) in Parkinson’s disease (PD) remains challenging despite several trials reporting improvements in motor symptoms using subthalamic nucleus or globus pallidus internus (GPi) deep brain stimulation (DBS). Pedunculopontine nucleus (PPN) region DBS has been used for medication-refractory FoG, with mixed findings. FoG, as a paroxysmal phenomenon, provides an ideal framework for the possibility of closed-loop DBS (CL-DBS). Methods: In this clinical trial (NCT02318927), five subjects with medication-refractory FoG underwent bilateral GPi DBS implantation to address levodopa-responsive PD symptoms with open-loop stimulation. Additionally, PPN DBS leads were implanted for CL-DBS to treat FoG. The primary outcome of the study was a 40% improvement in medication-refractory FoG in 60% of subjects at 6 months when “on” PPN CL-DBS. Secondary outcomes included device feasibility to gauge the recruitment potential of this four-lead DBS approach for a potentially larger clinical trial. Safety was judged based on adverse events and explantation rate. Findings: The feasibility of this approach was demonstrated as we recruited five subjects with both “on” and “off” medication freezing. The safety for this population of patients receiving four DBS leads was suboptimal and associated with a high explantation rate of 40%. The primary clinical outcome in three of the five subjects was achieved at 6 months. However, the group analysis of the primary clinical outcome did not reveal any benefit. Interpretation: This study of a human PPN CL-DBS trial in medication-refractory FoG showed feasibility in recruitment, suboptimal safety, and a heterogeneous clinical effect in FoG outcomes.
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Affiliation(s)
- Rene Molina
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States.,Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States
| | - Chris J Hass
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Stephanie Cernera
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Kristen Sowalsky
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Abigail C Schmitt
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Jaimie A Roper
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | | | - Enrico Opri
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Christopher W Hess
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Robert S Eisinger
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Aysegul Gunduz
- Department of Electrical and Computer Engineering, University of Florida, Gainesville, FL, United States.,Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases and The Program for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Florida, Gainesville, FL, United States.,Department of Neurosurgery, University of Florida, Gainesville, FL, United States
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Doshi PK, Rai N, Das D. Surgical and Hardware Complications of Deep Brain Stimulation-A Single Surgeon Experience of 519 Cases Over 20 Years. Neuromodulation 2021; 25:895-903. [PMID: 33496063 DOI: 10.1111/ner.13360] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) surgery has its own set of risks and complications. This study from a single center and a single surgeon analyzes various risk factors for complications and tries to establish if there is a learning curve effect in minimizing the complications. MATERIALS AND METHODS A retrospective analysis of 519 patients (1024 leads) who underwent DBS surgery and 232 patients who underwent implantable pulse generator replacement (IPG), by a single surgeon, between the years 1999 and 2019 was performed. Perioperative and hardware related complications were evaluated. RESULTS The follow-up period ranged from six months to 20 years. Surgery-related complications occurred in 46 (8.9%) cases which included confusion in 31 (5.98%), intracerebral hemorrhage in 7 (1.3%), vasovagal attack in 3 (0.58%), respiratory distress in 2 (0.38%), postoperative aggressiveness in 1 (0.19%), and blepharospasm in 2 (0.38%) patients. Complications related to the DBS hardware were found in 35 cases, including erosion and infection in 22 (2.95%), inaccurate lead placement or migration in 6 (0.6%) lead fracture/extension wire failure in 2 (0.26%), IPG malfunction in 2 (0.26%), and hardware discomfort in 3 (0.4%) cases. In three patients, one lead was repositioned. In cases of infection, 87% of patients had either partial or complete removal of hardware. There was no mortality. The complications were analyzed for every 100 DBS procedures. There was a significant drop in the percentage of complications in from 23% in the first 100 cases to 7% in the last 100 cases (p < 0.0001). CONCLUSION Confusion remains the most frequent operative and perioperative complication. Erosion and infection of the surgical site represents the most frequent hardware complication. DBS surgery is safe and the complication rates are acceptably low. The complication rate also decreases with cumulative years of experience, demonstrating a learning curve effect.
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Affiliation(s)
- Paresh K Doshi
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Neha Rai
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
| | - Deepak Das
- Department of Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
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Dayal V, Rajabian A, Jahanshahi M, Aviles-Olmos I, Cowie D, Peters A, Day B, Hyam J, Akram H, Limousin P, Hariz M, Zrinzo L, Foltynie T. Pedunculopontine Nucleus Deep Brain Stimulation for Parkinsonian Disorders: A Case Series. Stereotact Funct Neurosurg 2020; 99:287-294. [PMID: 33279909 DOI: 10.1159/000511978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been investigated for the treatment of levodopa-refractory gait dysfunction in parkinsonian disorders, with equivocal results so far. OBJECTIVES To summarize the clinical outcomes of PPN-DBS-treated patients at our centre and elicit any patterns that may guide future research. MATERIALS AND METHODS Pre- and post-operative objective overall motor and gait subsection scores as well as patient-reported outcomes were recorded for 6 PPN-DBS-treated patients, 3 with Parkinson's disease (PD), and 3 with progressive supranuclear palsy (PSP). Electrodes were implanted unilaterally in the first 3 patients and bilaterally in the latter 3, using an MRI-guided MRI-verified technique. Stimulation was initiated at 20-30 Hz and optimized in an iterative manner. RESULTS Unilaterally treated patients did not demonstrate significant improvements in gait questionnaires, UPDRS-III or PSPRS scores or their respective gait subsections. This contrasted with at least an initial response in bilaterally treated patients. Diurnal cycling of stimulation in a PD patient with habituation to the initial benefit reproduced substantial improvements in freezing of gait (FOG) 3 years post-operatively. Among the PSP patients, 1 with a parkinsonian subtype had a sustained improvement in FOG while another with Richardson syndrome (PSP-RS) did not benefit. CONCLUSIONS PPN-DBS remains an investigational treatment for levodopa-refractory FOG. This series corroborates some previously reported findings: bilateral stimulation may be more effective than unilateral stimulation; the response in PSP patients may depend on the disease subtype; and diurnal cycling of stimulation to overcome habituation merits further investigation.
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Affiliation(s)
- Viswas Dayal
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom,
| | - Ali Rajabian
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Marjan Jahanshahi
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Iciar Aviles-Olmos
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Dorothy Cowie
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Amy Peters
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Brian Day
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Jonathan Hyam
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Marwan Hariz
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.,Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, University College London Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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8
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Chang SJ, Cajigas I, Opris I, Guest JD, Noga BR. Dissecting Brainstem Locomotor Circuits: Converging Evidence for Cuneiform Nucleus Stimulation. Front Syst Neurosci 2020; 14:64. [PMID: 32973468 PMCID: PMC7473103 DOI: 10.3389/fnsys.2020.00064] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/03/2020] [Indexed: 01/06/2023] Open
Abstract
There are a pressing and unmet need for effective therapies for freezing of gait (FOG) and other neurological gait disorders. Deep brain stimulation (DBS) of a midbrain target known as the pedunculopontine nucleus (PPN) was proposed as a potential treatment based on its postulated involvement in locomotor control as part of the mesencephalic locomotor region (MLR). However, DBS trials fell short of expectations, leading many clinicians to abandon this strategy. Here, we discuss the potential reasons for this failure and review recent clinical data along with preclinical optogenetics evidence to argue that another nearby nucleus, the cuneiform nucleus (CnF), may be a superior target.
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Affiliation(s)
- Stephano J. Chang
- Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL, United States
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Iahn Cajigas
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ioan Opris
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
| | - James D. Guest
- Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL, United States
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Brian R. Noga
- Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL, United States
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
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Marsili L, Bologna M, Kojovic M, Berardelli A, Espay AJ, Colosimo C. Dystonia in atypical parkinsonian disorders. Parkinsonism Relat Disord 2019; 66:25-33. [PMID: 31443953 DOI: 10.1016/j.parkreldis.2019.07.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023]
Abstract
Dystonia is common in the classic atypical parkinsonian disorders such as multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration, and to a lesser extent in dementia with Lewy bodies. Its clinical phenomenology, including body distribution, timing of appearance, severity, and relationship to dopaminergic and other medications may vary considerably within and between atypical parkinsonian disorders. From a pathophysiological standpoint, the coexistence of dystonia with parkinsonism challenges the functional model of the basal ganglia. Clinical recognition of specific dystonic features may assist in the differential diagnosis of atypical parkinsonian disorders and in distinguishing them from Parkinson's disease. The presence of dystonia in atypical parkinsonian disorders informs management decisions. Reduction or withdrawal of levodopa should be considered if there is a close relationship between the onset of dystonia with periods of high dopaminergic tone. Botulinum neurotoxin may be considered in focal presentations. We here provide an updated overview of dystonia arising in the setting of atypical parkinsonian disorders, summarizing relevant clinical and clinicopathological studies, underlying pathophysiological mechanisms, diagnostic clues and potential pitfalls in the diagnosis. Finally, we suggest a tailored therapeutic approach for the management of these patients.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Maja Kojovic
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, Terni, Italy.
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Stefani A, Galati S. PPN-DBS: A utopic vision or a realistic perspective? Neurobiol Dis 2019; 128:1-2. [PMID: 30885790 DOI: 10.1016/j.nbd.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Sébille SB, Rolland AS, Faillot M, Perez-Garcia F, Colomb-Clerc A, Lau B, Dumas S, Vidal SF, Welter ML, Francois C, Bardinet E, Karachi C. Normal and pathological neuronal distribution of the human mesencephalic locomotor region. Mov Disord 2018; 34:218-227. [PMID: 30485555 DOI: 10.1002/mds.27578] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/10/2018] [Accepted: 10/22/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Deep brain stimulation of the pedunculopontine nucleus has been performed to treat dopamine-resistant gait and balance disorders in patients with degenerative diseases. The outcomes, however, are variable, which may be the result of the lack of a well-defined anatomical target. OBJECTIVES The objectives of this study were to identify the main neuronal populations of the pedunculopontine and the cuneiform nuclei that compose the human mesencephalic locomotor region and to compare their 3-dimensional distribution with those found in patients with Parkinson's disease and progressive supranuclear palsy. METHODS We used high-field MRI, immunohistochemistry, and in situ hybridization to characterize the distribution of the different cell types, and we developed software to merge all data within a common 3-dimensional space. RESULTS We found that cholinergic, GABAergic, and glutamatergic neurons comprised the main cell types of the mesencephalic locomotor region, with the peak densities of cholinergic and GABAergic neurons similarly located within the rostral pedunculopontine nucleus. Cholinergic and noncholinergic neuronal losses were homogeneous in the mesencephalic locomotor region of patients, with the peak density of remaining neurons at the same location as in controls. The degree of denervation of the pedunculopontine nucleus was highest in patients with progressive supranuclear palsy, followed by Parkinson's disease patients with falls. CONCLUSIONS The peak density of cholinergic and GABAergic neurons was located similarly within the rostral pedunculopontine nucleus not only in controls but also in pathological cases. The neuronal loss was homogeneously distributed and highest in the pedunculopontine nucleus of patients with falls, which suggests a potential pathophysiological link. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Sophie B Sébille
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France.,Centre de Neuro-Imagerie de Recherche, Paris, France
| | - Anne-Sophie Rolland
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France
| | - Matthieu Faillot
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France.,Neurosurgical Department, La Pitié-Salpêtrière University Hospital, Paris, France
| | | | - Antoine Colomb-Clerc
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France
| | - Brian Lau
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France
| | | | | | - Marie-Laure Welter
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France.,Neurosurgical Department, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Chantal Francois
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France
| | - Eric Bardinet
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France.,Centre de Neuro-Imagerie de Recherche, Paris, France
| | - Carine Karachi
- Sorbonne University, Univ. Pierre & Marie Curie Paris 06, Cnrs, Inserm, AP-HP Pitié-Salpêtrière hospital, Brain and Spinal Cord Institute, Paris, France.,Neurosurgical Department, La Pitié-Salpêtrière University Hospital, Paris, France
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12
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Galazky I, Kaufmann J, Lorenzl S, Ebersbach G, Gandor F, Zaehle T, Specht S, Stallforth S, Sobieray U, Wirkus E, Casjens F, Heinze HJ, Kupsch A, Voges J. Deep brain stimulation of the pedunculopontine nucleus for treatment of gait and balance disorder in progressive supranuclear palsy: Effects of frequency modulations and clinical outcome. Parkinsonism Relat Disord 2018; 50:81-86. [PMID: 29503154 DOI: 10.1016/j.parkreldis.2018.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 01/08/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Imke Galazky
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; Clinic and Policlinic for Palliative Care, Klinikum der Universität München, Ludwig Maximilians University, Munich, Germany; Department of Neurology, Agatharied University Hospital, Hausham, Germany
| | - Georg Ebersbach
- Neurological Specialist Hospital for Movement Disorders/Parkinson, Beelitz-Heilstätten, Germany
| | - Florin Gandor
- Neurological Specialist Hospital for Movement Disorders/Parkinson, Beelitz-Heilstätten, Germany
| | - Tino Zaehle
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Sylke Specht
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Sabine Stallforth
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Uwe Sobieray
- German Centre for Neurodegenerative Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Edyta Wirkus
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Franziska Casjens
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; German Centre for Neurodegenerative Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Department of Behavioural Neurology, Leibniz Institute of Neurobiology, Brenneckestr. 6, 39120 Magdeburg, Germany
| | - Andreas Kupsch
- Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; NEUROLOGY MOVES, Academic Neurological Practice, Bismarckstrasse 45-47, 10627 Berlin, Germany
| | - Jürgen Voges
- German Centre for Neurodegenerative Diseases, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany; Department of Behavioural Neurology, Leibniz Institute of Neurobiology, Brenneckestr. 6, 39120 Magdeburg, Germany; Department of Stereotactic Neurosurgery, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
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Scelzo E, Lozano AM, Hamani C, Poon YY, Aldakheel A, Zadikoff C, Lang AE, Moro E. Peduncolopontine nucleus stimulation in progressive supranuclear palsy: a randomised trial. J Neurol Neurosurg Psychiatry 2017; 88:613-616. [PMID: 28214797 DOI: 10.1136/jnnp-2016-315192] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/31/2016] [Accepted: 01/24/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Emma Scelzo
- Division of Neurology, CHU Grenoble, Grenoble Alpes University, Grenoble, France.,Clinical Center for Neurotechnology, Neurostimulation and Movement Disorders, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Neurology, Policlinico San Donato, University of Milan, Milan, Italy
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Clement Hamani
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Yu-Yan Poon
- Movement Disorders Center, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Amaal Aldakheel
- Division of Neurology, CHU Grenoble, Grenoble Alpes University, Grenoble, France
| | - Cindy Zadikoff
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anthony E Lang
- Movement Disorders Center, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Elena Moro
- Division of Neurology, CHU Grenoble, Grenoble Alpes University, Grenoble, France.,Movement Disorders Center, Division of Neurology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, Ontario, Canada
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14
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Shoeibi A, Litvan I. Therapeutic options for Progressive Supranuclear Palsy including investigational drugs. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1335596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ali Shoeibi
- Movement Disorder Center, UC San Diego Department of Neurosciences, La Jolla, CA, USA
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Irene Litvan
- Movement Disorder Center, UC San Diego Department of Neurosciences, La Jolla, CA, USA
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15
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Peduncolopontine DBS improves balance in progressive supranuclear palsy: Instrumental analysis. Clin Neurophysiol 2016; 127:3470-3471. [PMID: 27721105 DOI: 10.1016/j.clinph.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 01/01/2023]
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16
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Baizabal-Carvallo JF, Alonso-Juarez M. Low-frequency deep brain stimulation for movement disorders. Parkinsonism Relat Disord 2016; 31:14-22. [DOI: 10.1016/j.parkreldis.2016.07.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 12/24/2022]
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Abstract
Progressive supranuclear palsy (PSP) is an atypical parkinsonian condition characterized by a symmetric akinetic-rigid syndrome, early falls, supranuclear gaze palsy, and a frontotemporal behavioral syndrome. The typical phenotype is termed Richardson's syndrome, but numerous other phenotypes have been described. The pathophysiology of PSP is not fully understood, but dysfunction of the tau protein seems to play a central role. Despite exciting new knowledge on the pathophysiology of PSP, there is still no highly effective symptomatic or disease-modifying treatment. We review the evidence on pharmacotherapy and experimental therapies in PSP and provide levels of recommendation for the off-label use of commonly used drugs in this disorder.
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De Jesus S, Almeida L, Peng-Chen Z, Okun MS, Hess CW. Novel targets and stimulation paradigms for deep brain stimulation. Expert Rev Neurother 2015; 15:1067-80. [DOI: 10.1586/14737175.2015.1083421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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20
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Kondziolka D. Comment on the paper by Doshi et al. Entitled 'bilateral pedunculopontine nucleus stimulation for progressive supranuclear palsy'. Stereotact Funct Neurosurg 2015; 93:66. [PMID: 25659372 DOI: 10.1159/000369771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Douglas Kondziolka
- Department of Neurosurgery, New York University, NYU Langone Medical Center, New York, N.Y., USA
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