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Jiang JL, Chen SY, Tsai ST, Ma YC, Wang JH. Long-Term Effects of Subthalamic Stimulation on Motor Symptoms and Quality of Life in Patients with Parkinson's Disease. Healthcare (Basel) 2023; 11:healthcare11060920. [PMID: 36981577 PMCID: PMC10048478 DOI: 10.3390/healthcare11060920] [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: 01/14/2023] [Revised: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder affecting both motor functions and quality of life (QoL). This study compared motor symptoms and QoL in patients with PD before and at 1 and 5 years after subthalamic nucleus deep brain stimulation (STN-DBS) surgery in Taiwan. This study included 53 patients with PD undergoing STN-DBS. The motor symptoms improved by 39.71 ± 26.52% and 18.83 ± 37.15% in the Unified Parkinson's Disease Rating Scale (UPDRS) part II and by 36.83 ± 22.51% and 22.75 ± 36.32% in the UPDRS part III at 1 and 5 years after STN-DBS in the off-medication/on-stimulation state, respectively. The Hoehn and Yahr stage significantly improved at the 1-year follow-up but declined progressively and returned to the baseline stage 5 years post-surgery. The Schwab and England Activities of Daily Living improved and sustained for 5 years following STN-DBS. Levodopa equivalent daily dose decreased by 35.32 ± 35.87% and 15.26 ± 65.76% at 1 and 5 years post-surgery, respectively. The QoL revealed significant improvement at 1 year post-surgery; however, patients regressed to near baseline levels 5 years post-surgery. The long-term effects of STN-DBS on motor symptoms were maintained over 5 years after STN-DBS surgery. At the same time, STN-DBS had no long-lasting effect on QoL. The study findings will enable clinicians to become more aware of visible and invisible manifestations of PD.
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Affiliation(s)
- Jiin-Ling Jiang
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Shin-Yuan Chen
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Sheng-Tzung Tsai
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Yu-Chin Ma
- Department of Nursing, Tzu Chi University, Hualien 97004, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
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Grembecka B, Glac W, Listowska M, Jerzemowska G, Plucińska K, Majkutewicz I, Badtke P, Wrona D. Subthalamic Deep Brain Stimulation Affects Plasma Corticosterone Concentration and Peripheral Immunity Changes in Rat Model of Parkinson's Disease. J Neuroimmune Pharmacol 2021; 16:454-469. [PMID: 32648088 PMCID: PMC8087570 DOI: 10.1007/s11481-020-09934-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (DBS-STN) is an effective treatment for advanced motor symptoms of Parkinson's disease (PD). Recently, a connection between the limbic part of the STN and side effects of DBS-STN has been increasingly recognized. Animal studies have shown that DBS-STN influences behavior and provokes neurochemical changes in regions of the limbic system. Some of these regions, which are activated during DBS-STN, are involved in neuroimmunomodulation. The therapeutic effects of DBS-STN in PD treatment are clear, but the influence of DBS-STN on peripheral immunity has not been reported so far. In this study, we examined the effects of unilateral DBS-STN applied in male Wistar rats with 6-hydroxydopamine PD model (DBS-6OHDA) and rats without nigral dopamine depletion (DBS) on corticosterone (CORT) plasma concentration, blood natural killer cell cytotoxicity (NKCC), leukocyte numbers, lymphocyte population and apoptosis numbers, plasma interferon gamma (IFN-γ), interleukin 6 (IL-6), and tumor necrosis factor (TNF-α) concentration. The same peripheral immune parameters we measured also in non-stimulated rats with PD model (6OHDA). We observed peripheral immunity changes related to PD model. The NKCC and percentage of T cytotoxic lymphocytes were enhanced, while the level of lymphocyte apoptosis was down regulated in 6OHDA and DBS-6OHDA groups. After DBS-STN (DBS-6OHDA and DBS groups), the plasma CORT and TNF-α were elevated, the number of NK cells and percentage of apoptosis were increased, while the number of B lymphocytes was decreased. We also found, changes in plasma IFN-γ and IL-6 levels in all the groups. These results suggest potential peripheral immunomodulative effects of DBS-STN in the rat model of PD. However, further studies are necessary to explain these findings and their clinical implication. Graphical Abstract Influence of deep brain stimulation of the subthalamic nucleus on peripheral immunity in rat model of Parkinson's disease.
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Affiliation(s)
- Beata Grembecka
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland.
| | - Wojciech Glac
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Magdalena Listowska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Grażyna Jerzemowska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Karolina Plucińska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Irena Majkutewicz
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Piotr Badtke
- Department of Physiology, Medical University of Gdańsk, 1 Dębinki Str, 80-211, Gdańsk, Poland
| | - Danuta Wrona
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
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Sidtis JJ, Sidtis DVL, Dhawan V, Tagliati M, Eidelberg D. Stimulation of the Subthalamic Nucleus Changes Cortical-Subcortical Blood Flow Patterns During Speech: A Positron Emission Tomography Study. Front Neurol 2021; 12:684596. [PMID: 34122323 PMCID: PMC8187801 DOI: 10.3389/fneur.2021.684596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD) but can have an adverse effect on speech. In normal speakers and in those with spinocerebellar ataxia, an inverse relationship between regional cerebral blood flow (rCBF) in the left inferior frontal (IFG) region and the right caudate (CAU) is associated with speech rate. This pattern was examined to determine if it was present in PD, and if so, whether it was altered by STN-DBS. Methods: Positron Emission Tomography (PET) measured rCBF during speech in individuals with PD not treated with STN-DBS (n = 7), and those treated with bilateral STN-DBS (n = 7). Previously reported results from non-PD control subjects (n = 16) were reported for comparison. The possible relationships between speech rate during scanning and data from the left and right IFG and CAU head regions were investigated using a step-wise multiple linear regression to identify brain regions that interacted to predict speech rate. Results: The multiple linear regression analysis replicated previously reported predictive coefficients for speech rate involving the left IFG and right CAU regions. However, the relationships between these predictive coefficients and speech rates were abnormal in both PD groups. In PD who had not received STN-DBS, the right CAU coefficient decreased normally with increasing speech rate but the left IFG coefficient abnormally decreased. With STN-DBS, this pattern was partially normalized with the addition of a left IFG coefficient that increased with speech rate, as in normal controls, but the abnormal left IFG decreasing coefficient observed in PD remained. The magnitudes of both cortical predictive coefficients but not the CAU coefficient were exaggerated with STN-DBS. Conclusions: STN-DBS partially corrects the abnormal relationships between rCBF and speech rate found in PD by introducing a left IFG subregion that increases with speech rate, but the conflicting left IFG subregion response remained. Conflicting IFG responses may account for some of the speech problems observed after STN-DBS. Cortical and subcortical regions may be differentially affected by STN-DBS.
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Affiliation(s)
- John J Sidtis
- Brain and Behavior Laboratory, Geriatrics Department, Nathan Kline Institute, Orangeburg, NY, United States.,Department of Psychiatry, School of Medicine, New York University Langone, New York, NY, United States
| | - Diana Van Lancker Sidtis
- Brain and Behavior Laboratory, Geriatrics Department, Nathan Kline Institute, Orangeburg, NY, United States.,Department of Communicative Disorders and Sciences, New York University Steinhardt School, New York, NY, United States
| | - Vijay Dhawan
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, United States
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Hanssen H, Steinhardt J, Münchau A, Al-Zubaidi A, Tzvi E, Heldmann M, Schramm P, Neumann A, Rasche D, Saryyeva A, Voges J, Galazky I, Büntjen L, Heinze HJ, Krauss JK, Tronnier V, Münte TF, Brüggemann N. Cerebello-striatal interaction mediates effects of subthalamic nucleus deep brain stimulation in Parkinson's disease. Parkinsonism Relat Disord 2019; 67:99-104. [PMID: 31494048 DOI: 10.1016/j.parkreldis.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Parkinson's disease (PD), dopamine replacement therapy (DRT) enhances the effective connectivity of the prefrontal cortex (PFC) and supplementary motor area (SMA). The clinical effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) go beyond DRT effects including highly beneficial tremor suppression. OBJECTIVES Here, we aimed to determine DBS-related changes of a motor network using resting state fMRI in PD patients with chronic STN DBS. METHODS In a repeated-measurement design, 26 medicated PD patients (60.9 years (SD 8.9)) were investigated using resting state fMRI while bipolar STN stimulation was (i) active or (ii) switched off, and dynamic causal modelling was subsequently performed. RESULTS DBS improved the MDS-UPDRS-III score by 26.4% (DBS ON/Med ON vs. DBS OFF/Med ON). Active stimulation resulted in an increased effective connectivity from cerebellum to putamen (p = 0.00118). In addition, there was a stronger coupling from PFC to cerebellum (p = 0.021), as well as from cerebellum to SMA (p = 0.043) on an uncorrected level. Coupling strength from PFC to cerebellum correlated with the DBS-related change of the resting tremor subscore (r = 0.54, p = 0.031). Self-connections increased as a function of DBS in the right PFC, PMC, SMA, M1, thalamus and left cerebellum. CONCLUSIONS DBS-related improvement of Parkinsonian signs appears to be driven by an interaction between the cerebellum and the putamen. Resting tremor suppression may be related to an enhanced prefronto-cerebellar network. Activation of the mesial premotor loop (PFC-SMA) as seen in DRT may thus be secondary due to the primary modulation of cerebellar networks.
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Affiliation(s)
- Henrike Hanssen
- Department of Neurology, University of Lübeck, Lübeck, Germany; Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Julia Steinhardt
- Department of Neurology, University of Lübeck, Lübeck, Germany; Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | | | - Elinor Tzvi
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | - Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany; Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Peter Schramm
- Institute of Neuroradiology, University of Lübeck, Lübeck, Germany
| | | | - Dirk Rasche
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Medical School Hanover, MHH, Hanover, Germany
| | - Jürgen Voges
- Department of Stereotactic Neurosurgery, University Hospital Magdeburg, Magdeburg, Germany; Leibniz Institute of Neurobiology, Magdeburg, Germany
| | - Imke Galazky
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Lars Büntjen
- Department of Stereotactic Neurosurgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hanover, MHH, Hanover, Germany
| | - Volker Tronnier
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany; Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany; Department of Internal Medicine, University of Lübeck, Lübeck, Germany.
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