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Aleid A, Aleid M, Alehaiwi G, Alharbi H, Alhuthayli A, Al Rebih ZM, Alhumaidi N, Albashrawi W, Bazarah RS, Alharbi A, Alhejji AH, Aldawood HA, AlHumud O, Alkathem JA, Almalki S. Advancements in the Clinical Outcomes of Functional Neurosurgery With Deep Brain Stimulation for Movement Disorders: A Literature Review. Cureus 2023; 15:e40350. [PMID: 37456406 PMCID: PMC10339274 DOI: 10.7759/cureus.40350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
This literature review explores recent advancements in deep brain stimulation (DBS) surgery for movement disorders. It highlights notable improvements, including closed-loop stimulation techniques, optogenetics, and improved surgical targeting. Positive clinical outcomes with low complication rates and improved motor symptoms are consistently reported. The review emphasizes the importance of minimizing risks through meticulous surgical practices and discusses potential complications associated with DBS surgery. Future prospects focus on enhancing technology, refining surgical techniques, and conducting further research. Closed-loop stimulation optimizes DBS efficacy by tailoring stimulation parameters to individual patient needs. Optogenetics offers precise modulation of neural activity with light-sensitive proteins, enabling more targeted treatments. Cybersecurity measures are essential due to the integration of wireless and digital technologies in DBS systems. DBS surgery has significantly improved the management of movement disorders with its safety and effectiveness. Ongoing research in closed-loop stimulation, optogenetics, and cybersecurity is expected to further enhance DBS technology and outcomes, benefiting patients with treatment-resistant movement disorders.
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Affiliation(s)
- Abdulsalam Aleid
- Department of Neurosurgery, King Faisal University, Al Ahsa, SAU
| | - Masowma Aleid
- Department of Neurosurgery, Medical College, King Faisal University, Al Ahsa, SAU
| | - Ghadeer Alehaiwi
- Department of Biological Sciences, Umm-Al Qura University, Mecca, SAU
| | - Hajar Alharbi
- Department of Pediatric Surgery, Gdańsk Medical University, Gdańsk, POL
| | - Abdulaziz Alhuthayli
- Department of Pharmaceutical Care, General Network for Healthcare Providers Hospital, Kharj, SAU
| | - Zainb M Al Rebih
- Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
- Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Wihad Albashrawi
- Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
- Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Anas Alharbi
- College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, SAU
| | - Ahmed H Alhejji
- Department of Surgery, College of Veterinary Medicine, Al Ahsa, SAU
| | - Hassan A Aldawood
- Neurosurgery, College of Medicine, Imam Abdurrahman Bin Faisal University, Dammam, SAU
| | - Osama AlHumud
- Department of Medicine, King Faisal University, Al Ahsa, SAU
- Department of Surgery, King Faisal University, Al Ahsa, SAU
| | - Jafar A Alkathem
- Department of Internal Medicine, King Faisal University, Al Ahsa, SAU
| | - Sami Almalki
- Department of Neurosurgery, King Faisal University, Al Ahsa, SAU
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Hadley AJ, Riley DE, Heldman DA. Real-World Evidence for a Smartwatch-Based Parkinson's Motor Assessment App for Patients Undergoing Therapy Changes. Digit Biomark 2021; 5:206-215. [PMID: 34703975 DOI: 10.1159/000518571] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction Parkinson's disease (PD) is poorly quantified by patients outside the clinic, and paper diaries have problems with subjective descriptions and bias. Wearable sensor platforms; however, can accurately quantify symptoms such as tremor, dyskinesia, and bradykinesia. Commercially available smartwatches are equipped with accelerometers and gyroscopes that can measure motion for objective evaluation. We sought to evaluate the clinical utility of a prescription smartwatch-based monitoring system for PD utilizing periodic task-based motor assessment. Methods Sixteen patients with PD used a smartphone- and smartwatch-based monitoring system to objectively assess motor symptoms for 1 week prior to instituting a doctor recommended change in therapy and for 4 weeks after the change. After 5 weeks the participants returned to the clinic to discuss their results with their doctor, who made therapy recommendations based on the reports and his clinical judgment. Symptom scores were synchronized with the medication diary and the temporal effects of therapy on weekly and hourly timescales were calculated. Results Thirteen participants successfully completed the study and averaged 4.9 assessments per day for 3 days per week during the study. The doctor instructed 8 participants to continue their new regimens and 5 to revert to their previous regimens. The smartwatch-based assessments successfully captured intraday fluctuations and short- and long-term responses to therapies, including detecting significant improvements (p < 0.05) in at least one symptom in 7 participants. Conclusions The smartwatch-based app successfully captured temporal trends in symptom scores following application of new therapy on hourly, daily, and weekly timescales. These results suggest that validated smartwatch-based PD monitoring can provide clinically relevant information and may reduce the need for traditional office visits for therapy adjustment.
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Pinto S, Cardoso R, Sadat J, Guimarães I, Mercier C, Santos H, Atkinson-Clement C, Carvalho J, Welby P, Oliveira P, D'Imperio M, Frota S, Letanneux A, Vigario M, Cruz M, Martins IP, Viallet F, Ferreira JJ. Dysarthria in individuals with Parkinson's disease: a protocol for a binational, cross-sectional, case-controlled study in French and European Portuguese (FraLusoPark). BMJ Open 2016; 6:e012885. [PMID: 27856480 PMCID: PMC5128890 DOI: 10.1136/bmjopen-2016-012885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Individuals with Parkinson's disease (PD) have to deal with several aspects of voice and speech decline and thus alteration of communication ability during the course of the disease. Among these communication impairments, 3 major challenges include: (1) dysarthria, consisting of orofacial motor dysfunction and dysprosody, which is linked to the neurodegenerative processes; (2) effects of the pharmacological treatment, which vary according to the disease stage; and (3) particular speech modifications that may be language-specific, that is, dependent on the language spoken by the patients. The main objective of the FraLusoPark project is to provide a thorough evaluation of changes in PD speech as a result of pharmacological treatment and disease duration in 2 different languages (French vs European Portuguese). METHODS AND ANALYSIS Individuals with PD are enrolled in the study in France (N=60) and Portugal (N=60). Their global motor disability and orofacial motor functions is assessed with specific clinical rating scales, without (OFF) and with (ON) pharmacological treatment. 2 groups of 60 healthy age-matched volunteers provide the reference for between-group comparisons. Along with the clinical examinations, several speech tasks are recorded to obtain acoustic and perceptual measures. Patient-reported outcome measures are used to assess the psychosocial impact of dysarthria on quality of life. ETHICS AND DISSEMINATION The study has been approved by the local responsible committees on human experimentation and is conducted in accordance with the ethical standards. A valuable large-scale database of speech recordings and metadata from patients with PD in France and Portugal will be constructed. Results will be disseminated in several articles in peer-reviewed journals and in conference presentations. Recommendations on how to assess speech and voice disorders in individuals with PD to monitor the progression and management of symptoms will be provided. TRIAL REGISTRATION NUMBER NCT02753192, Pre-results.
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Affiliation(s)
- Serge Pinto
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Rita Cardoso
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
| | - Jasmin Sadat
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Isabel Guimarães
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Speech Therapy Department, Escola Superior de Saude do Alcoitão, Alcabideche, Portugal
| | - Céline Mercier
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Helena Santos
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Cyril Atkinson-Clement
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Joana Carvalho
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
| | - Pauline Welby
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Pedro Oliveira
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Mariapaola D'Imperio
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
| | - Sónia Frota
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Alban Letanneux
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
| | - Marina Vigario
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Marisa Cruz
- Centre of Linguistics, School of Arts and Humanities, University of Lisbon, Lisbon, Portugal
| | - Isabel Pavão Martins
- Neurology Department, Faculty of Medicine, Language Research Laboratory, University of Lisbon, Lisbon, Portugal
| | - François Viallet
- Aix Marseille Université, Centre National de la Recherche Scientifique (CNRS), Laboratoire Parole et Langage (LPL), Aix-en-Provence, France
- Brain and Language Research Institute, Aix-en-Provence, France
- Neurology Department, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Joaquim J Ferreira
- Campus Neurológico Sénior (CNS), Torres Vedras, Portugal
- Faculty of Medicine, Instituto de Medicina Molecular (IMM), University of Lisbon, Lisbon, Portugal
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Abstract
Deep brain stimulation (DBS) is an implanted electrical device that modulates specific targets in the brain resulting in symptomatic improvement in a particular neurologic disease, most commonly a movement disorder. It is preferred over previously used lesioning procedures due to its reversibility, adjustability, and ability to be used bilaterally with a good safety profile. Risks of DBS include intracranial bleeding, infection, malposition, and hardware issues, such migration, disconnection, or malfunction, but the risk of each of these complications is low--generally ≤ 5% at experienced, large-volume centers. It has been used widely in essential tremor, Parkinson's disease, and dystonia when medical treatment becomes ineffective, intolerable owing to side effects, or causes motor complications. Brain targets implanted include the thalamus (most commonly for essential tremor), subthalamic nucleus (most commonly for Parkinson's disease), and globus pallidus (Parkinson's disease and dystonia), although new targets are currently being explored. Future developments include brain electrodes that can steer current directionally and systems capable of "closed loop" stimulation, with systems that can record and interpret regional brain activity and modify stimulation parameters in a clinically meaningful way. New, image-guided implantation techniques may have advantages over traditional DBS surgery.
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Affiliation(s)
- Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, CA, 94143-0112, USA,
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