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Cucinotta F, Swinnen B, Makovac E, Hirschbichler S, Pereira E, Little S, Morgante F, Ricciardi L. Short term cardiovascular symptoms improvement after deep brain stimulation in patients with Parkinson's disease: a systematic review. J Neurol 2024; 271:3764-3776. [PMID: 38809271 PMCID: PMC11233308 DOI: 10.1007/s00415-024-12459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/19/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Autonomic dysfunction is common and disabling in Parkinson's disease (PD). The effects of deep brain stimulation (DBS) on the cardiovascular system in PD remain poorly understood. We aimed to assess the effect of DBS on cardiovascular symptoms and objective measures in PD patients. METHODS We conducted a systematic literature search in PubMed/MEDLINE. RESULTS 36 out of 472 studies were included, mostly involving DBS of the subthalamic nucleus, and to a lesser extent the globus pallidus pars interna and pedunculopontine nucleus. Seventeen studies evaluated the effect of DBS on patient-reported or clinician-rated cardiovascular symptoms, showing an improvement in the first year after surgery but not with longer-term follow-up. DBS has no clear direct effects on blood pressure during an orthostatic challenge (n = 10 studies). DBS has inconsistent effects on heart rate variability (n = 10 studies). CONCLUSION Current evidence on the impact of DBS on cardiovascular functions in PD is inconclusive. DBS may offer short-term improvement of cardiovascular symptoms in PD, particularly orthostatic hypotension, which may be attributed to dopaminergic medication reduction after surgery. There is insufficient evidence to draw conclusions on the direct effect of DBS on blood pressure and heart rate variability.
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Affiliation(s)
- Francescopaolo Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Neurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, St George's University of London, London, UK
| | - Bart Swinnen
- UCSF, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- UCSF, Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Elena Makovac
- Neurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, St George's University of London, London, UK
- Centre for Neuroimaging Science, King's College, London, UK
- Brunel University London, Uxbridge, UK
| | - Stephanie Hirschbichler
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
- Department of Neurology, University Hospital St. Pölten, Dunant-Platz 1, 3100, St. Pölten, Austria
| | - Erlick Pereira
- Neurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, St George's University of London, London, UK
| | - Simon Little
- UCSF, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
- UCSF, Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
| | - Francesca Morgante
- Neurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, St George's University of London, London, UK
| | - Lucia Ricciardi
- Neurosciences and Cell Biology Institute, Neuromodulation and Motor Control Section, St George's University of London, London, UK.
- UCSF, Weill Institute for Neurosciences, Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA.
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2
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Non-motor effects of subthalamic nucleus stimulation in Parkinson patients. Brain Imaging Behav 2022; 16:161-168. [PMID: 35029801 DOI: 10.1007/s11682-021-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/02/2022]
Abstract
The current white matter connectivity analyses of the subthalamic region have focused on the motor effects of deep brain stimulation. We investigate white matter connectivity associated with the stimulation-induced non-motor acute clinical effects in three domains: mood changes, dizziness, and sweating. We performed whole-brain probabilistic tractography seeded from the domain-specific stimulation volumes. The resultant connectivity maps were statistically compared across patients. The cortical voxels associated with each non-motor domain were compared with stimulation-induced motor improvements in a multivariate model. The resulting voxel maps were thresholded for false discovery (FDR q < 0.05) and clustered using a multimodal atlas. We also performed a group-level parcellation of stimulation volumes to identify the local pathways associated with each non-motor domain. The non-motor effects were rarely observed during stimulation titration: from 1100 acute clinical effects, mood change was observed in 14, dizziness in 23, and sweating in 20. Distinct cortical clusters were associated with each domain; notably, mood change was associated with voxels in the salience network and dizziness with voxels in the visual association cortex. The subthalamic parcellation yielded a mediolateral gradient, with the motor parcel being lateral and the non-motor parcels medial. We also observed an anteroposterior organization in the medial non-motor clusters with mood changes being anterior, followed posteriorly by dizziness, and sweating. We interpret these findings based on the literature and foresee these to be useful in guiding DBS programming.
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Neudorfer C, Elias GJB, Jakobs M, Boutet A, Germann J, Narang K, Loh A, Paff M, Horn A, Kucharczyk W, Deeb W, Salvato B, Almeida L, Foote KD, Rosenberg PB, Tang-Wai DF, Anderson WS, Mari Z, Ponce FA, Wolk DA, Burke AD, Salloway S, Sabbagh MN, Chakravarty MM, Smith GS, Lyketsos CG, Okun MS, Lozano AM. Mapping autonomic, mood, and cognitive effects of hypothalamic region deep brain stimulation. Brain 2021; 144:2837-2851. [PMID: 33905474 DOI: 10.1093/brain/awab170] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/12/2022] Open
Abstract
Due to its involvement in a wide variety of cardiovascular, metabolic, and behavioral functions, the hypothalamus constitutes a potential target for neuromodulation in a number of treatment-refractory conditions. The precise neural substrates and circuitry subserving these responses, however, are poorly characterized to date. We sought to retrospectively explore the acute sequalae of hypothalamic region deep brain stimulation and characterize their neuroanatomical correlates. To this end we studied at multiple international centers 58 patients (mean age: 68.5 ± 7.9 years, 26 females) suffering from mild Alzheimer's disease who underwent stimulation of the fornix region between 2007 and 2019. We catalogued the diverse spectrum of acutely induced clinical responses during electrical stimulation and interrogated their neural substrates using volume of tissue activated modelling, voxel-wise mapping, and supervised machine learning techniques. In total 627 acute clinical responses to stimulation - including tachycardia, hypertension, flushing, sweating, warmth, coldness, nausea, phosphenes, and fear - were recorded and catalogued across patients using standard descriptive methods. The most common manifestations during hypothalamic region stimulation were tachycardia (30.9%) and warmth (24.6%) followed by flushing (9.1%) and hypertension (6.9%). Voxel-wise mapping identified distinct, locally separable clusters for all sequelae that could be mapped to specific hypothalamic and extrahypothalamic gray- and white-matter structures. K-nearest neighbor classification further validated the clinico-anatomical correlates emphasizing the functional importance of identified neural substrates with area under the receiving operating characteristic curves (AUROC) between 0.67 - 0.91. Overall, we were able to localize acute effects of hypothalamic region stimulation to distinct tracts and nuclei within the hypothalamus and the wider diencephalon providing clinico-anatomical insights that may help to guide future neuromodulation work.
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Affiliation(s)
- Clemens Neudorfer
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martin Jakobs
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Keshav Narang
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michelle Paff
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Wissam Deeb
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | | | - Leonardo Almeida
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | - Paul B Rosenberg
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - David F Tang-Wai
- Department of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna D Burke
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Stephen Salloway
- Department of Psychiatry and Human Behavior and Neurology, Alpert Medical School of Brown University, Providence, RI, USA
| | - Marwan N Sabbagh
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Research Centre, Montreal QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Biological and Biomedical Engineering, McGill University, Montreal, QC, Canada
| | - Gwenn S Smith
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Departments of Neurology and Neurosurgery, University of Florida Health, Gainesville, FL, USA
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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Horisawa S, Kohara K, Nonaka T, Mochizuki T, Kawamata T, Taira T. Case Report: Deep Cerebellar Stimulation for Tremor and Dystonia. Front Neurol 2021; 12:642904. [PMID: 33746894 PMCID: PMC7973230 DOI: 10.3389/fneur.2021.642904] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The cerebellum plays an important role in the pathogenesis and pathophysiology of movement disorders, including tremor and dystonia. To date, there have been few reports on deep cerebellar stimulation. Case Report: The patient was a 35-year-old previously healthy man with no history of movement disorders. He developed a tremor and stiffness in his left hand at the age of 27 years, which was diagnosed as a dystonic tremor. We performed right thalamotomy, which resulted in a complete resolution of the tremor; however, the dystonia persisted. Subsequently, the patient developed left foot dystonia with inversion and a newly developed tremor in the right hand and foot. The patient underwent left ventralis intermedius (VIM) deep brain stimulation (VIM-DBS) and left pallidothalamic tract DBS (PTT-DBS). Left VIM-DBS completely resolved the right hand and foot tremor, and PTT-DBS significantly improved the left hand and foot dystonia. Three months postoperatively, the patient developed an infection and wound disruption at the surgical site. We performed palliative surgery for deep cerebellar stimulation via the posterior cranial region, which was not infected. The surgery was performed under general anesthesia with the patient lying in the prone position. Eight contact DBS electrodes were used. The placement of electrodes extended from the superior cerebellar peduncle to the dentate nucleus. Both the right hand and foot tremor improved with right cerebellar stimulation. Further, both the left hand and foot dystonia improved with left cerebellar stimulation. Right and left cerebellar stimulation led to no improvement in the left hand and foot dystonia and right hand and foot tremor, respectively. Stimulation-induced complications observed in the patient included dizziness, dysphagia, and dysarthria. After the surgery, the patient developed hypersalivation and hyperhidrosis in the left side of the body, both of which did not improve with adjustments of stimulation parameters. At the 6-month follow-up, the tremor and dystonia had almost completely resolved. Conclusion: Deep cerebellar stimulation deserves consideration as a potential treatment for tremor and dystonia.
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Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Kotaro Kohara
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Taku Nonaka
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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Gerlach DA, Manuel J, Hoff A, Kronsbein H, Hoffmann F, Heusser K, Ehmke H, Jordan J, Tank J, Beissner F. Medullary and Hypothalamic Functional Magnetic Imaging During Acute Hypoxia in Tracing Human Peripheral Chemoreflex Responses. Hypertension 2021; 77:1372-1382. [PMID: 33641354 DOI: 10.1161/hypertensionaha.120.16385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Darius A Gerlach
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.)
| | - Jorge Manuel
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.).,Institute for Neuroradiology, Hannover Medical School, Germany (J.M., F.B.)
| | - Alex Hoff
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.)
| | - Hendrik Kronsbein
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.).,Institute of Cellular and Integrative Physiology, University Medical Center Eppendorf, Hamburg, Germany (H.K., H.E.)
| | - Fabian Hoffmann
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.)
| | - Karsten Heusser
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.)
| | - Heimo Ehmke
- Institute of Cellular and Integrative Physiology, University Medical Center Eppendorf, Hamburg, Germany (H.K., H.E.)
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.).,Chair of Aerospace Medicine, University of Cologne, Germany (J.J.)
| | - Jens Tank
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany (D.A.G., J.M., A.H., H.K., F.H., K.H., J.J., J.T.)
| | - Florian Beissner
- Institute for Neuroradiology, Hannover Medical School, Germany (J.M., F.B.)
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6
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He W, Li H, Lai Y, Wu Y, Wu Y, Ramirez-Zamora A, Yi W, Zhang C. Weight Change After Subthalamic Nucleus Deep Brain Stimulation in Patients With Isolated Dystonia. Front Neurol 2021; 12:632913. [PMID: 33716933 PMCID: PMC7944092 DOI: 10.3389/fneur.2021.632913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/21/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment method for advanced Parkinson's disease (PD) and isolated dystonia and provides marked improvement of major motor symptoms. In addition, non-motor effects have been reported including weight gain (WG) in patients with PD after STN-DBS. However, it is still unclear whether patients with isolated dystonia also experience WG. Methods: Data from 47 patients with isolated dystonia who underwent bilateral STN-DBS surgery between October 2012 and June 2019 were retrospectively collected. The severity of dystonia was assessed via the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Changes in the body mass index (BMI) and BFMDRS score were analyzed using paired Student's t-tests. Regression analysis was performed to identify factors that affected the BMI after surgery. Results: Postoperative WG was observed in 78.7% of patients. The percentage of overweight and obese patients increased from 25.5% (before STN-DBS) to 48.9% (at the last follow-up). The mean BMI and mean percentage change in BMI increased by 1.32 ± 1.83 kg/m2 (P < 0.001) and 6.28 ± 8.34%, respectively. BMI increased more in female than in male patients. At the last follow-up, BFMDRS movement and disability scores improved by 69.76 ± 33.23% and 65.66 ± 31.41%, respectively (both P < 0.001). The final regression model analysis revealed that sex and preoperative BMI alone were independently associated with BMI change (P < 0.05). Conclusions: STN-DBS is associated with postoperative WG with patients with isolated dystonia. WG is more prominent in female patients and is associated with preoperative weight but not with the efficacy of STN-DBS on motor symptoms.
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Affiliation(s)
- Weibin He
- Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Hongxia Li
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijie Lai
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhao Wu
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Adolfo Ramirez-Zamora
- Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Wei Yi
- Department of Neurosurgery, Renmin Hospital, Wuhan University, Wuhan, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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7
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Niemann N, Billnitzer A, Jankovic J. Parkinson's disease and skin. Parkinsonism Relat Disord 2020; 82:61-76. [PMID: 33248395 DOI: 10.1016/j.parkreldis.2020.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/18/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
Parkinson's disease is associated with a variety of dermatologic disorders and the study of skin may provide insights into pathophysiological mechanisms underlying this common neurodegenerative disorder. Skin disorders in patients with Parkinson's disease can be divided into two major groups: 1) non-iatrogenic disorders, including melanoma, seborrheic dermatitis, sweating disorders, bullous pemphigoid, and rosacea, and 2) iatrogenic disorders related either to systemic side effects of antiparkinsonian medications or to the delivery system of antiparkinsonian therapy, including primarily carbidopa/levodopa, rotigotine and other dopamine agonists, amantadine, catechol-O-methyl transferase inhibitors, subcutaneous apomorphine, levodopa/carbidopa intestinal gel, and deep brain stimulation. Recent advances in our understanding of the role of α-synuclein in peripheral tissues, including the skin, and research based on induced pluripotent stem cells derived from skin fibroblasts have made skin an important target for the study of Parkinson's disease pathogenesis, drug discovery, novel stem cell therapies, and diagnostics.
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Affiliation(s)
- Nicki Niemann
- Muhammad Ali Parkinson Center, Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA.
| | - Andrew Billnitzer
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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8
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Farrell SM, Green A, Aziz T. The Use of Neuromodulation for Symptom Management. Brain Sci 2019; 9:brainsci9090232. [PMID: 31547392 PMCID: PMC6769574 DOI: 10.3390/brainsci9090232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 01/23/2023] Open
Abstract
Pain and other symptoms of autonomic dysregulation such as hypertension, dyspnoea and bladder instability can lead to intractable suffering. Incorporation of neuromodulation into symptom management, including palliative care treatment protocols, is becoming a viable option scientifically, ethically, and economically in order to relieve suffering. It provides further opportunity for symptom control that cannot otherwise be provided by pharmacology and other conventional methods.
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Affiliation(s)
- Sarah Marie Farrell
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Alexander Green
- Nuffield department of clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
- Nuffield department of clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
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9
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Walker WH, Borniger JC. Molecular Mechanisms of Cancer-Induced Sleep Disruption. Int J Mol Sci 2019; 20:E2780. [PMID: 31174326 PMCID: PMC6600154 DOI: 10.3390/ijms20112780] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023] Open
Abstract
Sleep is essential for health. Indeed, poor sleep is consistently linked to the development of systemic disease, including depression, metabolic syndrome, and cognitive impairments. Further evidence has accumulated suggesting the role of sleep in cancer initiation and progression (primarily breast cancer). Indeed, patients with cancer and cancer survivors frequently experience poor sleep, manifesting as insomnia, circadian misalignment, hypersomnia, somnolence syndrome, hot flushes, and nightmares. These problems are associated with a reduction in the patients' quality of life and increased mortality. Due to the heterogeneity among cancers, treatment regimens, patient populations and lifestyle factors, the etiology of cancer-induced sleep disruption is largely unknown. Here, we discuss recent advances in understanding the pathways linking cancer and the brain and how this leads to altered sleep patterns. We describe a conceptual framework where tumors disrupt normal homeostatic processes, resulting in aberrant changes in physiology and behavior that are detrimental to health. Finally, we discuss how this knowledge can be leveraged to develop novel therapeutic approaches for cancer-associated sleep disruption, with special emphasis on host-tumor interactions.
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Affiliation(s)
- William H Walker
- Department of Neuroscience, West Virginia University, Morgantown, WV 26506, USA.
| | - Jeremy C Borniger
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
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10
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Abstract
Cancer is a systemic disease. In order to fully understand it, we must take a holistic view on how cancer interacts with its host. The brain monitors and responds to natural and aberrant signals arriving from the periphery, particularly those of metabolic or immune origin. As has been well described, a hallmark of cancer is marked disruption of metabolic and inflammatory processes. Depending on the salience and timing of these inputs, the brain responds via neural and humoral routes to alter whole-body physiology. These responses have consequences for tumor growth and metastasis, directly influencing patient quality of life and subsequent mortality. Additionally, environmental inputs such as light, diet, and stress, can promote inappropriate neural activity that benefits cancer. Here, I discuss evidence for brain-tumor interactions, with special emphasis on subcortical neuromodulator neural populations, and potential ways of harnessing this cross-talk as a novel approach for cancer treatment.
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Affiliation(s)
- Jeremy C Borniger
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, P154 MSLS Building, 1201 Welch Rd., Stanford, CA 94305, USA
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11
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Analysis of Contact Position for Subthalamic Nucleus Deep Brain Stimulation-Induced Hyperhidrosis. PARKINSONS DISEASE 2019; 2019:8180123. [PMID: 30956787 PMCID: PMC6431408 DOI: 10.1155/2019/8180123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 02/14/2019] [Indexed: 12/26/2022]
Abstract
Objectives To analyze the hyperhidrosis neural network structure induced by subthalamic nucleus (STN) - deep brain stimulation (DBS). Materials and Methods Patients with Parkinson's disease treated with STN-DBS in Changhai Hospital between July 1, 2015, and December 1, 2016, were analyzed retrospectively. Using records of side effects of the intraoperative macrostimulation test, patients with skin sweats were selected as the sweating group. Based on the number of cases in the sweating group, the same number of patients was randomly selected from other STN-DBS patients without sweating to form the control group. The study standardized electrode position with Lead-DBS software to Montreal Neurological Institute (MNI) standard stereotactic space to compare the differences in three-dimensional coordinates of activated contacts between groups. Results Of 355 patients, 11 patients had sweats during intraoperative macrostimulation tests. There was no significant difference in the preoperative baseline information and the postoperative UPDRS-III improvement rate (Med-off, IPG-on) between groups. Contacts inducing sweat were more medial (X-axis) (11.02 ± 0.69 mm vs 11.98 ± 0.84 mm, P=0.00057) and more upward (Z-axis) (−7.15 ± 1.06 mm VS −7.98 ± 1.21 mm, P=0.032) than those of the control group. The straight-line distance between the center of the sweat contact and the nearest voxel of the red nucleus was closer than that of the control group (2.72 ± 0.65 mm VS 3.76 ± 0.85 mm, P=0.00012). Conclusions STN-DBS-induced sweat indicated that the contact was at superior medial of STN.
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12
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Hyperhidrosis caused by deep brain stimulation in the posterior subthalamic area. J Neurol Sci 2017; 380:277-279. [PMID: 28739206 DOI: 10.1016/j.jns.2017.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/06/2017] [Accepted: 07/17/2017] [Indexed: 11/21/2022]
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Sauerbier A, Cova I, Rosa-Grilo M, Taddei RN, Mischley LK, Chaudhuri KR. Treatment of Nonmotor Symptoms in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 132:361-379. [PMID: 28554415 DOI: 10.1016/bs.irn.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonmotor symptoms (NMS) are integral to Parkinson's disease (PD) and the management can often be challenging. In spite of the growing evidence that NMS have a key impact on the quality of life of patients and caregivers, most clinical trials still focus on motor symptoms as primary outcomes. As a consequence strong evidence-based treatment recommendations for NMS occurring in PD are spare. In this chapter, the current data addressing the treatment of major NMS such as sleep, cognitive and autonomic dysfunction, and depression and anxiety are described.
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Affiliation(s)
- Anna Sauerbier
- King's College London and King's College Hospital, London, United Kingdom.
| | - Ilaria Cova
- Center for Research and Treatment on Cognitive Dysfunctions, Institute of Clinical Neurology, Luigi Sacco' Hospital, University of Milan, Milan, Italy
| | - Miguel Rosa-Grilo
- King's College London and King's College Hospital, London, United Kingdom
| | - Raquel N Taddei
- King's College London and King's College Hospital, London, United Kingdom
| | - Laurie K Mischley
- Bastyr University Research Institute, Kenmore, WA, United States; UW Graduate Program in Nutritional Sciences, Seattle, WA, United States; University of Washington (UW), Seattle, WA, United States
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, Kings College and Kings College Hospital, London, United Kingdom; Maurice Wohl Clinical Neuroscience Institute, Kings College, London, United Kingdom; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) and Dementia Unit at South London and Maudsley NHS Foundation Trust, London, United Kingdom
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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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Basiago A, Binder DK. Effects of Deep Brain Stimulation on Autonomic Function. Brain Sci 2016; 6:brainsci6030033. [PMID: 27537920 PMCID: PMC5039462 DOI: 10.3390/brainsci6030033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 12/22/2022] Open
Abstract
Over the course of the development of deep brain stimulation (DBS) into a well-established therapy for Parkinson's disease, essential tremor, and dystonia, its utility as a potential treatment for autonomic dysfunction has emerged. Dysfunction of autonomic processes is common in neurological diseases. Depending on the specific target in the brain, DBS has been shown to raise or lower blood pressure, normalize the baroreflex, to alter the caliber of bronchioles, and eliminate hyperhidrosis, all through modulation of the sympathetic nervous system. It has also been shown to improve cortical control of the bladder, directly induce or inhibit the micturition reflex, and to improve deglutition and gastric emptying. In this review, we will attempt to summarize the relevant available studies describing these effects of DBS on autonomic function, which vary greatly in character and magnitude with respect to stimulation target.
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Affiliation(s)
- Adam Basiago
- School of Medicine, University of California, Riverside, CA 92521, USA.
| | - Devin K Binder
- Division of Biomedical Sciences, School of Medicine, University of California, 1247 Webber Hall, Riverside, CA 92521, USA.
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Rossi S, Santarnecchi E, Valenza G, Ulivelli M. The heart side of brain neuromodulation. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0187. [PMID: 27044999 DOI: 10.1098/rsta.2015.0187] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 05/03/2023]
Abstract
Neuromodulation refers to invasive, minimally invasive or non-invasive techniques to stimulate discrete cortical or subcortical brain regions with therapeutic purposes in otherwise intractable patients: for example, thousands of advanced Parkinsonian patients, as well as patients with tremor or dystonia, benefited by deep brain stimulation (DBS) procedures (neural targets: basal ganglia nuclei). A new era for DBS is currently opening for patients with drug-resistant depression, obsessive-compulsive disorders, severe epilepsy, migraine and chronic pain (neural targets: basal ganglia and other subcortical nuclei or associative fibres). Vagal nerve stimulation (VNS) has shown clinical benefits in patients with pharmacoresistant epilepsy and depression. Non-invasive brain stimulation neuromodulatory techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are also being increasingly investigated for their therapeutic potential in several neurological and psychiatric disorders. In this review, we first address the most common neural targets of each of the mentioned brain stimulation techniques, and the known mechanisms of their neuromodulatory action on stimulated brain networks. Then, we discuss how DBS, VNS, rTMS and tDCS could impact on the function of brainstem centres controlling vital functions, critically reviewing their acute and long-term effects on brain sympathetic outflow controlling heart function and blood pressure. Finally, as there is clear experimental evidence in animals that brain stimulation can affect autonomic and heart functions, we will try to give a critical perspective on how it may enhance our understanding of the cortical/subcortical mechanisms of autonomic cardiovascular regulation, and also if it might find a place among therapeutic opportunities in patients with otherwise intractable autonomic dysfunctions.
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Affiliation(s)
- Simone Rossi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| | - Emiliano Santarnecchi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Gaetano Valenza
- Department of Information Engineering, and Research Center E. Piaggio, University of Pisa, 56122 Pisa, Italy Neuroscience Statistics Research Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Monica Ulivelli
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
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18
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Hyperhidrosis associated with subthalamic deep brain stimulation in Parkinson's disease: Insights into central autonomic functional anatomy. J Neurol Sci 2016; 366:59-64. [PMID: 27288777 DOI: 10.1016/j.jns.2016.04.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/02/2016] [Accepted: 04/24/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is limited evidence regarding the precise location and connections of thermoregulatory centers in humans. We present two patients managed with subthalamic nucleus (STN) Deep Brain Stimulation (DBS) for motor fluctuations in PD that developed reproducible hyperhidrosis with high frequency DBS. OBJECTIVE To describe the clinical features and analyze the location of the electrodes leading to autonomic activation in both patients. METHODS We retrospectively assessed the anatomical localization, electrode programming settings and effects of unilateral STN DBS leading to hyperhidrosis. RESULTS Unilateral stimulation of anterior and medially located contacts within the STN and zona incerta (Zi) caused bilateral, consistent, reproducible, and reversible sweating in our patients. Adequate control of motor symptoms without autonomic side effects was accomplished with alternative programming settings. CONCLUSION Stimulation of the medial Zi and medial and anterior STN causes hyperhidrosis in a pattern similar to that described in primates and rats. We speculate that central autonomic fibers originating in the lateral hypothalamic area project laterally to the ventral/medial Zi and then to brainstem nuclei following an medial and posterior trajectory in relationship to STN.
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Hyam JA, Aziz TZ, Green AL. Control of the lungs via the human brain using neurosurgery. PROGRESS IN BRAIN RESEARCH 2014; 209:341-66. [PMID: 24746057 DOI: 10.1016/b978-0-444-63274-6.00018-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurosurgery can alter cardiorespiratory performance via central networks and includes deep brain stimulation (DBS), a routinely employed therapy for movement disorders and chronic pain syndromes. We review the established cardiovascular effects of DBS and the presumed mechanism by which they are produced via the central autonomic network. We then review the respiratory effects of DBS, including modulation of respiratory rate and lung function indices, and the mechanisms via which these may occur. We conclude by highlighting the potential future therapeutic applications of DBS for intractable airway diseases.
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Affiliation(s)
- Jonathan A Hyam
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexander L Green
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Sánchez-Ferro A, Benito-León J, Gómez-Esteban JC. The management of orthostatic hypotension in Parkinson's disease. Front Neurol 2013; 4:64. [PMID: 23772219 PMCID: PMC3677136 DOI: 10.3389/fneur.2013.00064] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 05/19/2013] [Indexed: 12/23/2022] Open
Abstract
Orthostatic hypotension (OH) is a common and disabling symptom affecting Parkinson's disease (PD) patients. We present the effect of the different therapies commonly used to manage PD on this clinical manifestation. For this purpose, we describe the relationship between OH and the current treatments employed in PD, such as L-DOPA, dopaminergic agonists, and continuous dopaminergic stimulation therapies. Additionally, we review the therapeutic measures that could be used to ameliorate OH. There are different approaches to deal with this manifestation, including pharmacological and non-pharmacological treatments, although none of them is specifically aimed for treating OH in PD.
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Affiliation(s)
- Alvaro Sánchez-Ferro
- Department of Neurology, University Hospital "12 de Octubre," Madrid , Spain ; Department of Medicine, Faculty of Medicine, Complutense University , Madrid , Spain ; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas , Madrid , Spain ; Instituto de Salud Carlos III , Madrid , Spain
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21
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Liu KD, Shan DE, Kuo TBJ, Yang CCH. The effects of bilateral stimulation of the subthalamic nucleus on heart rate variability in patients with Parkinson’s disease. J Neurol 2013; 260:1714-23. [DOI: 10.1007/s00415-013-6849-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 11/25/2022]
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22
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Borgohain R, Kandadai RM, Jabeen A, Kannikannan MA. Nonmotor outcomes in Parkinson's disease: is deep brain stimulation better than dopamine replacement therapy? Ther Adv Neurol Disord 2012; 5:23-41. [PMID: 22276074 DOI: 10.1177/1756285611423412] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nonmotor symptoms are an integral part of Parkinson's disease and cause significant morbidity. Pharmacological therapy helps alleviate the disease but produces nonmotor manifestations. While deep brain stimulation (DBS) has emerged as the treatment of choice for motor dysfunction, the effect on nonmotor symptoms is not well known. Compared with pharmacological therapy, bilateral subthalamic nucleus (STN)-DBS or globus pallidum interna (GPi)-DBS has significant beneficial effects on pain, sleep, gastrointestinal and urological symptoms. STN-DBS is associated with a mild worsening in verbal fluency while GPi-DBS has no effect on cognition. STN-DBS may improve cardiovascular autonomic disturbances by reducing the dose of dopaminergic drugs. Because the motor effects of STN-DBS and GPi-DBS appear to be similar, nonmotor symptoms may determine the target choice in surgery of future patients.
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Ettrup K, Sørensen J, Rodell A, Alstrup A, Bjarkam C. Hypothalamic Deep Brain Stimulation Influences Autonomic and Limbic Circuitry Involved in the Regulation of Aggression and Cardiocerebrovascular Control in the Göttingen Minipig. Stereotact Funct Neurosurg 2012; 90:281-91. [DOI: 10.1159/000338087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 02/29/2012] [Indexed: 11/19/2022]
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24
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Hyam JA, Kringelbach ML, Silburn PA, Aziz TZ, Green AL. The autonomic effects of deep brain stimulation--a therapeutic opportunity. Nat Rev Neurol 2012; 8:391-400. [PMID: 22688783 DOI: 10.1038/nrneurol.2012.100] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Deep brain stimulation (DBS) is an expanding field in neurosurgery and has already provided important insights into the fundamental mechanisms underlying brain function. One of the most exciting emerging applications of DBS is modulation of blood pressure, respiration and micturition through its effects on the autonomic nervous system. DBS stimulation at various sites in the central autonomic network produces rapid changes in the functioning of specific organs and physiological systems that are distinct from its therapeutic effects on central nervous motor and sensory systems. For example, DBS modulates several parameters of cardiovascular function, including heart rate, blood pressure, heart rate variability, baroreceptor sensitivity and blood pressure variability. The beneficial effects of DBS also extend to improvements in lung function. This article includes an overview of the anatomy of the central autonomic network, which consists of autonomic nervous system components in the cortex, diencephalon and brainstem that project to the spinal cord or cranial nerves. The effects of DBS on physiological functioning (particularly of the cardiovascular and respiratory systems) are discussed, and the potential for these findings to be translated into therapies for patients with autonomic diseases is examined.
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Affiliation(s)
- Jonathan A Hyam
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Department of Psychiatry, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, UK.
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25
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Guimarães J, Matos E, Rosas MJ, Vieira-Coelho A, Borges N, Correia F, Vaz R, Garrett C. Modulation of nutritional state in Parkinsonian patients with bilateral subthalamic nucleus stimulation. J Neurol 2012; 256:2072-8. [PMID: 19633906 DOI: 10.1007/s00415-009-5252-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 06/21/2009] [Accepted: 07/07/2009] [Indexed: 01/22/2023]
Abstract
Chronic bilateral subthalamic stimulation (DBS-STN) provides considerable clinical benefits in Parkinson disease patients, with improvement in primary symptoms and resolution of side effects of chronic pharmacological treatment. Apart from its therapeutic effects on PD symptoms, DBS-STN also appears to induce weight gain, which may itself induce critical metabolic disorders and limit the benefits of surgery. No data are available in literature showing the efficacy of a nutritional intervention to prevent rapid and/or excessive weight gain after DBSSTN. Fifty-seven PD patients were included in this study and were divided into two groups: Group 1 comprised 16 patients with a nutritional intervention immediately after surgery (1 week after); Group 2 comprised 41 patients with a nutritional intervention in a later period after surgery (mean time of 2.5 ± 1.6 years). Weight, body mass index (BMI), percentage of fat mass, levodopa daily dose (LDD) and part III of the Unified Parkinson's disease rating scale (UPDRS) were studied before and after an individualized and structured nutritional intervention. Three months after nutritional intervention, Group 1 had a mean BMI (24.1 ± 2.99), that was not significantly different (p = 0.114) from BMI before intervention, with stability of the weight and in percentage of fat mass. In Group 2 all the patients gained weight, reaching to 13.17 ± 10%; a total of 63% of patients became overweight (BMI 25 kg/m(2)). Three months after nutritional intervention, Group 2 had a mean BMI (24.80 ± 2.45) that was significantly (p = 0.03) different from BMI before intervention (26.75 ± 2.99), although percentage of fat mass was higher in women. With this study, we have conclude that nutritional intervention adequate to patient-age, disease characteristics, medical therapy with L-dopa and physical activity, is effective incontrolling weight after DBS-STN surgery.
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Affiliation(s)
- Joana Guimarães
- Department of Neurology, Faculty of Medicine, University of Porto, Hospital de São João, São João Hospital, Alameda Hernani Monteiro, 4202-451 Porto, Portugal.
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26
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Tykocki T, Mandat T, Nauman P. [Influence of subthalamic deep brain stimulation on dysautonomia observed in Parkinson's disease]. Neurol Neurochir Pol 2010; 44:277-84. [PMID: 20625964 DOI: 10.1016/s0028-3843(14)60042-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dysfunctions of the autonomic nervous system (DA) are common in Parkinson's disease (PD). DA appear in the premotor phase of PD and may antedate cardinal motor symptoms by years or decades. DA significantly impair quality of life in the majority of PD patients. DA are related to accumulation of Lewy bodies in the central and peripheral nervous system. Progression of neurodegeneration and chronic dopaminergic therapy may increase DA as well. It is accepted that bilateral deep brain stimulation of the subthalamic nucleus (STN DBS) improves motor symptoms in PD. The effect of STN DBS on DA, such as cardio-vascular symptoms and urinary, gastrointestinal and sexual dysfunction in PD, is not clear. STN DBS ameliorates some DA, but others might deteriorate at the same time.
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Affiliation(s)
- Tomasz Tykocki
- Klinika Neurochirurgii, Instytut Psychiatrii i Neurologii w Warszawie, ul. Sobieskiego 9, 02-957 Warszawa.
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Strowd RE, Cartwright MS, Passmore LV, Ellis TL, Tatter SB, Siddiqui MS. Weight change following deep brain stimulation for movement disorders. J Neurol 2010; 257:1293-7. [DOI: 10.1007/s00415-010-5509-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 01/30/2010] [Accepted: 02/17/2010] [Indexed: 11/24/2022]
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Sanghera M, Ward C, Stewart R, Mewes K, Simpson R, Lai E. Alleviation of drenching sweats following subthalamic deep brain stimulation in a patient with Parkinson's disease — A case report. J Neurol Sci 2009; 285:246-9. [DOI: 10.1016/j.jns.2009.06.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 05/22/2009] [Accepted: 06/10/2009] [Indexed: 11/16/2022]
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Rezai AR, Machado AG, Deogaonkar M, Azmi H, Kubu C, Boulis NM. Surgery for movement disorders. Neurosurgery 2008; 62 Suppl 2:809-38; discussion 838-9. [PMID: 18596424 DOI: 10.1227/01.neu.0000316285.52865.53] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Movement disorders, such as Parkinson's disease, tremor, and dystonia, are among the most common neurological conditions and affect millions of patients. Although medications are the mainstay of therapy for movement disorders, neurosurgery has played an important role in their management for the past 50 years. Surgery is now a viable and safe option for patients with medically intractable Parkinson's disease, essential tremor, and dystonia. In this article, we provide a review of the history, neurocircuitry, indication, technical aspects, outcomes, complications, and emerging neurosurgical approaches for the treatment of movement disorders.
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Affiliation(s)
- Ali R Rezai
- Center for Neurological Restoration, and Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio 44122, USA.
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30
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Diamond A, Kenney C, Almaguer M, Jankovic J. Hyperhidrosis due to deep brain stimulation in a patient with essential tremor. J Neurosurg 2007; 107:1036-8. [DOI: 10.3171/jns-07/11/1036] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The authors present a unique case of hyperhidrosis as a side effect of a misplaced deep brain stimulation (DBS) electrode near the ventrointermedius (Vim) nucleus in a patient with essential tremor. Magnetic resonance imaging of the brain showed electrode placement in the left anterior thalamus traversing the hypothalamus. High-frequency electrical stimulation possibly resulted in unilateral activation of the efferent sympathetic pathways in the zona incerta. Although a rare complication, hypothalamic dysfunction may occur as a stimulation-related side effect of Vim-DBS.
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31
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Cortelli P, Guaraldi P, Leone M, Pierangeli G, Barletta G, Grimaldi D, Cevoli S, Bussone G, Baruzzi A, Montagna P. Effect of deep brain stimulation of the posterior hypothalamic area on the cardiovascular system in chronic cluster headache patients. Eur J Neurol 2007; 14:1008-15. [PMID: 17718693 DOI: 10.1111/j.1468-1331.2007.01850.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to determine the cardiovascular effects of chronic stimulation of the posterior hypothalamic area (PHA) in cluster headache (CH) patients. Systolic and diastolic blood pressure (SBP, DBP), cardiac output, total peripheral resistance (TPR), heart rate (HR) and breathing were monitored at supine rest and during head-up tilt test (HUTT), Valsalva manoeuvre, deep breathing, cold face test and isometric handgrip in eight drug-resistant chronic CH patients who underwent monolateral electrode implantation in the PHA for therapeutic purposes. Autoregressive power spectral analysis (PSA) of HR variability (HRV) was calculated at rest and during HUTT. Each subject was studied before surgery (condition A) and after chronic deep brain stimulation (DBS) of PHA (condition B). Baseline SBP, DBP, HR and cardiovascular reflexes were normal and similar in both conditions. With respect to condition A, DBP, TPR and the LF/HF obtained from the PSA of HRV were significantly (P < 0.05) increased during HUTT in condition B. In conclusion, chronic DBS of the PHA in chronic CH patients is associated with an enhanced sympathoexcitatory drive on the cardiovascular system during HUTT.
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Affiliation(s)
- P Cortelli
- Department of Neurological Sciences, University of Bologna, Bologna, Italy.
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Ludwig J, Remien P, Guballa C, Binder A, Binder S, Schattschneider J, Herzog J, Volkmann J, Deuschl G, Wasner G, Baron R. Effects of subthalamic nucleus stimulation and levodopa on the autonomic nervous system in Parkinson's disease. J Neurol Neurosurg Psychiatry 2007; 78:742-5. [PMID: 17371906 PMCID: PMC2117689 DOI: 10.1136/jnnp.2006.103739] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Dysfunctions of the autonomic nervous system (ANS) are common in Parkinson's disease (PD). Regarding motor disability, deep brain stimulation of the subthalamic nucleus (STN) is an effective treatment option in long lasting PD. The aims of this study were to examine whether STN stimulation has an influence on functions of the ANS and to compare these effects to those induced by levodopa. Blood pressure (BP) and heart rate (HR) during rest and orthostatic conditions, HR variability (HRV) and breathing-induced cutaneous sympathetic vasoconstriction (CVC) were tested in 14 PD patients treated with STN stimulation during "ON" and "OFF" condition of the stimulator. The effects of a single dose of levodopa on ANS were tested in 15 PD patients without DBS. STN stimulation had no influence on cardiovascular ANS functions, whereas CVC was significantly increased. In contrast, levodopa significantly lowered BP and HR at rest and enhanced orthostatic hypotension. Further, HRV, skin perfusion and temperature increased after administration of levodopa. Our results suggest that in contrast to levodopa, STN stimulation has only minor effects on autonomic functions. Since less pharmacotherapy is needed after STN stimulation, reduced levodopa intake results in relative improvement of autonomic function in deep brain stimulated PD patients.
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Affiliation(s)
- Janne Ludwig
- Division of Neurological Pain Research and Therapy, University of Kiel, Kiel, Germany.
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Shekhar A, Johnson PL, Sajdyk TJ, Fitz SD, Keim SR, Kelley PE, Gehlert DR, DiMicco JA. Angiotensin-II is a putative neurotransmitter in lactate-induced panic-like responses in rats with disruption of GABAergic inhibition in the dorsomedial hypothalamus. J Neurosci 2006; 26:9205-15. [PMID: 16957077 PMCID: PMC6674511 DOI: 10.1523/jneurosci.2491-06.2006] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 07/15/2006] [Accepted: 07/17/2006] [Indexed: 11/21/2022] Open
Abstract
Intravenous sodium lactate infusions or the noradrenergic agent yohimbine reliably induce panic attacks in humans with panic disorder but not in healthy controls. However, the exact mechanism of lactate eliciting a panic attack is still unknown. In rats with chronic disruption of GABA-mediated inhibition in the dorsomedial hypothalamus (DMH), achieved by chronic microinfusion of the glutamic acid decarboxylase inhibitor L-allylglycine, sodium lactate infusions or yohimbine elicits panic-like responses (i.e., anxiety, tachycardia, hypertension, and tachypnea). In the present study, previous injections of the angiotensin-II (A-II) type 1 receptor antagonist losartan and the nonspecific A-II receptor antagonist saralasin into the DMH of "panic-prone" rats blocked the anxiety-like and physiological components of lactate-induced panic-like responses. In addition, direct injections of A-II into the DMH of these panic-prone rats also elicited panic-like responses that were blocked by pretreatment with saralasin. Microinjections of saralasin into the DMH did not block the panic-like responses elicited by intravenous infusions of the noradrenergic agent yohimbine or by direct injections of NMDA into the DMH. The presence of the A-II type 1 receptors in the region of the DMH was demonstrated using immunohistochemistry. Thus, these results implicate A-II pathways and the A-II receptors in the hypothalamus as putative substrates for sodium lactate-induced panic-like responses in vulnerable subjects.
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Affiliation(s)
- Anantha Shekhar
- Department of Psychiatry, Institute of Psychiatric Research, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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