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Giordano U, Mizera J, Żak E, Pilch J, Tomecka P, Dudzik T, Palczewski M, Biziorek W, Piotrowski P. Surgical treatment methods in the course of psychiatric disorders: Deep brain stimulation-Novel insights and indications. Indian J Psychiatry 2023; 65:799-807. [PMID: 37736228 PMCID: PMC10510643 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_266_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/23/2023] Open
Abstract
Deep brain stimulation (DBS) is a relatively dated treatment procedure that emerged in the late 1980s. Nonetheless, numerous studies are being carried out to examine its influence on the human brain and develop new treatment indications. This systematic review aims to summarize the current state of knowledge referring to DBS, investigate novel insights into its indications, and discuss the technical aspects and rationale behind DBS application. In particular, we sought to subject to scrutiny the application of DBS specifically in anorexia nervosa (AN), various addiction types, depression, and obsessive-compulsive disorders (OCDs). The method is supposed to offer promising results, especially in pharmacologically resistant forms of the upper-mentioned psychiatric disorders. Moreover, further insight has been provided into the historical notions of the method and differences in the surgical approach in specific disease entities. Furthermore, we mark the possible influence of comorbidities on treatment results. Our review consists of articles and studies found on PubMed, Google Scholar, Cochrane, and Scopus, which were then analyzed with scrutiny in the identification process, including the most resourceful ones. After methodological quality and risk of bias assessment, a total of 53 studies were included. To this date, DBS's usefulness in the treatment of AN, OCDs, depression, and addictions has been proven, despite an ongoing debate concerning the technical aspects and parameters when applying DBS. To the best of our knowledge, we have not found any paper that would recapitulate the current state of DBS in the context of psychiatric disorders with an addition of technical insights.
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Affiliation(s)
- Ugo Giordano
- Department of Psychiatry, University Clinical Hospital (USK) in Wroclaw, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Mizera
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Elżbieta Żak
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Justyna Pilch
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Paulina Tomecka
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Dudzik
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Mikołaj Palczewski
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Weronika Biziorek
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, University Clinical Hospital (USK) in Wroclaw, Wroclaw Medical University, Wroclaw, Poland
- Department of Psychiatry, Students Scientific Association at the Clinic of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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Zhou Y, Yao Y, Yang Z, Tang Y, Wei G. Naphthoquinone-dopamine hybrids disrupt α-synuclein fibrils by their intramolecular synergistic interactions with fibrils and display a better effect on fibril disruption. Phys Chem Chem Phys 2023; 25:14471-14483. [PMID: 37190853 DOI: 10.1039/d3cp00340j] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
α-Synuclein (αSyn) is an intrinsically disordered protein and its abnormal aggregation into amyloid fibrils is the main hallmark of Parkinson's disease (PD). The disruption of preformed αSyn fibrils using small molecules is considered as a potential strategy for PD treatment. Recent experiments have reported that naphthoquinone-dopamine hybrids (NQDA), synthesized by naphthoquinone (NQ) and dopamine (DA) molecules, can significantly disrupt αSyn fibrils and cross the blood-brain barrier. To unravel the fibril-disruptive mechanisms at the atomic level, we performed microsecond molecular dynamics simulations of αSyn fibrils in the absence and presence of NQDA, NQ, DA, or NQ+DA molecules. Our simulations showed that NQDA reduces the β-sheet content, disrupts K45-E57 and E46-K80 salt-bridges, weakens the inter-protofibril interaction, and thus destabilizes the αSyn fibril structure. NQDA has the ability to form cation-π and H-bonding interactions with K45/K80, and form π-π stacking interactions with Y39/F94. Those interactions between NQDA and αSyn fibrils play a crucial role in disaggregating αSyn fibrils. Moreover, we found that NQDA has a better fibril destabilization effect than that of NQ, DA, and NQ+DA molecules. This is attributed to the synergistic fibril-binding effect between NQ and DA groups in NQDA molecules. The DA group can form strong π-π stacking interactions with aromatic residues Y39/F94 of the αSyn fibril, while the DA molecule cannot. In addition, NQDA can form stronger cation-π interactions with residues K45/K80 than those of both NQ and DA molecules. Our results provide the molecular mechanism underlying the disaggregation of the αSyn fibril by NQDA and its better performance in fibril disruption than NQ, DA, and NQ+DA molecules, which offers new clues for the screening and development of promising drug candidates to treat PD.
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Affiliation(s)
- Yun Zhou
- Department of Physics, State Key Laboratory of Surface Physics, Key Laboratory for Computational Physical Sciences (Ministry of Education), Fudan University, Shanghai 200438, People's Republic of China.
| | - Yifei Yao
- Department of Physics, State Key Laboratory of Surface Physics, Key Laboratory for Computational Physical Sciences (Ministry of Education), Fudan University, Shanghai 200438, People's Republic of China.
| | - Zhongyuan Yang
- Department of Physics, State Key Laboratory of Surface Physics, Key Laboratory for Computational Physical Sciences (Ministry of Education), Fudan University, Shanghai 200438, People's Republic of China.
| | - Yiming Tang
- Department of Physics, State Key Laboratory of Surface Physics, Key Laboratory for Computational Physical Sciences (Ministry of Education), Fudan University, Shanghai 200438, People's Republic of China.
| | - Guanghong Wei
- Department of Physics, State Key Laboratory of Surface Physics, Key Laboratory for Computational Physical Sciences (Ministry of Education), Fudan University, Shanghai 200438, People's Republic of China.
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Effects of square-stepping exercise on executive function in individuals with Parkinson's disease: A randomized controlled pilot study. Geriatr Nurs 2022; 47:273-279. [DOI: 10.1016/j.gerinurse.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022]
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Cacabelos R, Carrera I, Martínez O, Alejo R, Fernández-Novoa L, Cacabelos P, Corzo L, Rodríguez S, Alcaraz M, Nebril L, Tellado I, Cacabelos N, Pego R, Naidoo V, Carril JC. Atremorine in Parkinson's disease: From dopaminergic neuroprotection to pharmacogenomics. Med Res Rev 2021; 41:2841-2886. [PMID: 34106485 DOI: 10.1002/med.21838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/11/2021] [Accepted: 05/21/2021] [Indexed: 12/15/2022]
Abstract
Atremorine is a novel bioproduct obtained by nondenaturing biotechnological processes from a genetic species of Vicia faba. Atremorine is a potent dopamine (DA) enhancer with powerful effects on the neuronal dopaminergic system, acting as a neuroprotective agent in Parkinson's disease (PD). Over 97% of PD patients respond to a single dose of Atremorine (5 g, p.o.) 1 h after administration. This response is gender-, time-, dose-, and genotype-dependent, with optimal doses ranging from 5 to 20 g/day, depending upon disease severity and concomitant medication. Drug-free patients show an increase in DA levels from 12.14 ± 0.34 pg/ml to 6463.21 ± 1306.90 pg/ml; and patients chronically treated with anti-PD drugs show an increase in DA levels from 1321.53 ± 389.94 pg/ml to 16,028.54 ± 4783.98 pg/ml, indicating that Atremorine potentiates the dopaminergic effects of conventional anti-PD drugs. Atremorine also influences the levels of other neurotransmitters (adrenaline, noradrenaline) and hormones which are regulated by DA (e.g., prolactin, PRL), with no effect on serotonin or histamine. The variability in Atremorine-induced DA response is highly attributable to pharmacogenetic factors. Polymorphic variants in pathogenic (SNCA, NUCKS1, ITGA8, GPNMB, GCH1, BCKDK, APOE, LRRK2, ACMSD), mechanistic (DRD2), metabolic (CYP2D6, CYP2C9, CYP2C19, CYP3A4/5, NAT2), transporter (ABCB1, SLC6A2, SLC6A3, SLC6A4) and pleiotropic genes (APOE) influence the DA response to Atremorine and its psychomotor and brain effects. Atremorine enhances DNA methylation and displays epigenetic activity via modulation of the pharmacoepigenetic network. Atremorine is a novel neuroprotective agent for dopaminergic neurons with potential prophylactic and therapeutic activity in PD.
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Affiliation(s)
- Ramón Cacabelos
- Department of Genomic Medicine, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Iván Carrera
- Department of Health Biotechnology, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Olaia Martínez
- Department of Medical Epigenetics, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | | | | | - Pablo Cacabelos
- Department of Digital Diagnosis, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Lola Corzo
- Department of Medical Biochemistry, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Susana Rodríguez
- Department of Medical Biochemistry, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Margarita Alcaraz
- Department of Genomic Medicine, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Laura Nebril
- Department of Genomic Medicine, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Iván Tellado
- Department of Digital Diagnosis, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Natalia Cacabelos
- Department of Medical Documentation, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Rocío Pego
- Department of Neuropsychology, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Vinogran Naidoo
- Department of Neuroscience, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
| | - Juan C Carril
- Department of Genomics & Pharmacogenomics, EuroEspes Biomedical Research Center, International Center of Neuroscience and Genomic Medicine, Bergondo, Spain
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Parkinsonism and subthalamic deep brain stimulation dysregulate behavioral motivation in a rodent model. Brain Res 2020; 1736:146776. [PMID: 32171706 DOI: 10.1016/j.brainres.2020.146776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/18/2020] [Accepted: 03/10/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Apathy and impulsivity constitute opposite poles of a behavioral motivation spectrum often disrupted by both the symptoms and therapies for Parkinson's Disease (PD). Upwards of 70% of PD patients experience symptoms of apathy, frequently unresolved or worsened by deep brain stimulation (DBS) of the subthalamic nucleus (STN). Worse, more than half of patients receiving DBS for PD experience new-onset impulse control disorders of varying severity following therapy initiation. While these symptoms and side-effects have been widely reported in clinical studies, they are largely unexplored in animal models. METHODS We applied high-frequency DBS in a 6-OHDA hemiparkinsonian rat model. We trained rats on a series of go/stop and go/no-go behavioral paradigms and examined how parkinsonism and DBS modulated task responses. RESULTS STN DBS in healthy rodents drove impulsive behavior in the form of stop and no-go task failure, impulsive reward seeking, and noninstructed task attempts. While trained rats without DBS only tended to fail stop and no-go cues very shortly after the cue, DBS led to failures at significantly later time points. Hemiparkinsonism slowed response times and reduced response rates, not alleviated by effective DBS. INTERPRETATIONS PD interrupts neural signaling responsible for healthy action selection, not restored by DBS. PD may be associated with a dearth of action commands, manifesting as apathy. Conversely, effective DBS may bias the system toward the impulsive end of the behavioral motivation spectrum without restoring behaviorally reasonable actions, mis-weighting reward-based action selection and manifesting as impulsivity, aided by DBS interfering with stop signaling.
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Ye H, Fussenegger M. Optogenetic Medicine: Synthetic Therapeutic Solutions Precision-Guided by Light. Cold Spring Harb Perspect Med 2019; 9:a034371. [PMID: 30291146 PMCID: PMC6719591 DOI: 10.1101/cshperspect.a034371] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gene- and cell-based therapies are well recognized as central pillars of next-generation medicine, but controllability remains a critical issue for clinical applications. In this context, optogenetics is opening up exciting new opportunities for precision-guided medicine by using illumination with light of appropriate intensity and wavelength as a trigger signal to achieve pinpoint spatiotemporal control of cellular activities, such as transgene expression. In this review, we highlight recent advances in optogenetics, focusing on devices for biomedical applications. We introduce the construction and applications of optogenetic-based biomedical tools to treat neurological diseases, diabetes, heart diseases, and cancer, as well as bioelectronic implants that combine light-interfaced electronic devices and optogenetic systems into portable personalized precision bioelectronic medical tools. Optogenetics-based technology promises the capability to achieve traceless, remotely controlled precision dosing of an enormous range of therapeutic outputs. Finally, we discuss the prospects for optogenetic medicine, as well as some emerging challenges.
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Affiliation(s)
- Haifeng Ye
- Shanghai Key Laboratory of Regulatory Biology, Institute of Biomedical Sciences and School of Life Sciences, East China Normal University, 200241 Shanghai, China
| | - Martin Fussenegger
- Department of Biosystems Science and Engineering, ETH Zurich, CH-4058 Basel, Switzerland
- University of Basel, Faculty of Science, CH-4058 Basel, Switzerland
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Li S, Ou R, Yuan X, Liu H, Hou Y, Wei Q, Song W, Cao B, Chen Y, Shang H. Executive dysfunctions and behavioral changes in early drug-naïve patients with Parkinson's disease. J Affect Disord 2019; 243:525-530. [PMID: 30292146 DOI: 10.1016/j.jad.2018.09.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/06/2018] [Accepted: 09/15/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study aims to explore the clinical profiles and onset age-related difference of executive dysfunctions and behavioral changes in early drug-naïve patients with Parkinson's disease (PD). METHODS A cross-sectional analysis on 419 early stage drug-naïve PD patients was conducted. The frontal assessment battery (FAB) was used to assess executive functions and the frontal behavioral inventory (FBI) was used to assess behavioral changes. RESULTS Executive dysfunctions were detected in 113 patients (27.0%), and 219 patients (52.3%) displayed varied degrees of behavioral changes. The most frequent affected domain for the FAB was lexical fluency (31.7%), while the three most frequent affected domains for the FBI were apathy (26.0%), irritability (24.3%) and inattention (20.8%). Compared to the early-onset PD (EOPD) patients, the late-onset PD (LOPD) patients exhibited significantly higher frequent damage in FAB especially similarities, motor series, and conflicting instructions as well as lower frequent damage in lexical fluency. The frequencies of FBI-abnormal were not different between the two groups. Multivariate analyses indicated that age at PD onset was independently associated with FAB total score and its subscores including lexical fluency, motor series, conflicting instructions and go-no go task, but it has no relationship with FBI total score and its subscores. CONCLUSIONS Executive deficits and behavioral changes are common in the early stage of PD. Age at PD onset is independently associated with the performance of executive functions. However, behavioral changes in PD may be not affected by onset age.
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Affiliation(s)
- Shirong Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China; Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiaoqin Yuan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hui Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yanbing Hou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Wei Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Bei Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
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Asllani M, Expert P, Carletti T. A minimally invasive neurostimulation method for controlling abnormal synchronisation in the neuronal activity. PLoS Comput Biol 2018; 14:e1006296. [PMID: 30024878 PMCID: PMC6067766 DOI: 10.1371/journal.pcbi.1006296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/31/2018] [Accepted: 06/12/2018] [Indexed: 12/04/2022] Open
Abstract
Many collective phenomena in Nature emerge from the -partial- synchronisation of the units comprising a system. In the case of the brain, this self-organised process allows groups of neurons to fire in highly intricate partially synchronised patterns and eventually lead to high level cognitive outputs and control over the human body. However, when the synchronisation patterns are altered and hypersynchronisation occurs, undesirable effects can occur. This is particularly striking and well documented in the case of epileptic seizures and tremors in neurodegenerative diseases such as Parkinson's disease. In this paper, we propose an innovative, minimally invasive, control method that can effectively desynchronise misfiring brain regions and thus mitigate and even eliminate the symptoms of the diseases. The control strategy, grounded in the Hamiltonian control theory, is applied to ensembles of neurons modelled via the Kuramoto or the Stuart-Landau models and allows for heterogeneous coupling among the interacting unities. The theory has been complemented with dedicated numerical simulations performed using the small-world Newman-Watts network and the random Erdős-Rényi network. Finally the method has been compared with the gold-standard Proportional-Differential Feedback control technique. Our method is shown to achieve equivalent levels of desynchronisation using lesser control strength and/or fewer controllers, being thus minimally invasive.
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Affiliation(s)
- Malbor Asllani
- naXys, Namur Institute for Complex Systems, University of Namur, Namur, Belgium
| | - Paul Expert
- Department of Mathematics, Imperial College London, London, United Kingdom
- EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, United Kingdom
| | - Timoteo Carletti
- naXys, Namur Institute for Complex Systems, University of Namur, Namur, Belgium
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Cho KH, Kim TH, Jung WS, Moon SK, Ko CN, Cho SY, Jeon CY, Choi TY, Lee MS, Lee SH, Chung EK, Kwon S. Pharmacoacupuncture for Idiopathic Parkinson's Disease: A Systematic Review of Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:3671542. [PMID: 30046336 PMCID: PMC6036809 DOI: 10.1155/2018/3671542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/03/2018] [Accepted: 04/17/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Pharmacoacupuncture is a new acupuncture treatment that stimulates acupuncture points by injecting herbal medicine into them. Recently, pharmacoacupuncture has been widely used in the treatment of idiopathic Parkinson's disease in traditional East Asian medicine. The purpose of this systematic review is to evaluate the efficacy and safety of pharmacoacupuncture in the treatment of idiopathic Parkinson's disease. METHODS The following electronic databases were searched for studies published in or before December 2016: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, OASIS, and CNKI, without language restriction. The main outcome assessed was the total Unified Parkinson's Disease Rating Scale (UPDRS) score. The details of the pharmacoacupuncture intervention, such as the herbal medicine and acupuncture points used, were also investigated. RESULTS From 138 studies, 3 randomized controlled trials were included; the number of patients analyzed was 134. Most of the studies showed considerable methodological flaws. There was heterogeneity of the intervention type and treatment duration in the included studies. Therefore, we could not conduct a meta-analysis. In one study, adjunctive bee venom pharmacoacupuncture therapy significantly improved total UPDRS scores compared with conventional therapy alone. Another study, which used adjunctive Kakkonein pharmacoacupuncture, did not reveal significant improvement compared with conventional therapy alone. A third study reported that Mailuoning pharmacoacupuncture was able to significantly improve the modified Webster Symptom Score when compared with no treatment. Adverse events related to the pharmacoacupuncture were reported in only one case, itching caused by the bee venom. CONCLUSIONS Our findings regarding the efficacy of pharmacoacupuncture as a therapy for idiopathic Parkinson's disease are currently inconclusive. Further large and rigorous clinical trials are needed.
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Affiliation(s)
- Ki-Ho Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Woo-Sang Jung
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-Kwan Moon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Nam Ko
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seung-Yeon Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chan-Yong Jeon
- Department of Korean Internal Medicine, College of Korean Medicine, Gachon University, Seongnam, Republic of Korea
| | - Tae Young Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sang-Ho Lee
- Gangdong Mokhuri Oriental Medical Hospital, Department of Internal Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Chung
- Division of Clinical Pharmacy, Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Getz SJ, Levin B. Cognitive and Neuropsychiatric Features of Early Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:769-785. [PMID: 29077803 DOI: 10.1093/arclin/acx091] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022] Open
Abstract
The clinical definition of Parkinson's disease (PD) is based on cardinal motor features including bradykinesia as well as an additional symptom of tremor, postural instability, or rigidity. Evidence from neuropathological, imaging, and clinical research suggests a premotor, early phase of PD pathology. Further understanding of the earliest biomarkers of PD is crucial for the development of neuroprotective, disease modifying, cognitive, and psychiatric interventions. Recent research has explored early non-motor markers of PD pathology. This issue is especially timely as the International Parkinson and Movement Disorder Society has recently provided a research definition for prodromal PD which includes combinations of prodromal markers and risk factors aimed at identifying target populations for disease-prevention trials. In this review of early PD, we will outline early non-motor symptoms, early cognitive and neuropsychiatric features, neuropsychological assessment strategies, emerging evidence for early biomarkers, and treatment recommendations.
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Affiliation(s)
- Sarah J Getz
- Department of Neurology, Division of Neuropsychology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Bonnie Levin
- Department of Neurology, Division of Neuropsychology, University of Miami Miller School of Medicine, Miami, FL, USA
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Tröster AI. Some Clinically Useful Information that Neuropsychology Provides Patients, Carepartners, Neurologists, and Neurosurgeons About Deep Brain Stimulation for Parkinson's Disease. Arch Clin Neuropsychol 2018; 32:810-828. [PMID: 29077802 PMCID: PMC5860398 DOI: 10.1093/arclin/acx090] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 09/06/2017] [Indexed: 12/02/2022] Open
Abstract
Deep brain stimulation (DBS) is an effective (but non-curative) treatment for some of the motor symptoms and treatment complications associated with dopaminergic agents in Parkinson's disease (PD). DBS can be done relatively safely and is associated with quality of life gains. In most DBS centers, neuropsychological evaluations are performed routinely before surgery, and sometimes after surgery. The purpose of such evaluation is not to decide solely on its results whether or not to offer DBS to a given candidate, but to provide the patient and treatment team with the best available information to make reasonable risk-benefit assessments. This review provides information relevant to the questions often asked by patients and their carepartners, neurologists, and neurosurgeons about neuropsychological outcomes of DBS, including neuropsychological adverse event rates, magnitude of cognitive changes, outcomes after unilateral versus bilateral surgery directed at various targets, impact of mild cognitive impairment (MCI) on outcome, factors implicated in neurobehavioral outcomes, and safety of newer interventions or techniques such as asleep surgery and current steering.
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Affiliation(s)
- Alexander I Tröster
- Department of Clinical Neuropsychology and Center for Neuromodulation, Barrow Neurological Institute, Phoenix, AZ, USA
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12
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Hogg E, Wertheimer J, Graner S, Tagliati M. Deep Brain Stimulation and Nonmotor Symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1045-1089. [DOI: 10.1016/bs.irn.2017.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Szatmari S, Illigens BMW, Siepmann T, Pinter A, Takats A, Bereczki D. Neuropsychiatric symptoms in untreated Parkinson's disease. Neuropsychiatr Dis Treat 2017; 13:815-826. [PMID: 28352181 PMCID: PMC5360401 DOI: 10.2147/ndt.s130997] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Neuropsychiatric and cognitive symptoms are common in Parkinson's disease (PD) and may precede and exceed motor symptoms as major factors impacting disease course and quality of life. Neuropsychiatric symptoms (NPS) in PD are various and are attributed to pathologic changes within multiple brain regions, to psychological stress, and to adverse effects of dopamine replacement therapy. Sleep disorders and mood symptoms such as apathy, depression, and anxiety may antedate the development of motor symptoms by years, while other NPS such as impulse control disorders, psychosis, and cognitive impairment are more common in later stages of the disease. Few studies report on NPS in the early, untreated phase of PD. We reviewed the current literature on NPS in PD with a focus on the early, drug-naive stages of PD. Among these early disease stages, premotor and early motor phases were separately addressed in our review, highlighting the underlying pathophysiological mechanisms as well as epidemiological characteristics, clinical features, risk factors, and available techniques of clinical assessment.
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Affiliation(s)
- Szabolcs Szatmari
- Department of Neurology, Sibiu County Emergency Hospital, Sibiu; 2nd Department of Neurology, Targu Mures Emergency Clinical County Hospital, Targu Mures, Romania; János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
| | - Ben Min-Woo Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Alexandra Pinter
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University; Department of Family Medicine
| | - Annamaria Takats
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
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Tröster AI, Jankovic J, Tagliati M, Peichel D, Okun MS. Neuropsychological outcomes from constant current deep brain stimulation for Parkinson's disease. Mov Disord 2016; 32:433-440. [PMID: 27753157 PMCID: PMC5363377 DOI: 10.1002/mds.26827] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/03/2016] [Accepted: 09/06/2016] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to evaluate the neurobehavioral safety of constant‐current subthalamic deep brain stimulation and to compare the neuropsychological effects of stimulation versus electrode placement alone. Methods A total of 136 patients with Parkinson's disease underwent bilateral subthalamic device implantation in this randomized trial. Patients received stimulation either immediately after device implantation (n = 101; active stimulation) or beginning 3 months after surgery (n = 35; delayed activation control). Patients were administered neuropsychological tests before, 3, and 12 months after device implantation. Results Neuropsychological change in stimulation and control groups were comparable. Within‐group analyses revealed declines in category and switching verbal fluency in both groups, but only the stimulation group had letter verbal fluency and Stroop task declines. Depression symptom improvements occurred in both groups, but more often in the stimulation group. Letter fluency declines were associated with worse Parkinson's Disease Questionnaire Communication subscale scores. Baseline and 12‐month comparisons (in the combined group) revealed gains in verbal and visual delayed recall scores and improvement in depression symptoms, but decrements in verbal fluency and Stroop scores. Conclusions Constant‐current bilateral subthalamic stimulation had a good cognitive safety profile except for decrements in verbal fluency and on the Stroop task. These abnormalities are related to device implantation, but stimulation likely had an additive effect. One year after surgery, the cognitive changes did not exert a detrimental effect on quality of life, although letter fluency declines were associated with communication dissatisfaction at 12 months. Improvement in depressive symptom severity appears dependent on stimulation and not placebo or lesion effects. © 2016 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alexander I Tröster
- Department of Clinical Neuropsychology and Barrow Center for Neuromodulation, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Joseph Jankovic
- Baylor College of Medicine, Department of Neurology, Houston, Texas, USA
| | - Michele Tagliati
- Cedar-Sinai Medical Center, Department of Neurology, Los Angeles, California, USA
| | - DeLea Peichel
- St. Jude Medical, Clinical Studies, Plano, Texas, USA
| | - Michael S Okun
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida School, Gainesville, Florida, USA
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Yin XF, Xu HM, Jiang YX, Zhi YL, Liu YX, Xiang HW, Liu K, Ding XD, Sun P. Lentivirus-mediated Persephin over-expression in Parkinson's disease rats. Neural Regen Res 2016; 10:1814-8. [PMID: 26807117 PMCID: PMC4705794 DOI: 10.4103/1673-5374.170309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Persephin, together with glial cell line-derived neurotrophic factor and neurturin, has a neurotrophic effect and promotes the survival of motor neurons cultured in vitro. In this study, dopaminergic neurons in the substantia nigra of rats were transfected with the Persephin gene. One week later 6-hydroxydopamine was injected into the anterior medial bundle to establish a Parkinson's disease model in the rats. Results found that the number of dopaminergic neurons in the substantia nigra increased, tyrosine hydroxylase expression was upregulated and concentrations of dopamine and its metabolites in corpus striatum were increased after pretreatment with Persephin gene. In addition, the rotating effect of the induced Parkinson's disease rats was much less in the group pretreated with the Persephin gene. Persephin has a neuroprotective effect on the 6-hydroxydopamine-induced Parkinson's disease through protecting dopaminergic neurons.
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Affiliation(s)
- Xiao-Feng Yin
- Department of Neurosurgery, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hua-Min Xu
- Department of Physiology, Qingdao University, Qingdao, Shandong Province, China
| | - Yun-Xia Jiang
- Nursing College of Qingdao University, Qingdao, Shandong Province, China
| | - Yun-Lai Zhi
- Department of Pediatric Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yu-Xiu Liu
- Department of Nursing, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Heng-Wei Xiang
- Department of Neurosurgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong Province, China
| | - Kai Liu
- Department of Neurosurgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong Province, China
| | - Xiao-Dong Ding
- Department of Neurosurgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong Province, China
| | - Peng Sun
- Department of Neurosurgery, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong Province, China
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Deep Brain Stimulation of Thalamic Nuclei for Treatment of Intractable Epilepsy. ARCHIVES OF NEUROSCIENCE 2015. [DOI: 10.5812/archneurosci.22285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Oh YS, Kim JS, Lee PH. Effect of Rivastigmine on Behavioral and Psychiatric Symptoms of Parkinson's Disease Dementia. J Mov Disord 2015; 8:98-102. [PMID: 26090082 PMCID: PMC4460546 DOI: 10.14802/jmd.15041] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 02/04/2015] [Accepted: 02/11/2015] [Indexed: 12/22/2022] Open
Abstract
Objective A recent study showed that rivastigmine and memantin improved behavioral and psychiatric symptoms of dementia (BPSD) in Alzheimer’s dementia. Furthermore, according to recent guidelines presented by the Movement Disorder Society, rivastigmine is efficacious for the treatment of dementia in Parkinson’s disease (PD). We investigated the efficacy of rivastigmine for BPSD in patients with Parkinson’s disease dementia (PDD). Methods Twenty-three patients in whom cognitive impairment occurred at least one year after a diagnosis of PD participated in this open-label trial. Cognitive, psychiatric, and motor symptoms were assessed before and after 24 weeks of treatment with rivastigmine using unstructured clinical assessments and rating scales including the Unified Parkinson’s Disease Rating Scale, Mini-Mental State Examination (MMSE), and the Neuropsychiatric Inventory. Results Age (± standard deviation) was 74.7 ± 5.9 years, average duration of PD was 3.5 ± 3.7 years, Hoehn and Yahr scores were 2.2 ± 0.8, and baseline MMSE scores were 19.1 ± 4.2. Improvements in global mental symptoms and neuropsychiatric symptoms were significant; among them, hallucination, depression and appetite changes improved. Caregiver distress significantly decreased, including distress resulting from hallucinations, depression, apathy, and appetite changes. Conclusions Although controlled trials are required, the findings suggest that rivastigmine is useful for control of several neuropsychiatric symptoms and beneficial for caregiver distress in patients with PDD.
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Affiliation(s)
- Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, College of Medicine, Yonsei University, Seoul, Korea
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Oh YS, Lee JE, Lee PH, Kim JS. Neuropsychiatric symptoms in Parkinson's disease dementia are associated with increased caregiver burden. J Mov Disord 2015; 8:26-32. [PMID: 25614783 PMCID: PMC4298716 DOI: 10.14802/jmd.14019] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/04/2014] [Accepted: 09/18/2014] [Indexed: 12/31/2022] Open
Abstract
Objective Neuropsychiatric symptoms are common in Parkinson’s disease dementia (PDD). Frequent and severe neuropsychiatric symptoms create high levels of distress for patients and caregivers, decreasing their quality of life. The aim of this study was to investigate neuropsychiatric symptoms that may contribute to increased caregiver burden in PDD patients. Methods Forty-eight PDD patients were assessed using the 12-item Neuropsychiatric Inventory (NPI) to determine the frequency and severity of mental and behavioral problems. The Burden Interview and Caregiver Burden Inventory were used to evaluate caregiver burden. Results All but one patient showed one or more neuropsychiatric symptoms. The three most frequent neuropsychiatric symptoms were apathy (70.8%) and anxiety (70.8%), followed by depression (68.7%). More severe neuropsychiatric symptoms were significantly correlated with increased caregiver burden. The domains of delusion, hallucination, agitation and aggression, anxiety, irritability and lability, and aberrant motor behavior were associated with caregiver stress. After controlling for age and other potential confounding variables, total NPI score was significantly associated with caregiver burden. Conclusions The results of this study confirm that neuropsychiatric symptoms are frequent and severe in patients with PDD and are associated with increased caregiver distress. A detailed evaluation and management of neuropsychiatric symptoms in PDD patients appears necessary to improve patient quality of life and reduce caregiver burden.
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Affiliation(s)
- Yoon-Sang Oh
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji E Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Non pharmacological treatment, in addition to pharmacological treatment is indicated in patients with refractory/pharmacoresistant epilepsy and includes ketogenic diet, deep brain stimulator, vagal nerve stimulator, transcranial magnetic stimulation and epilepsy surgery. Ketogenic diet has been recommended since 1921 and has been proved to be a safe and effective treatment for intractable epilepsy. Deep brain stimulator, has been used in the treatment of movement disorders for many years and recently been tried in the treatment of pharmacoresistant epilepsy. Vagus nerve stimulator is increasingly being used as an effective seizure aborting technique in patients not responding to anticonvulsants. Transcranial magnetic stimulation is a noninvasive brain stimulation technique which is being increasingly researched for use in patients with medication-refractory seizures who are not suitable candidates for surgery. Evolution of epilepsy surgery including Vagal nerve stimulator and Deep brain stimulator, as a successful treatment modality for intractable epilepsy has been influenced over the last decade by substantial advancement in imaging and operative/device related technology. The current article reviews the indications, mechanism of action, technological aspects and efficacy of the aforementioned modalities in the treatment of intractable/pharmacoresistant epilepsy in pediatric age group.
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de la Riva P, Smith K, Xie SX, Weintraub D. Course of psychiatric symptoms and global cognition in early Parkinson disease. Neurology 2014; 83:1096-103. [PMID: 25128183 DOI: 10.1212/wnl.0000000000000801] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the course and predictors of neuropsychiatric symptoms (NPS) and cognition in patients with de novo Parkinson disease (PD). METHODS Cross-sectional study of the cohort of de novo, untreated (at enrollment) patients with PD and healthy controls (HCs) from the Parkinson's Progression Markers Initiative. Participants have serial assessments of global cognition and symptoms of depression, anxiety, psychosis, impulse control disorders (ICDs), sleep and wakefulness, apathy, and fatigue. Available data up to 24 months of follow-up were included. RESULTS The available sample size was as follows: baseline (PD = 423, HCs = 196), 12 months (PD = 261, HCs = 145), and 24 months (PD = 96, HCs = 83). Patients with PD experienced more depression, fatigue, apathy, and anxiety than HCs at all time points, and apathy (p = 0.001) and psychosis (p = 0.003) increased over time in patients with PD. Approximately two-thirds of patients with PD who screened positive for depression at any given visit were not taking an antidepressant. The Montreal Cognitive Assessment score decreased significantly over time in patients with PD (p < 0.001), but the change was comparable to that in HCs. At the 24-month visit, 44% of patients had been on dopamine replacement therapy (DRT) for at least 1 year, and this group reported more incident ICDs (p = 0.009) and excessive daytime sleepiness (p = 0.03). CONCLUSION Multiple NPS are more common in de novo, untreated patients with PD compared with the general population, but they also remain relatively stable in early disease, while global cognition slightly deteriorates. In contrast, initiation of DRT is associated with increasing frequency of several other NPS.
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Affiliation(s)
- Patricia de la Riva
- From the Department of Neurology (P.d.l.R.), University Hospital Donostia, San Sebastián, Spain; Department of Biostatistics and Epidemiology (S.X.X.) and Departments of Neurology and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania (K.S.), Philadelphia; and Department of Veterans Affairs (D.W.), Philadelphia VA Medical Center.
| | - Kara Smith
- From the Department of Neurology (P.d.l.R.), University Hospital Donostia, San Sebastián, Spain; Department of Biostatistics and Epidemiology (S.X.X.) and Departments of Neurology and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania (K.S.), Philadelphia; and Department of Veterans Affairs (D.W.), Philadelphia VA Medical Center
| | - Sharon X Xie
- From the Department of Neurology (P.d.l.R.), University Hospital Donostia, San Sebastián, Spain; Department of Biostatistics and Epidemiology (S.X.X.) and Departments of Neurology and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania (K.S.), Philadelphia; and Department of Veterans Affairs (D.W.), Philadelphia VA Medical Center
| | - Daniel Weintraub
- From the Department of Neurology (P.d.l.R.), University Hospital Donostia, San Sebastián, Spain; Department of Biostatistics and Epidemiology (S.X.X.) and Departments of Neurology and Psychiatry (D.W.), Perelman School of Medicine at the University of Pennsylvania (K.S.), Philadelphia; and Department of Veterans Affairs (D.W.), Philadelphia VA Medical Center
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Acute changes in mood induced by subthalamic deep brain stimulation in Parkinson disease are modulated by psychiatric diagnosis. Brain Stimul 2014; 7:701-8. [PMID: 25017671 DOI: 10.1016/j.brs.2014.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/30/2014] [Accepted: 06/04/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Deep brain stimulation of the subthalamic nucleus (STN DBS) reduces Parkinson disease (PD) motor symptoms but has unexplained, variable effects on mood. OBJECTIVE The study tested the hypothesis that pre-existing mood and/or anxiety disorders or increased symptom severity negatively affects mood response to STN DBS. METHODS Thirty-eight PD participants with bilateral STN DBS and on PD medications were interviewed with Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID) and completed Beck Depression Inventory (BDI) and Spielberger State Anxiety Inventory (SSAI) self-reports. Subsequently, during OFF and optimal ON (clinical settings) STN DBS conditions and while off PD medications, motor function was assessed with the United Parkinson Disease Rating Scale (UPDRS, part III), and participants rated their mood with Visual Analogue Scales (VAS), and again completed SSAI. VAS mood variables included anxiety, apathy, valence and emotional arousal. RESULTS STN DBS improved UPDRS scores and mood. Unexpectedly, PD participants diagnosed with current anxiety or mood disorders experienced greater STN DBS-induced improvement in mood than those diagnosed with remitted disorders or who were deemed as having never met threshold criteria for diagnosis. BDI and SSAI scores did not modulate mood response to STN DBS, indicating that clinical categorical diagnosis better differentiates mood response to STN DBS than self-rated symptom severity. SCID diagnosis, BDI and SSAI scores did not modulate motor response to STN DBS. CONCLUSIONS PD participants diagnosed with current mood or anxiety disorders are more sensitive to STN DBS-induced effects on mood, possibly indicating altered basal ganglia circuitry in this group.
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Abstract
Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Osvaldo Fustinoni
- INEBA Institute of Neurosciences, Buenos Aires, Argentina; Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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Sotoyama H, Namba H, Chiken S, Nambu A, Nawa H. Exposure to the cytokine EGF leads to abnormal hyperactivity of pallidal GABA neurons: implications for schizophrenia and its modeling. J Neurochem 2013; 126:518-28. [DOI: 10.1111/jnc.12223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 02/03/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Hidekazu Sotoyama
- Department of Molecular Neurobiology; Brain Research Institute; Niigata University; Niigata Japan
| | - Hisaaki Namba
- Department of Molecular Neurobiology; Brain Research Institute; Niigata University; Niigata Japan
| | - Satomi Chiken
- Division of System Neurobiology; National Institute for Physiological Sciences and Department of Physiological Sciences; Graduate University for Advanced Studies; Myodaiji Okazaki Japan
| | - Atsushi Nambu
- Division of System Neurobiology; National Institute for Physiological Sciences and Department of Physiological Sciences; Graduate University for Advanced Studies; Myodaiji Okazaki Japan
| | - Hiroyuki Nawa
- Department of Molecular Neurobiology; Brain Research Institute; Niigata University; Niigata Japan
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Campbell MC, Black KJ, Weaver PM, Lugar HM, Videen TO, Tabbal SD, Karimi M, Perlmutter JS, Hershey T. Mood response to deep brain stimulation of the subthalamic nucleus in Parkinson's disease. J Neuropsychiatry Clin Neurosci 2012; 24:28-36. [PMID: 22450611 PMCID: PMC3354989 DOI: 10.1176/appi.neuropsych.11030060] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (STN DBS) in Parkinson's disease (PD) improves motor functioning but has variable effects on mood. Little is known about the relationship between electrode contact location and mood response. The authors identified the anatomical location of electrode contacts and measured mood response to stimulation with the Visual Analog Scale in 24 STN DBS PD patients. Participants reported greater positive mood and decreased anxiety and apathy with bilateral and unilateral stimulation. Left DBS improved mood more than right DBS. Right DBS-induced increase in positive mood was related to more medial and dorsal contact locations. These results highlight the functional heterogeneity of the STN.
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Affiliation(s)
- Meghan C. Campbell
- Department of Neurology, Washington University School of Medicine, St Louis, MO,Department of Radiology, Washington University School of Medicine, St Louis, MO
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St Louis, MO,Department of Psychiatry, Washington University School of Medicine, St Louis, MO,Department of Radiology, Washington University School of Medicine, St Louis, MO,Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, MO
| | - Patrick M. Weaver
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
| | - Heather M. Lugar
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO
| | - Tom O. Videen
- Department of Neurology, Washington University School of Medicine, St Louis, MO,Department of Radiology, Washington University School of Medicine, St Louis, MO
| | - Samer D. Tabbal
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Morvarid Karimi
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Joel S. Perlmutter
- Department of Neurology, Washington University School of Medicine, St Louis, MO,Department of Radiology, Washington University School of Medicine, St Louis, MO,Department of Anatomy and Neurobiology, Washington University School of Medicine, St Louis, MO,Programs in Physical Therapy and Occupational Therapy, Washington University School of Medicine, St Louis, MO
| | - Tamara Hershey
- Department of Neurology, Washington University School of Medicine, St Louis, MO,Department of Psychiatry, Washington University School of Medicine, St Louis, MO,Department of Radiology, Washington University School of Medicine, St Louis, MO
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Min HK, Hwang SC, Marsh MP, Kim I, Knight E, Striemer B, Felmlee JP, Welker KM, Blaha CD, Chang SY, Bennet KE, Lee KH. Deep brain stimulation induces BOLD activation in motor and non-motor networks: an fMRI comparison study of STN and EN/GPi DBS in large animals. Neuroimage 2012; 63:1408-20. [PMID: 22967832 DOI: 10.1016/j.neuroimage.2012.08.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 08/03/2012] [Accepted: 08/04/2012] [Indexed: 01/11/2023] Open
Abstract
The combination of deep brain stimulation (DBS) and functional MRI (fMRI) is a powerful means of tracing brain circuitry and testing the modulatory effects of electrical stimulation on a neuronal network in vivo. The goal of this study was to trace DBS-induced global neuronal network activation in a large animal model by monitoring the blood oxygenation level-dependent (BOLD) response on fMRI. We conducted DBS in normal anesthetized pigs, targeting the subthalamic nucleus (STN) (n=7) and the entopeduncular nucleus (EN), the non-primate analog of the primate globus pallidus interna (n=4). Using a normalized functional activation map for group analysis and the application of general linear modeling across subjects, we found that both STN and EN/GPi DBS significantly increased BOLD activation in the ipsilateral sensorimotor network (FDR<0.001). In addition, we found differential, target-specific, non-motor network effects. In each group the activated brain areas showed a distinctive correlation pattern forming a group of network connections. Results suggest that the scope of DBS extends beyond an ablation-like effect and that it may have modulatory effects not only on circuits that facilitate motor function but also on those involved in higher cognitive and emotional processing. Taken together, our results show that the swine model for DBS fMRI, which conforms to human implanted DBS electrode configurations and human neuroanatomy, may be a useful platform for translational studies investigating the global neuromodulatory effects of DBS.
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Affiliation(s)
- Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Müller T. Drug therapy in patients with Parkinson's disease. Transl Neurodegener 2012; 1:10. [PMID: 23211041 PMCID: PMC3514092 DOI: 10.1186/2047-9158-1-10] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 05/24/2012] [Indexed: 01/20/2023] Open
Abstract
Parkinson`s disease (PD) is a progressive, disabling neurodegenerative disorder with onset of motor and non-motor features. Both reduce quality of life of PD patients and cause caregiver burden. This review aims to provide a survey of possible therapeutic options for treatment of motor and non motor symptoms of PD and to discuss their relation to each other. MAO-B-Inhibitors, NMDA antagonists, dopamine agonists and levodopa with its various application modes mainly improve the dopamine associated motor symptoms in PD. This armentarium of PD drugs only partially influences the onset and occurrence of non motor symptoms. These PD features predominantly result from non dopaminergic neurodegeneration. Autonomic features, such as seborrhea, hyperhidrosis, orthostatic syndrome, salivation, bladder dysfunction, gastrointestinal disturbances, and neuropsychiatric symptoms, such as depression, sleep disorders, psychosis, cognitive dysfunction with impaired execution and impulse control may appear. Drug therapy of these non motor symptoms complicates long-term PD drug therapy due to possible occurrence of drug interactions, - side effects, and altered pharmacokinetic behaviour of applied compounds. Dopamine substituting compounds themselves may contribute to onset of these non motor symptoms. This complicates the differentiation from the disease process itself and influences therapeutic options, which are often limited because of additional morbidity with necessary concomitant drug therapy.
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Affiliation(s)
- Thomas Müller
- Department of Neurology, St, Joseph Hospital Berlin-Weissensee, Gartenstr, 1, 13088, Berlin, Germany.
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Lindemann C, Krauss JK, Schwabe K. Deep brain stimulation of the subthalamic nucleus in the 6-hydroxydopamine rat model of Parkinson's disease: Effects on sensorimotor gating. Behav Brain Res 2012; 230:243-50. [DOI: 10.1016/j.bbr.2012.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 02/02/2012] [Indexed: 12/27/2022]
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Behavioral and Psychological Symptoms in Patients with Parkinson's Disease According to Cognitive Function. Dement Neurocogn Disord 2012. [DOI: 10.12779/dnd.2012.11.3.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Müller T, Gerlach M, Youdim MB, Riederer P. Psychiatric, nonmotor aspects of Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:477-90. [DOI: 10.1016/b978-0-444-52002-9.00028-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Chung SS, Kelly K, Schusse C. New and emerging treatments for epilepsy: review of clinical studies of lacosamide, eslicarbazepine acetate, ezogabine, rufinamide, perampanel, and electrical stimulation therapy. J Epilepsy Res 2011; 1:35-46. [PMID: 24649444 PMCID: PMC3952328 DOI: 10.14581/jer.11008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/17/2011] [Indexed: 01/26/2023] Open
Abstract
Although many different medical and surgical treatment options for epilepsy exist, approximately 30% of epilepsy patients remain poorly controlled. For those patients who are refractory to medical treatment, epilepsy surgery often provides meaningful improvement. However, when surgical resection of epileptic foci cannot be offered or failed, combined administration of AEDs or the application of novel AEDs is the most appropriate therapeutic options. The most recent AEDs tend to offer new mechanisms of action and more favorable safety profiles than the first generation of AEDs. More recently, alternative options of thalamic or cortical stimulation emerged as potentiall effective treatment for epilepsy. The purpose of this article is to compare and review clinical information for the new and emerging medications such as lacosamide, eslicarbazepine acetate, ezogabine (retigabine), rufinamide, perampanel, as well as deep brain stimulation and responsive neurostimulation devices.
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Affiliation(s)
- Steve S. Chung
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Kristen Kelly
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | - Courtney Schusse
- Department of Neurology, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
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Kelly KM, Chung SS. Surgical treatment for refractory epilepsy: review of patient evaluation and surgical options. EPILEPSY RESEARCH AND TREATMENT 2011; 2011:303624. [PMID: 22937231 PMCID: PMC3420605 DOI: 10.1155/2011/303624] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 02/04/2011] [Accepted: 03/22/2011] [Indexed: 11/17/2022]
Abstract
Treatment of epilepsy often imposes an exposure to various antiepileptic drugs and requires long-term commitment and compliance from the patient. Although many new medications are now available for the treatment of epilepsy, approximately 30% of epilepsy patients still experience recurrent seizures and many experience undesirable side effects. Treatment of epilepsy requires a multidisciplinary approach. For those patients with medically refractory seizures, surgical treatment has increased in prevalence as techniques and devices improve. With increased utilization, proper patient selection has become crucial in evaluating appropriateness of surgical intervention. Epilepsy syndromes in which surgery has shown to be effective include mesial temporal sclerosis, cortical dysplasia, many pediatric epilepsy syndromes, and vascular malformations. Monitoring in an epilepsy monitoring unit with continuous scalp or intracranial EEG is an important step in localization of seizure focus. MRI is the standard imaging technique for evaluation of anatomy. However, other imaging studies including SPECT and PET have become more widespread, often offering increased diagnostic value in select situations. In addition, as an alternative or adjunct to surgical resection, implantable devices such as vagus nerve stimulators, deep brain stimulators, and direct brain stimulators could be useful in seizure treatment.
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Affiliation(s)
- Kristen M. Kelly
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 720, Phoenix, AZ 85013, USA
| | - Steve S. Chung
- Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 720, Phoenix, AZ 85013, USA
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Kerber CS, Schlenker E, Hickey K. Does your older adult client have a gambling problem? J Psychosoc Nurs Ment Health Serv 2011; 49:38-43. [PMID: 21598867 DOI: 10.3928/02793695-20110503-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 03/30/2011] [Indexed: 11/20/2022]
Abstract
Pathological gambling is becoming an increasing problem in today's culture, particularly because opportunities and inducements to gamble abound. This article describes symptoms, consequences, and comorbidities experienced by pathological gamblers. Gambling pathology is often invisible because pathological gamblers seldom disclose gambling problems to their primary care provider. Thus, nurses will benefit from knowledge of the physical and emotional signs of the disorder. A two-question assessment tool, the Lie/Bet Questionnaire, is useful in helping nurses identify pathological gamblers. Interventions and treatment options, including group therapy and environmental modification, are also discussed. As always, education concerning problems and consequences of pathological gambling is a first step. Because research has indicated that visits to casinos by older adults have doubled since 1975, the authors use an example of an older adult to clarify the issues. Although the article's content is applicable to clients across the life span, it has particular significance for older adults.
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Affiliation(s)
- Cindy Sullivan Kerber
- Mennonite College of Nursing, Illinois State University, Normal, IL 61790-5815, USA.
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Wishart S, Macphee GJA. Evaluation and management of the non-motor features of Parkinson's disease. Ther Adv Chronic Dis 2011; 2:69-85. [PMID: 23251743 PMCID: PMC3513877 DOI: 10.1177/2040622310387847] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parkinson's disease (PD) is traditionally viewed as a motor disorder with a characteristic triad of tremor, rigidity and bradykinesia. There is now increasing awareness that PD is a complex systemic disorder with many nonmotor symptoms (NMS) which include autonomic dysfunction, sleep disorders, sensory and neuropsychiatric features. NMS become more common in severity and frequency with advancing disease when neuropsychiatric features such as cognitive impairment and psychosis dominate the clinical picture. NMS are strongly correlated with quality of life for patients and their families as well as institutional care placement. Despite their importance, NMS are poorly recognized by clinicians and often undeclared by patients. Use of a validated screening tool NMSQuest followed by specific symptom assessment instruments strengthens the recognition and holistic management of NMS in PD. Some NMS such as mood disturbance, anxiety, pain and insomnia may be improved by optimization of dopaminergic therapy. Conversely, psychosis, excess daytime somnolence or impulse control disorder (ICD) may be triggered by dopaminergic drugs. Other NMS such as dementia and severe depression may be unresponsive to dopaminergic treatment and may reflect perturbations in cholinergic, serotonergic or noradrenergic neurotransmitter function. These symptoms are more challenging to manage but may be ameliorated to some extent by agents such as acetylcholinesterase inhibitor or antidepressant drugs. This contribution reviews the evidence for the evaluation and management of key NMS in PD (apathy, anxiety, depression, psychosis, dementia, ICD, sleep disturbance, autonomic dysfunction, pain) and highlights the urgent need for both novel therapies and more controlled trials for current therapeutic strategies.
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Affiliation(s)
- Steven Wishart
- Medicine for the Elderly/Movement Disorders Clinic, Southern General Hospital, Glasgow, Scotland G51 4TF, UK
| | - Graeme J. A. Macphee
- Medicine for the Elderly/Movement Disorders Clinic, Southern General Hospital, Glasgow, Scotland G51 4TF, UK
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Saleh C. DBS: should the STN be avoided in progressive Parkinson's disease? Acta Neurochir (Wien) 2010; 152:2101-2; author reply 2103-4. [PMID: 20878338 DOI: 10.1007/s00701-010-0814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 09/16/2010] [Indexed: 10/19/2022]
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Cyron D, Funk M, Deletter MA, Scheufler K. Preserved cognition after deep brain stimulation (DBS) in the subthalamic area for Parkinson's disease: a case report. Acta Neurochir (Wien) 2010; 152:2097-100. [PMID: 20676703 DOI: 10.1007/s00701-010-0755-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 07/16/2010] [Indexed: 11/24/2022]
Abstract
At present, subthalamic nucleus (STN) stimulation is the preferred procedure for the amelioration of motor symptoms in medication refractory Parkinson's disease. Results are however impaired by negative impacts on mood, cognition, incentive, and social judgment. Alternative targets are therefore explored. We describe a case with stimulation of subthalamic fibre tracts that showed clear improvement of cognitive and social abilities. Avoiding the STN may be advantageous in progressive Parkinson's disease to avoid non-motor complications and enhance quality of life.
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Affiliation(s)
- Donatus Cyron
- Department of Neurosurgery, Klinik Hirslanden, Zürich, Switzerland.
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D'Haese PF, Pallavaram S, Li R, Remple MS, Kao C, Neimat JS, Konrad PE, Dawant BM. CranialVault and its CRAVE tools: a clinical computer assistance system for deep brain stimulation (DBS) therapy. Med Image Anal 2010; 16:744-53. [PMID: 20732828 DOI: 10.1016/j.media.2010.07.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 03/09/2010] [Accepted: 07/11/2010] [Indexed: 11/29/2022]
Abstract
A number of methods have been developed to assist surgeons at various stages of deep brain stimulation (DBS) therapy. These include construction of anatomical atlases, functional databases, and electrophysiological atlases and maps. But, a complete system that can be integrated into the clinical workflow has not been developed. In this paper we present a system designed to assist physicians in pre-operative target planning, intra-operative target refinement and implantation, and post-operative DBS lead programming. The purpose of this system is to centralize the data acquired a the various stages of the procedure, reduce the amount of time needed at each stage of the therapy, and maximize the efficiency of the entire process. The system consists of a central repository (CranialVault), of a suite of software modules called CRAnialVault Explorer (CRAVE) that permit data entry and data visualization at each stage of the therapy, and of a series of algorithms that permit the automatic processing of the data. The central repository contains image data for more than 400 patients with the related pre-operative plans and position of the final implants and about 10,550 electrophysiological data points (micro-electrode recordings or responses to stimulations) recorded from 222 of these patients. The system has reached the stage of a clinical prototype that is being evaluated clinically at our institution. A preliminary quantitative validation of the planning component of the system performed on 80 patients who underwent the procedure between January 2009 and December 2009 shows that the system provides both timely and valuable information.
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Affiliation(s)
- Pierre-François D'Haese
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA.
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Rivera-Mancía S, Pérez-Neri I, Ríos C, Tristán-López L, Rivera-Espinosa L, Montes S. The transition metals copper and iron in neurodegenerative diseases. Chem Biol Interact 2010; 186:184-99. [DOI: 10.1016/j.cbi.2010.04.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 01/22/2010] [Accepted: 04/08/2010] [Indexed: 12/14/2022]
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Dormont D, Seidenwurm D, Galanaud D, Cornu P, Yelnik J, Bardinet E. Neuroimaging and deep brain stimulation. AJNR Am J Neuroradiol 2009; 31:15-23. [PMID: 19749225 DOI: 10.3174/ajnr.a1644] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD). Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future.
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Affiliation(s)
- D Dormont
- Cogimage, Université Pierre et Marie Curie Paris VI, CRICM, CNRS, UMR 7225, Groupe Hospitalier Pitié-Salpêtrière AP-HP, Paris, France.
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Gubellini P, Salin P, Kerkerian-Le Goff L, Baunez C. Deep brain stimulation in neurological diseases and experimental models: From molecule to complex behavior. Prog Neurobiol 2009; 89:79-123. [DOI: 10.1016/j.pneurobio.2009.06.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 04/28/2009] [Accepted: 06/18/2009] [Indexed: 11/30/2022]
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41
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Impulse control disorders and dopamine dysregulation syndrome associated with dopamine agonist therapy in Parkinson's disease. Behav Pharmacol 2009; 20:363-79. [DOI: 10.1097/fbp.0b013e32833109a0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caixeta L, Soares VL, Soares CD, Reis G. Dementia and mild cognitive impairment in Parkinson's disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:959. [PMID: 19838542 DOI: 10.1590/s0004-282x2009000500047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Leonardo Caixeta
- Cognitive and Behavioral Neurology Unit, Hospital das Clínicas, Federal University of Goiás
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43
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Juckel G, Uhl I, Padberg F, Brüne M, Winter C. Psychosurgery and deep brain stimulation as ultima ratio treatment for refractory depression. Eur Arch Psychiatry Clin Neurosci 2009; 259:1-7. [PMID: 19137233 DOI: 10.1007/s00406-008-0826-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 05/14/2008] [Indexed: 11/27/2022]
Abstract
For decades, the most severe, protracted and therapy-resistant forms of major depression have compelled clinicians and researchers to look for last resort treatment. Early psychosurgical procedures were hazardous and often associated with severe and persistent side effects including avolition, apathy and change of personality. With the introduction of psychopharmacological treatments in the 1950s, the frequency of ablative procedures declined rapidly. The past decade, however, has witnessed the resurgence of surgical strategies as a result of refined techniques and advances such as high frequency stimulation of deep brain nuclei. Recent data suggest that the overall effect of high frequency stimulation lies in the functional inhibition of neural activity in the region stimulated. Contrary to other psychosurgical procedures, high frequency stimulation reversibly modulates targeted brain areas and allows a postsurgical adaption of the stimulation parameters according to clinical outcome. With increased understanding of the brain regions and functional circuits involved in the pathogenesis of psychiatric disorders, major depression has emerged as a target for new psychosurgical approaches to selectively and precisely modulate neural areas involved in the disease process. Recent studies of minimally intervening procedures report good clinical outcome in the treatment of therapy-resistant forms of major depression. High frequency stimulation was successfully applied in several small samples of patients with treatment-resistant depression when the stimulation focused on different areas, e.g., nucleus accumbens, the lateral habenula or cortical areas. Nevertheless, the reticence toward psychosurgery, even for those patients suffering from the most debilitating forms of depression, still prevails, even though recent studies have shown significant improvement in terms of quality of life with the limitation that the number of treated cases has been small. In any event, valid and unambiguous criteria for patient eligibility have yet to be refined and standardized. In this review, we suggest possible standard criteria for the application of deep brain stimulation on patients suffering from otherwise treatment-resistant depression.
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Affiliation(s)
- Georg Juckel
- Department of Psychiatry Psychotherapy and Psychosomatic Medicine, Ruhr-University, Alexandrinenstr. 1, Bochum 44791, Germany.
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44
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Rapid Resolution of Dopamine Dysregulation Syndrome (DDS) After Subthalamic DBS for Parkinson Disease (PD). Cogn Behav Neurol 2008; 21:187-9. [DOI: 10.1097/wnn.0b013e318185e6e2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Parkinson's disease is a common condition, usually treated by dopaminergic agents, both ergot and non-ergot. Many behavioural abnormalities are associated with such usage, including impulse control disorders (ICDs), dopamine dysregulation syndrome and 'punding'. Pathological gambling, a form of ICD, comprises persistent and maladaptive gambling of various types that disrupts personal, family or occupational activity. Pathological gambling may be associated with other abnormal actions such as pathological shopping, hoarding and hypersexuality. The incidence varies widely from study to study but may be up to 7% of users of dopaminergic agents. Recognition of this problem has led drug regulatory agencies to add precautions concerning pathological gambling to official drug information for the entire class of antiparkinsonian medications. The literature is not entirely consistent and opinions differ greatly, but pramipexole (a dopamine D2 and D3 agonist), and perhaps ropinirole (also a D2/D3 agonist), may be especially likely to be associated with pathological gambling, although the precise nature of the relationship is unclear. Treatment involves reducing the dose of the medication or switching to another medication; unfortunately, the Parkinson's disease may worsen. The mechanism of this adverse effect is believed to be excessive dopaminergic stimulation but probably not specifically involving D3 receptors. A parallel to addictive behaviour with stimulant drugs has been noted.
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Affiliation(s)
- Malcolm Lader
- Institute of Psychiatry, King's College, London, England.
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Campbell MC, Karimi M, Weaver PM, Wu J, Perantie DC, Golchin NA, Tabbal SD, Perlmutter JS, Hershey T. Neural correlates of STN DBS-induced cognitive variability in Parkinson disease. Neuropsychologia 2008; 46:3162-9. [PMID: 18682259 DOI: 10.1016/j.neuropsychologia.2008.07.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 05/21/2008] [Accepted: 07/14/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although deep brain stimulation of the subthalamic nucleus (STN DBS) in Parkinson disease (PD) improves motor function, it has variable effects on working memory (WM) and response inhibition (RI) performance. The purpose of this study was to determine the neural correlates of STN DBS-induced variability in cognitive performance. METHODS We measured bilateral STN DBS-induced blood flow changes (PET and [(15)O]-water on one day) in the supplementary motor area (SMA), dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), and right inferior frontal cortex (rIFC) as well as in exploratory ROIs defined by published meta-analyses. STN DBS-induced WM and RI changes (Spatial Delayed Response and Go-No-Go on the next day) were measured in 24 PD participants. On both days, participants withheld PD medications overnight and conditions (OFF vs. ON) were administered in a counterbalanced, double-blind manner. RESULTS As predicted, STN DBS-induced DLPFC blood flow change correlated with change in WM, but not RI performance. Furthermore, ACC blood flow change correlated with change in RI but not WM performance. For both relationships, increased blood flow related to decreased cognitive performance in response to STN DBS. Of the exploratory regions, only blood flow changes in DLPFC and ACC were correlated with performance. CONCLUSIONS These results demonstrate that variability in the effects of STN DBS on cognitive performance relates to STN DBS-induced cortical blood flow changes in DLPFC and ACC. This relationship highlights the need to further understand the factors that mediate the variability in neural and cognitive response to STN DBS.
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Affiliation(s)
- M C Campbell
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, United States
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47
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Potenza MN, Voon V, Weintraub D. Drug Insight: impulse control disorders and dopamine therapies in Parkinson's disease. ACTA ACUST UNITED AC 2008; 3:664-72. [PMID: 18046439 DOI: 10.1038/ncpneuro0680] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 10/16/2007] [Indexed: 11/09/2022]
Abstract
Impulse control disorders (ICDs) constitute a group of relatively common psychiatric conditions. ICDs typically involve pleasurable or hedonic behaviors (e.g. gambling, shopping or sex) that are performed repetitively, excessively or compulsively, to an extent that interferes in major areas of life functioning. Over the past decade, case reports, case studies and controlled examinations have reported ICDs in neurological patients, particularly those with Parkinson's disease (PD). A relationship between dopamine agonist treatment and ICDs was initially suggested on the basis of clinical observations, and subsequent systematic studies have provided more-substantial support for this association. Ongoing studies of the clinical characteristics of individuals with PD with and without ICDs suggest that certain individuals might be at increased risk of developing ICDs during PD treatment. Emerging data suggest that the association between dopamine agonists and ICDs extends into other neurological patient populations in which these agents are employed, such as those with restless legs syndrome. In this article, we summarize current knowledge regarding ICDs, review their relationships with PD and its treatments, provide practical clinical recommendations based on existing data, and suggest avenues for future research directed at advancing clinical care strategies.
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Affiliation(s)
- Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, CT 06519, USA.
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Videen TO, Campbell MC, Tabbal SD, Karimi M, Hershey T, Perlmutter JS. Validation of a fiducial-based atlas localization method for deep brain stimulation contacts in the area of the subthalamic nucleus. J Neurosci Methods 2007; 168:275-81. [PMID: 18061273 DOI: 10.1016/j.jneumeth.2007.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 10/11/2007] [Accepted: 10/11/2007] [Indexed: 10/22/2022]
Abstract
Differences in the location of active contacts with respect to the subthalamic nucleus (STN) may account for much variability in motor, psychiatric and cognitive responses to deep brain stimulation (DBS) in Parkinson disease (PD) patients. Because localization of STN based on hypointensity in T2-weighted MR images is unreliable and further limited by artifacts from the metal electrodes, we developed and validated a method to transform brain images into stereotactic space [Mai JK, Assheuer J, Paxinos G. Atlas of the Human Brain, 2nd ed. San Diego: Elsevier Academic; 2004] using reliably-identified anatomic fiducials identified in high-resolution T2-weighted pre-operative MR images. Average intraclass correlation between two raters for 29 PD patients was 0.93 for those fiducials used to define the atlas. Accuracy of the registration was tested by comparing the rater-identified centers of the red nuclei with their predicted locations from the fiducial-based atlas transformation. Mean discrepancies were 0.1, 0.9, and 0.0mm (x, y, z) with standard deviations of 0.9, 0.7 and 1.1mm, respectively. Because post-operative determination of contact location with respect to the STN is necessary due to possible shifting of electrodes during surgical placement, we identified active contacts on post-operative CT images and transformed their locations into stereotactic space. This method provides an accurate and reliable means for STN DBS contact localization.
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Affiliation(s)
- Tom O Videen
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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49
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Aarsland D, Brønnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, Cummings JL. Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress. J Neurol Neurosurg Psychiatry 2007; 78:36-42. [PMID: 16820421 PMCID: PMC2117797 DOI: 10.1136/jnnp.2005.083113] [Citation(s) in RCA: 289] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the profile of neuropsychiatric symptoms in patients with dementia associated with Parkinson's disease (PDD). METHODS 537 patients with PDD drawn from an international multicentre clinical trial of rivastigmine were assessed using the 10-item Neuropsychiatric Inventory (NPI). A cluster analysis was used to investigate the inter-relationship of NPI items. Associations between the clusters and demographic and clinical variables were analysed. RESULTS 89% of the patients presented at least one symptom on the NPI, 77% had two or more symptoms and 64% had at least one symptom with a score > or = 4. The most common symptoms were depression (58%), apathy (54%), anxiety (49%) and hallucinations (44%). Patients with more severe dementia and advanced Parkinson's disease had more neuropsychiatric symptoms. Nearly 60% of the care givers reported at least one NPI symptom to be of at least moderate severe distress. Five NPI clusters were identified: one group with few and mild symptoms (52%); a mood cluster (11%, high scores on depression, anxiety and apathy); apathy (24%; high apathy and low scores on other items); agitation (5%, high score on agitation and high total NPI score); and a psychosis cluster (8%; high scores on delusions and hallucinations). The psychosis and agitation clusters had the lowest Mini-Mental State Examination score and the highest Unified Parkinson's Disease Rating Scale and care giver distress scores. CONCLUSION Neuropsychiatric symptoms are common in patients with PDD. The profile of these symptoms differs from that in other types of dementia. Subgroups with different neuropsychiatric profiles were identified. These subgroups may be associated with distinct neurobiological changes, which should be explored in future studies.
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Affiliation(s)
- D Aarsland
- Centre for Clinical Neuroscience Research, Stavanger University Hospital, Stavanger, Norway.
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50
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Morgan JC, diDonato CJ, Iyer SS, Jenkins PD, Smith JR, Sethi KD. Self-stimulatory behavior associated with deep brain stimulation in Parkinson's disease. Mov Disord 2006; 21:283-5. [PMID: 16258943 DOI: 10.1002/mds.20772] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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