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Zhu K, Peng S, Wu Y, Zhao Y, Lu Z. Deep brain stimulation of the subthalamic nucleus improves sleep in Parkinson disease patients: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e34509. [PMID: 37565888 PMCID: PMC10419437 DOI: 10.1097/md.0000000000034509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Sleep disorders significantly affect the quality of life in Parkinson disease (PD) patients. Deep brain stimulation of the subthalamic nucleus has been reported to improve motor symptoms and decrease medication usage. However, the impact of subthalamic nucleus deep brain stimulation (STN-DBS) on sleep quality in PD patients remains to be definitively determined. This systematic review and meta-analysis, conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines, aimed to clarify the effect of STN-DBS on sleep quality in PD patients. METHODS A rigorous literature search identified 6 studies, including 1 randomized controlled trial and 5 self-controlled trials, totaling 154 patients who underwent deep brain stimulation, providing 308 pairs of data for analysis. Parkinson disease sleep scale was the primary measure of interest, while the Movement Disorder Society-sponsored revision of the unified Parkinson disease rating scale was documented in all trials. Study quality was assessed using the Newcastle-Ottawa scale. RESULTS STN-DBS significantly improved Parkinson disease sleep scale scores (mean difference = 20.41, 95% CI: [13.03, 27.79], I² = 60.8%, P < .001), indicating enhanced sleep quality. Furthermore, a significant reduction in movement disorder society unified Parkinson disease rating scale part III scores postoperatively (mean difference = -12.59, 95% CI: [-14.70, -10.49], I² = 89.9%, P < .001) suggested improved motor function. PD medication usage was also significantly reduced postoperatively (mean difference = -314.71, 95% CI: [-468.13, -161.28], I² = 52.9%, P < .001). A sensitivity analysis confirmed the robustness of the main findings. The sample size was adequate, allowing for conclusive inferences. CONCLUSION The present study, which comprises a comprehensive systematic review and meta-analysis, offers compelling evidence that STN-DBS can ameliorate sleep quality, augment motor function, and curtail medication consumption among individuals afflicted with PD.
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Affiliation(s)
- Keying Zhu
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Sun Peng
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yulun Wu
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yuanyuan Zhao
- Department of Neurosurgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhonglei Lu
- Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
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Ma R, Yin Z, Chen Y, Yuan T, An Q, Gan Y, Xu Y, Jiang Y, Du T, Yang A, Meng F, Zhu G, Zhang J. Sleep outcomes and related factors in Parkinson's disease after subthalamic deep brain electrode implantation: a retrospective cohort study. Ther Adv Neurol Disord 2023; 16:17562864231161163. [PMID: 37200769 PMCID: PMC10185976 DOI: 10.1177/17562864231161163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/15/2023] [Indexed: 05/20/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) improves sleep qualities in Parkinson's disease (PD) patients; however, it remains elusive whether STN-DBS improves sleep by directly influencing the sleep circuit or alleviates other cardinal symptoms such as motor functions, other confounding factors including stimulation intensity may also involve. Studying the effect of microlesion effect (MLE) on sleep after STN-DBS electrode implantation may address this issue. Objective To examine the influence of MLE on sleep quality and related factors in PD, as well as the effects of regional and lateral specific correlations with sleep outcomes after STN-DBS electrode implantation. Study Design Case-control study; Level of evidence, 3. Data Sources and Methods In 78 PD patients who underwent bilateral STN-DBS surgery in our center, we compared the sleep qualities, motor performances, anti-Parkinsonian drug dosage, and emotional conditions at preoperative baseline and postoperative 1-month follow-up. We determined the related factors of sleep outcomes and visualized the electrodes position, simulated the MLE-engendered volume of tissue lesioned (VTL), and investigated sleep-related sweet/sour spots and laterality in STN. Results MLE improves sleep quality with Pittsburgh Sleep Quality Index (PSQI) by 13.36% and Parkinson's Disease Sleep Scale-2 (PDSS-2) by 17.95%. Motor (P = 0.014) and emotional (P = 0.001) improvements were both positively correlated with sleep improvements. However, MLE in STN associative subregions, as an independent factor, may cause sleep deterioration (r = 0.348, P = 0.002), and only the left STN showed significance (r = 0.327, P = 0.004). Sweet spot analysis also indicated part of the left STN associative subregion is the sour spot indicative of sleep deterioration. Conclusion The MLE of STN-DBS can overall improve sleep quality in PD patients, with a positive correlation between motor and emotional improvements. However, independent of all other factors, the MLE in the STN associative subregion, particularly the left side, may cause sleep deterioration.
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Affiliation(s)
- Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yingchuan Chen
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tingting Du
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
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Kamel WA, Majumdar P, Matis G, Fenoy AJ, Balakrishnan S, Zirh AT, Cevik A, Tomar AK, Ouerchefani N. Surgical Management for Dystonia: Efficacy of Deep Brain Stimulation in the Long Term. Neurol Int 2021; 13:371-386. [PMID: 34449699 PMCID: PMC8395937 DOI: 10.3390/neurolint13030037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Dystonia is a movement disorder substantially affecting the quality of life. Botulinum Neurotoxin (BoNT) is used intramuscularly as a treatment for dystonia; however, not all dystonia patients respond to this treatment. Deep brain stimulation (DBS) is an established treatment for Parkinson’s disease (PD) and essential tremor, but it can help in dystonia as well. Objectives: We studied a total of 67 dystonia patients who were treated with DBS over a period of 7 years to find out the long-term efficacy of DBS in those patients. First, we calculated patient improvement in post-surgery follow-up programs using the Global Dystonia Severity scale (GDS) and Burke–Fahn–Marsden dystonia rating scale (BFMDRS). Secondly, we analyzed the scales scores to see if there was any statistical significance. Methods: In our study we analyzed patients with ages from 38 to 78 years with dystonia who underwent DBS surgery between January 2014 and December 2020 in four different centers (India, Kuwait, Egypt, and Turkey). The motor response to DBS surgery was retrospectively measured for each patient during every follow-up visit using the GDS and the BFMDRS scales. Results: Five to 7 years post-DBS, the mean reduction in the GDS score was 30 ± 1.0 and for the BFMDRS score 26 ± 1.0. The longitudinal change in scores at 12 and 24 months post-op was also significant with mean reductions in GDS and BFMDRS scores of 68 ± 1.0 and 56 ± 1.0, respectively. The p-values were <0.05 for our post-DBS dystonia patients. Conclusions: This study illustrates DBS is an established, effective treatment option for patients with different dystonias, such as generalized, cervical, and various brain pathology-induced dystonias. Although symptoms are not completely eliminated, continuous improvements are noticed throughout the post-stimulation time frame.
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Affiliation(s)
- Walaa A. Kamel
- Neurology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef 62511, Egypt;
- Neurology Department, Ibn-Sina Hospital, Kuwait City 25427, Kuwait
| | - Pritam Majumdar
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, 50931 Cologne, Germany;
- Correspondence:
| | - Georgios Matis
- Department of Stereotactic and Functional Neurosurgery, University Cologne Hospital, 50931 Cologne, Germany;
| | - Albert J. Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas at Houston, UTHealth Neurosciences, Houston, TX 77030, USA;
| | - Shankar Balakrishnan
- Department of Neurology and Neuromodulation, MIOT International Hospital, Hennai 600089, India;
| | - Ali T. Zirh
- Department of Neurosurgery, Istanbul Medipol University, Istanbul 34810, Turkey;
| | - Aslihan Cevik
- Department of Neurosurgery, Istanbul Aydin University, Istanbul Medical Park Florya, Istanbul 34295, Turkey;
| | - Amit Kumar Tomar
- Department of Anesthesia and Neurosurgery, Indo-Gulf Hospital, Noida 201301, India;
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Zuzuárregui JRP, Ostrem JL. The Impact of Deep Brain Stimulation on Sleep in Parkinson's Disease: An update. JOURNAL OF PARKINSONS DISEASE 2021; 10:393-404. [PMID: 32250316 PMCID: PMC7242854 DOI: 10.3233/jpd-191862] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Parkinson’s disease (PD) can have a significant impact on sleep. Deep brain stimulation (DBS) is an effective treatment for motor features of PD, but less is understood about the impact DBS may have on sleep architecture and various sleep issues commonly seen in PD. Objective: To review the impact of DBS on various sleep issues in PD. Methods: We reviewed the literature regarding the impact of DBS on sleep patterns, nocturnal motor and non-motor symptoms, and sleep disorders in PD. Results: Objective sleep measures on polysomnography (PSG), including sleep latency and wake after sleep onset improve after subthalamic nucleus (STN) and globus pallidus interna (GPi) DBS. Subjective sleep measures, nocturnal motor symptoms, and some non-motor symptoms (nocturia) also may improve. Current evidence suggests STN DBS has no impact on Rapid Eye Movement Behavior Disorder (RBD), while STN DBS may improve symptoms of Restless Legs Syndrome (RLS). There are no studies that have evaluated the impact of GPi DBS on RBD, while it is unclear if GPi has an effect on RLS in PD. Conclusion: DBS therapy at either site appears to improve objective and subjective sleep parameters in patients with PD. Most likely, the improvement of motor and some non-motor nocturnal symptoms leads to an increase in total sleep time by up to an hour, as well as reduction of sleep fragmentation. DBS most likely has no impact on RBD, while there is evidence that STN DBS appears to help reduce RLS severity. Further studies are needed.
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Affiliation(s)
| | - Jill L Ostrem
- Department of Neurology, University of California, San Francisco, CA, USA
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Zahed H, Zuzuarregui JRP, Gilron R, Denison T, Starr PA, Little S. The Neurophysiology of Sleep in Parkinson's Disease. Mov Disord 2021; 36:1526-1542. [PMID: 33826171 DOI: 10.1002/mds.28562] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
Sleep disturbances are among the most common nonmotor complications of Parkinson's disease (PD), can present in prodromal stages, and progress with advancing disease. In addition to being a symptom of neurodegeneration, sleep disturbances may also contribute to disease progression. Currently, limited options exist to modulate sleep disturbances in PD. Studying the neurophysiological changes that affect sleep in PD at the cortical and subcortical level may yield new insights into mechanisms for reversal of sleep disruption. In this article, we review cortical and subcortical recording studies of sleep in PD with a particular focus on dissecting reported electrophysiological changes. These studies show that slow-wave sleep and rapid eye movement sleep are both notably disrupted in PD. We further explore the impact of these electrophysiological changes and discuss the potential for targeting sleep via stimulation therapy to modify PD-related motor and nonmotor symptoms. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Hengameh Zahed
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | | | - Ro'ee Gilron
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy Denison
- Institute of Biomedical Engineering and MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, California, USA
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6
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Jost ST, Ray Chaudhuri K, Ashkan K, Loehrer PA, Silverdale M, Rizos A, Evans J, Petry-Schmelzer JN, Barbe MT, Sauerbier A, Fink GR, Visser-Vandewalle V, Antonini A, Martinez-Martin P, Timmermann L, Dafsari HS. Subthalamic Stimulation Improves Quality of Sleep in Parkinson Disease: A 36-Month Controlled Study. JOURNAL OF PARKINSONS DISEASE 2021; 11:323-335. [PMID: 33074192 DOI: 10.3233/jpd-202278] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sleep disturbances and neuropsychiatric symptoms are some of the most common nonmotor symptoms in Parkinson's disease (PD). The effect of subthalamic stimulation (STN-DBS) on these symptoms beyond a short-term follow-up is unclear. OBJECTIVE To examine 36-month effects of bilateral STN-DBS on quality of sleep, depression, anxiety, and quality of life (QoL) compared to standard-of-care medical therapy (MED) in PD. METHODS In this prospective, controlled, observational, propensity score matched, international multicenter study, we assessed sleep disturbances using the PDSleep Scale-1 (PDSS), QoL employing the PDQuestionnaire-8 (PDQ-8), motor disorder with the Scales for Outcomes in PD (SCOPA), anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), and dopaminergic medication requirements (LEDD). Within-group longitudinal outcome changes were tested using Wilcoxon signed-rank and between-group longitudinal differences of change scores with Mann-Whitney U tests. Spearman correlations analyzed the relationships of outcome parameter changes at follow-up. RESULTS Propensity score matching applied on 159 patients (STN-DBS n = 75, MED n = 84) resulted in 40 patients in each treatment group. At 36-month follow-up, STN-DBS led to significantly better PDSS and PDQ-8 change scores, which were significantly correlated. We observed no significant effects for HADS and no significant correlations between change scores in PDSS, HADS, and LEDD. CONCLUSIONS We report Class IIb evidence of beneficial effects of STN-DBS on quality of sleep at 36-month follow-up, which were associated with QoL improvement independent of depression and dopaminergic medication. Our study highlights the importance of sleep for assessments of DBS outcomes.
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Affiliation(s)
- Stefanie T Jost
- Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - K Ray Chaudhuri
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Keyoumars Ashkan
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Alexandra Rizos
- Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, UK
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Sauerbier
- Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Angelo Antonini
- Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- Department of Neurology, University Hospital of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Hasegawa H, Selway R, Gnoni V, Beniczky S, Williams SCR, Kryger M, Ferini-Strambi L, Goadsby P, Leschziner GD, Ashkan K, Rosenzweig I. The subcortical belly of sleep: New possibilities in neuromodulation of basal ganglia? Sleep Med Rev 2020; 52:101317. [PMID: 32446196 PMCID: PMC7679363 DOI: 10.1016/j.smrv.2020.101317] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/22/2020] [Accepted: 03/09/2020] [Indexed: 12/30/2022]
Abstract
Early studies posited a relationship between sleep and the basal ganglia, but this relationship has received little attention recently. It is timely to revisit this relationship, given new insights into the functional anatomy of the basal ganglia and the physiology of sleep, which has been made possible by modern techniques such as chemogenetic and optogenetic mapping of neural circuits in rodents and intracranial recording, functional imaging, and a better understanding of human sleep disorders. We discuss the functional anatomy of the basal ganglia, and review evidence implicating their role in sleep. Whilst these studies are in their infancy, we suggest that the basal ganglia may play an integral role in the sleep-wake cycle, specifically by contributing to a thalamo-cortical-basal ganglia oscillatory network in slow-wave sleep which facilitates neural plasticity, and an active state during REM sleep which enables the enactment of cognitive and emotional networks. A better understanding of sleep mechanisms may pave the way for more effective neuromodulation strategies for sleep and basal ganglia disorders.
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Affiliation(s)
- Harutomo Hasegawa
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), UK; Department of Neurosurgery, King's College Hospital, London, UK
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Valentina Gnoni
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
| | - Sandor Beniczky
- Danish Epilepsy Centre, Dianalund, Denmark; Aarhus University Hospital, Aarhus, Denmark
| | | | - Meir Kryger
- Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, Connecticut, USA
| | | | - Peter Goadsby
- NIHR-Wellcome Trust Clinical Research Facility, SLaM Biomedical Research Centre, King's College London, London, UK
| | - Guy D Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK; Department of Neurology, Guy's and St Thomas' Hospital (GSTT) & Clinical Neurosciences, KCL, UK
| | | | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK.
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8
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A 3-year observation of excessive daytime sleepiness after subthalamic deep brain stimulation in patients with Parkinson’s disease. Clin Neurol Neurosurg 2020; 192:105721. [DOI: 10.1016/j.clineuro.2020.105721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/12/2020] [Accepted: 02/03/2020] [Indexed: 11/21/2022]
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9
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Beneficial effect of 24-month bilateral subthalamic stimulation on quality of sleep in Parkinson's disease. J Neurol 2020; 267:1830-1841. [PMID: 32152689 PMCID: PMC7293679 DOI: 10.1007/s00415-020-09743-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/27/2019] [Accepted: 02/01/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and sleep symptoms in Parkinson's disease (PD). However, the long-term effects of STN-DBS on sleep and its relationship with QoL outcome are unclear. METHODS In this prospective, observational, multicenter study including 73 PD patients undergoing bilateral STN-DBS, we examined PDSleep Scale (PDSS), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, -activities of daily living, and -complications (SCOPA-A, -B, -C), and levodopa-equivalent daily dose (LEDD) preoperatively, at 5 and 24 months follow-up. Longitudinal changes were analyzed with Friedman-tests or repeated-measures ANOVA, when parametric tests were applicable, and Bonferroni-correction for multiple comparisons. Post-hoc, visits were compared with Wilcoxon signed-rank/t-tests. The magnitude of clinical responses was investigated using effect size. RESULTS Significant beneficial effects of STN-DBS were observed for PDSS, PDQ-8, SCOPA-A, -B, and -C. All outcomes improved significantly at 5 months with subsequent decrements in gains at 24 months follow-up which were significant for PDSS, PDQ-8, and SCOPA-B. Comparing baseline and 24 months follow-up, we observed significant improvements of PDSS (small effect), SCOPA-A (moderate effect), -C, and LEDD (large effects). PDSS and PDQ-8 improvements correlated significantly at 5 and 24 months follow-up. CONCLUSIONS In this multicenter study with a 24 months follow-up, we report significant sustained improvements after bilateral STN-DBS using a PD-specific sleep scale and a significant relationship between sleep and QoL improvements. This highlights the importance of sleep in holistic assessments of DBS outcomes.
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10
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Choi JH, Kim HJ, Lee JY, Yoo D, Im JH, Paek SH, Jeon B. Long-term effects of bilateral subthalamic nucleus stimulation on sleep in patients with Parkinson's disease. PLoS One 2019; 14:e0221219. [PMID: 31454366 PMCID: PMC6711522 DOI: 10.1371/journal.pone.0221219] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 08/01/2019] [Indexed: 12/20/2022] Open
Abstract
Objectives Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to have a positive effect on sleep-wake disturbance in Parkinson's disease (PD). We aimed to investigate the long-term effects of STN DBS on sleep in patients with PD. Methods Sixty-one patients with PD who had undergone bilateral STN DBS were followed for 3 years with assessments including the Parkinson’s disease sleep scale (PDSS), Epworth sleepiness scale (ESS), total sleep hours per day, Unified PD Rating Scale part I-III, Hoehn & Yahr stage, levodopa equivalent dose, quality of life measure, and depression scale measured preoperatively and at 6 months after postoperatively, and annually thereafter. Results Among the 61 patients at baseline, 46 patients completed the last follow-up assessment. The total PDSS score significantly improved after STN DBS from baseline up to 3 years after STN DBS (79.0±30, 100.0±23.3, 98.8±23.0, 97.1±29.6, and 93.3±28.0 at baseline, 6, 12, 24, and 36 months, respectively, p = 0.006 for the change over time). Among the eight PDSS domains, the domains for overall quality of a night’s sleep, sleep onset and maintenance insomnia, and nocturnal motor symptoms showed significant improvement after STN DBS (p = 0.036, 0.029, and < 0.001, respectively, for the change over time). The total sleep hours per day were increased, but the total ESS score did not show significant change after STN DBS (p = 0.001 and 0.055, respectively, for the change over time). Changes in the total PDSS were associated with changes in the depression and motivation items in the Unified PD Rating Scale part I, depression scale, and quality of life measure, but those variables at baseline were not predictive of changes in the total PDSS after STN DBS. Conclusion In the largest systematic long-term follow-up study, the improvement in subjective sleep quality after bilateral STN DBS was sustained in PD patients. Improved nocturnal sleep and nocturnal motor symptoms were correlated with an improved mood and quality of life. However, STN DBS did not reduce excessive daytime sleepiness despite reductions in antiparkinsonian medications.
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Grants
- Travel Grant: Korea Research-Based Pharmaceutical Industry Association, Korean Pharmaceutical Manufacturers Association, Seoul National University Hospital (The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript)
- Research Grant: Seoul National University College of Medicine, Seoul National University Hospital, Sinyang Cultural Foundation, Peptron, Abbvie Korea (The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript)
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Affiliation(s)
- Ji-Hyun Choi
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dallah Yoo
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Hee Im
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (BJ); (SHP)
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (BJ); (SHP)
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11
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Dulski J, Schinwelski M, Konkel A, Grabowski K, Libionka W, Wąż P, Sitek EJ, Sławek J. The impact of subthalamic deep brain stimulation on sleep and other non-motor symptoms in Parkinson's disease. Parkinsonism Relat Disord 2019; 64:138-144. [PMID: 30975618 DOI: 10.1016/j.parkreldis.2019.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The non-motor symptoms have a major impact on quality of life in patients with Parkinson Disease (PD). We present results of the study on the impact of subthalamic deep brain stimulation (DBS-STN) on sleep and other non-motor symptoms in PD patients. MATERIALS AND METHODS Thirty-six patients with advanced PD were included into the study. Twenty four were evaluated with two-night polysomnography (PSG) before surgery and at 6 months after DBS programming. The whole group (n = 36) was assessed using motor, non-motor symptoms (sleep disturbances in particular) and quality of life measures (QoL), before surgery, 6 and 12 months after DBS programming. RESULTS DBS-STN resulted in the significant deterioration of objective sleep parameters, as assessed by PSG, mostly in terms of total sleep time, sleep efficiency, duration of N1 and N2 sleep, wakefulness after sleep onset and sleep latency. At the same time, improvement in the subjective sleep measures, other non-motor symptoms (particularly fatigue, cardiovascular, gastrointestinal, and sexual symptoms) and QoL was identified. The subjective improvement of sleep, other non-motor symptoms and QoL was most prominent in the first 6 months after DBS-STN, diminished slightly (being still better than before surgery) after 12 months, in parallel to mood deterioration. CONCLUSION DBS-STN resulted in the subjective sleep quality improvement with worsening of objective (PSG) sleep parameters after 6 months. After 12 months all sleep clinical outcome measures were still better than before surgery, albeit worse when compared to the first follow-up visit. Subjective sleep quality correlated positively with mood.
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Affiliation(s)
- Jarosław Dulski
- Neurology Department, St Adalbert Hospital Copernicus PL, Gdansk, Poland; Neurological and Psychiatric Nursing Department, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland.
| | - Michał Schinwelski
- Neurology Department, St Adalbert Hospital Copernicus PL, Gdansk, Poland
| | - Agnieszka Konkel
- Neurology Department, St Adalbert Hospital Copernicus PL, Gdansk, Poland; Neurological and Psychiatric Nursing Department, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Karol Grabowski
- Adult Psychiatry Clinic, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | | | - Piotr Wąż
- Department of Nuclear Medicine, Faculty of Health Sciences, Medical University of Gdańsk, Gdansk, Poland
| | - Emilia J Sitek
- Neurology Department, St Adalbert Hospital Copernicus PL, Gdansk, Poland; Neurological and Psychiatric Nursing Department, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Jarosław Sławek
- Neurology Department, St Adalbert Hospital Copernicus PL, Gdansk, Poland; Neurological and Psychiatric Nursing Department, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
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12
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Update on the clinical application of deep brain stimulation in sleep dysfunction of Parkinson's disease. Acta Neurol Belg 2018; 118:351-359. [PMID: 29987555 DOI: 10.1007/s13760-018-0971-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 07/02/2018] [Indexed: 12/19/2022]
Abstract
Sleep dysfunctions, including rapid eye movement sleep behavior disorder, sleep fragmentation, excessive daytime sleepiness and various other dysfunctions, can seriously affect quality of life in patients with Parkinson's disease (PD). Emerging evidence suggests that deep brain stimulation (DBS) exerts a substantial effect when used to treat sleep dysfunctions, which are common nonmotor symptoms experienced by patients with PD. However, far less is known about the specific mechanisms underlying the effects of DBS on sleep processes and the factors that potentially influence these effects. These issues therefore need to be further clarified. Intriguingly, a number of recent studies have evaluated the effects of applying DBS to various brain targets on sleep in patients with PD. Deeper research into the efficacy of applying DBS to each brain target may help determine which region should be targeted during surgery in PD patients. Furthermore, compared with pharmacological therapy, DBS had more beneficial effects on sleep symptoms, and appropriate management involving the joint application of dopamine replacement therapy and DBS might accelerate the effects of treatment. Here, we review the potential roles DBS may play and provide clinical guidance for the use of DBS in treating sleep dysfunctions in PD patients.
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13
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Sharma VD, Sengupta S, Chitnis S, Amara AW. Deep Brain Stimulation and Sleep-Wake Disturbances in Parkinson Disease: A Review. Front Neurol 2018; 9:697. [PMID: 30210429 PMCID: PMC6119706 DOI: 10.3389/fneur.2018.00697] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/02/2018] [Indexed: 12/02/2022] Open
Abstract
Sleep-wake disturbances are common non-motor manifestations in Parkinson Disease (PD). Complex pathophysiological changes secondary to neurodegeneration in combination with motor symptoms and dopaminergic medications contribute to development of sleep-wake disturbances. The management of sleep complaints in PD is important as this symptom can affect daily activities and impair quality of life. Deep brain stimulation (DBS) is an effective adjunctive therapy for management of motor symptoms in PD. However, its effect on non-motor symptoms including sleep-wake disturbances is not widely understood. In this article, we reviewed studies assessing the effect of DBS at various therapeutic targets on sleep-wake disturbances. Of the studies examining the role of DBS in sleep-wake disturbances, the effect of subthalamic nucleus stimulation is most widely studied and has shown improvement in sleep quality, sleep efficiency, and sleep duration. Although, studies investigating changes in sleep with stimulation of thalamus, globus pallidus interna, and pedunculopontine nucleus are limited, they support the potential for modulation of sleep-wake centers with DBS at these sites. The mechanism by which DBS at different anatomical targets affects sleep-wake disturbances in PD is unclear and may involves multiple factors, including improved motor symptoms, medication adjustment, and direct modulation of sleep-wake centers.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Samarpita Sengupta
- Department of Neurology, University of Southwestern Medical Center, Dallas, TX, United States
| | - Shilpa Chitnis
- Department of Neurology, University of Southwestern Medical Center, Dallas, TX, United States
| | - Amy W Amara
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, United States
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Deng Z, Pan Y, Zhang C, Zhang J, Qiu X, Zhan S, Li D, Sun B. Subthalamic deep brain stimulation in patients with primary dystonia: A ten-year follow-up study. Parkinsonism Relat Disord 2018; 55:103-110. [PMID: 29880315 DOI: 10.1016/j.parkreldis.2018.05.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/03/2018] [Accepted: 05/27/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subthalamic deep brain stimulation (STN-DBS) is a promising intervention for primary dystonia; however, evidence regarding its efficacy is lacking. Thus, a long-term follow-up is indispensable. OBJECTIVE This trial was designed to examine the efficacy and consistency of subthalamic deep brain stimulation in patients with primary dystonia over the long term. METHOD This was a retrospective study involving 14 patients with primary dystonia who underwent STN-DBS and consented to a follow-up of at least 10 years. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and 36-item Short-Form General Health Survey were employed, at five time points (pre-operation [baseline], 1 month post-operation, 1 year post-operation, 5 years post-operation, and last follow-up), to assess improvement of dystonic symptoms and changes in quality of life. OUTCOMES All patients gained extensive clinical benefits from STN-DBS therapy, without experiencing serious adverse effects. Improvements of 59.0% at 1 month, 85.0% at 1 year, and 90.8% at 5 years after the operation, and up to 91.4% at the last follow-up, were demonstrated by movement evaluation with the BFMDRS. All patients achieved a substantial improvement in quality of life. CONCLUSION Subthalamic deep brain stimulation is an effective and persisting alternative to pallidal deep brain stimulation, and importantly, it is very safe even with extremely long-term chronic stimulation.
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Affiliation(s)
- Zhengdao Deng
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xian Qiu
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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15
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Dafsari HS, Silverdale M, Strack M, Rizos A, Ashkan K, Mahlstedt P, Sachse L, Steffen J, Dembek TA, Visser-Vandewalle V, Evans J, Antonini A, Martinez-Martin P, Ray-Chaudhuri K, Timmermann L. Nonmotor symptoms evolution during 24 months of bilateral subthalamic stimulation in Parkinson's disease. Mov Disord 2018; 33:421-430. [PMID: 29465787 DOI: 10.1002/mds.27283] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/28/2017] [Accepted: 12/06/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The objective of this study was to investigate 24-month of effects of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on nonmotor symptoms in Parkinson's disease (PD). METHODS In this prospective, observational, multicenter, international study including 67 PD patients undergoing bilateral STN-DBS, we examined the Non-motor Symptom Scale, Non-Motor Symptoms Questionnaire, Parkinson's Disease Questionnaire-8, Scales for Outcomes in Parkinson's Disease-motor examination, -activities of daily living, and -complications, and levodopa-equivalent daily dose preoperatively and at 5 and 24-month of follow-up. After checking distribution normality, longitudinal outcome changes were investigated with Friedman tests or repeated-measures analysis of variance and Bonferroni correction for multiple comparisons using multiple tests. Post hoc, Wilcoxon signed rank t tests were computed to compare visits. The strength of clinical responses was analyzed using effect size. Explorative Spearman correlations of change scores from baseline to 24-month follow-up were calculated for all outcomes. RESULTS The Non-motor Symptom Scale and all other outcome parameters significantly improved from baseline to the 5-month follow-up. From 5 to 24-month, partial decrements in these gains were found. Nonetheless, comparing baseline with 24-month follow-up, significant improvements were observed for the Non-motor Symptom Scale (small effect), Scales for Outcomes in PD-motor examination showed a moderate effect, and Scales for Outcomes in Parkinson's Disease-complications and levodopa-equivalent daily dose showed large effects. Non-motor Symptom Scale change scores from baseline to 24-month follow-up correlated significantly with Parkinson's Disease Questionnaire-8, Scales for Outcomes in Parkinson's Disease-activities of daily living, and -motor complications change scores. CONCLUSIONS This study provides evidence of beneficial effects of bilateral STN-DBS on nonmotor symptoms at 24-month follow-up. The extent of nonmotor symptom improvement was directly proportionate to improvements in quality of life, activities of daily living, and motor complications. This study underlines the importance of nonmotor symptoms for holistic assessments of DBS outcomes. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
| | - Marian Strack
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Alexandra Rizos
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Keyoumars Ashkan
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Picabo Mahlstedt
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lena Sachse
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Julia Steffen
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Till A Dembek
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, IRCCS Hospital San Camillo, Venice, Italy.,Department of Neurosciences (DNS), Padova University, Padova, Italy
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - K Ray-Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany
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16
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Bargiotas P, Eugster L, Oberholzer M, Debove I, Lachenmayer ML, Mathis J, Pollo C, Schüpbach WMM, Bassetti CL. Sleep-wake functions and quality of life in patients with subthalamic deep brain stimulation for Parkinson's disease. PLoS One 2017; 12:e0190027. [PMID: 29253029 PMCID: PMC5734707 DOI: 10.1371/journal.pone.0190027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Sleep-wake disturbances (SWD) are frequent in Parkinson's disease (PD). The effect of deep brain stimulation (DBS) on SWD is poorly known. In this study we examined the subjective and objective sleep-wake profile and the quality of life (QoL) of PD patients in the context of subthalamic DBS. PATIENTS AND METHODS We retrospectively analyzed data from PD patients and candidates for DBS in the nucleus suthalamicus (STN). Pre-DBS, sleep-wake assessments included subjective and objective (polysomnography, vigilance tests and actigraphy) measures. Post-DBS, subjective measures were collected. QoL was assessed using the Parkinson's Disease Questionnaire (PDQ-39) and the RAND SF-36-item Health Survey (RAND SF-36). RESULTS Data from 74 PD patients (62% male, mean age 62.2 years, SD = 8.9) with a mean UPDRS-III (OFF) of 34.2 (SD = 14.8) and 11.8 (SD = 4.5) years under PD treatment were analyzed. Pre-DBS, daytime sleepiness, apathy, fatigue and depressive symptoms were present in 49%, 34%, 38% and 25% of patients respectively but not always as co-occurring symptoms. Sleep-wake disturbances were significantly correlated with QoL scores. One year after STN DBS, motor signs, QoL and sleepiness improved but apathy worsened. Changes in QoL were associated with changes in sleepiness and apathy but baseline sleep-wake functions were not predictive of STN DBS outcome. CONCLUSION In PD patients presenting for STN DBS, subjective and objective sleep-wake disturbances are common and have a negative impact on QoL before and after neurosurgery. Given the current preliminary evidence, prospective observational studies assessing subjective and objective sleep-wake variables prior to and after DBS are needed.
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Affiliation(s)
- Panagiotis Bargiotas
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
- * E-mail:
| | - Lukas Eugster
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Michael Oberholzer
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - M. Lenard Lachenmayer
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - W. M. Michael Schüpbach
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Claudio L. Bassetti
- Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
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17
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Chahine LM, Amara AW, Videnovic A. A systematic review of the literature on disorders of sleep and wakefulness in Parkinson's disease from 2005 to 2015. Sleep Med Rev 2017; 35:33-50. [PMID: 27863901 PMCID: PMC5332351 DOI: 10.1016/j.smrv.2016.08.001] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 01/06/2023]
Abstract
Sleep disorders are among the most common non-motor manifestations in Parkinson's disease (PD) and have a significant negative impact on quality of life. While sleep disorders in PD share most characteristics with those that occur in the general population, there are several considerations specific to this patient population regarding diagnosis, management, and implications. The available research on these disorders is expanding rapidly, but many questions remain unanswered. We thus conducted a systematic review of the literature published from 2005 to 2015 on the following disorders of sleep and wakefulness in PD: REM sleep behavior disorder, insomnia, nocturia, restless legs syndrome and periodic limb movements, sleep disordered breathing, excessive daytime sleepiness, and circadian rhythm disorders. We discuss the epidemiology, etiology, clinical implications, associated features, evaluation measures, and management of these disorders. The influence on sleep of medications used in the treatment of motor and non-motor symptoms of PD is detailed. Additionally, we suggest areas in need of further research.
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Affiliation(s)
- Lama M Chahine
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 330 S. 9th st, Philadelphia, PA 19107, USA.
| | - Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aleksandar Videnovic
- Neurobiological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Reese R, Volkmann J. Deep Brain Stimulation for the Dystonias: Evidence, Knowledge Gaps, and Practical Considerations. Mov Disord Clin Pract 2017; 4:486-494. [PMID: 30363085 PMCID: PMC6090587 DOI: 10.1002/mdc3.12519] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/10/2017] [Accepted: 06/17/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the globus pallidus internus (GPi-DBS) is among the most effective treatment options for dystonias. Because the term "dystonia" is defined by a characteristic phenomenology of involuntary muscle contractions, which may present with a large clinical and pathogenetic heterogeneity, decision making for or against GPi-DBS can be difficult in individual patients. METHODS A search of the PubMed database for research and review articles, focused on "deep brain stimulation" and "dystonia" was used to identify clinical trials and to determine current concepts in the surgical management of dystonia. Patient selection in previous studies was recategorized by the authors using the new dystonia classification put forward by a consensus committee of experts in dystonia research. The evidence and knowledge gaps are summarized and commented by the authors taking into account expert opinion and personal clinical experience for providing practical guidance in patient selection for DBS in dystonia. RESULTS The literature review shows that pallidal deep brain stimulation is most effective in patients with isolated dystonia irrespective of the underlying etiology. In contrast, patients with combined dystonias are less likely to benefit from DBS, because the associated neurological symptoms (e.g., hypotonia or ataxia), with the exception of myoclonus, do not respond to pallidal neurostimulation. CONCLUSIONS It is important to recognize the clinical features of dystonia, because the distinction between isolated and combined dystonia syndromes may predict the treatment response to pallidal deep brain stimulation. The aim of this review is to help guide clinicians with advising patients about deep brain stimulation therapy for dystonia and refering appropriate candidates to surgical centers.
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Affiliation(s)
- René Reese
- Department of NeurologyRostock University Medical CenterRostockGermany
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
| | - Jens Volkmann
- Department of NeurologyUniversity Hospital WürzburgWürzburgGermany
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19
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Albers JA, Chand P, Anch AM. Multifactorial sleep disturbance in Parkinson's disease. Sleep Med 2017; 35:41-48. [PMID: 28619181 DOI: 10.1016/j.sleep.2017.03.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder, ranking only behind Alzheimer's disease and affecting 2% of the population over the age of 65. Pathophysiologically, PD is characterized by selective degeneration of the dopaminergic neurons of the substantia nigra pars compacta (SNpc) and striatal dopamine depletion. Patients may also exhibit mild-to-severe degeneration of other central and peripheral nervous tissues. The most dramatic symptoms of the disease are profound dopamine-responsive motor disturbances, including bradykinesia, akinesia, rigidity, resting tremor, and postural instability. PD patients commonly present with debilitating non-motor symptoms, including cognitive impairment, autonomic nervous system dysfunction, and sleep disturbance. Of these, sleep disturbance is the most consistently reported, and likely represents a disorder integrative of PD-related motor impairment, autonomic nervous system dysfunction, iatrogenic insult, and central neurodegeneration. The pathophysiology of PD may also indirectly disrupt sleep by increasing susceptibility to sleep disorders, including sleep disordered breathing, periodic limb movements, and REM behavior disorder. In this review, we will discuss these systems representing a multifactorial etiology in PD sleep disturbance.
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Affiliation(s)
- J Andrew Albers
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St Louis, MO 63104 United States; Department of Psychology, Saint Louis University College of Arts and Sciences, Morrissey Hall, 3700 Lindell Blvd, St Louis, MO 63108 United States.
| | - Pratap Chand
- Saint Louis University School of Medicine, 1402 South Grand Blvd, St Louis, MO 63104 United States; Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Monteleone Hall, 1438 South Grand Blvd, St Louis, MO 63104 United States
| | - A Michael Anch
- Department of Psychology, Saint Louis University College of Arts and Sciences, Morrissey Hall, 3700 Lindell Blvd, St Louis, MO 63108 United States
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20
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Baumann-Vogel H, Imbach LL, Sürücü O, Stieglitz L, Waldvogel D, Baumann CR, Werth E. The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients. Sleep 2017; 40:3079010. [DOI: 10.1093/sleep/zsx033] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 11/12/2022] Open
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21
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Loddo G, Calandra-Buonaura G, Sambati L, Giannini G, Cecere A, Cortelli P, Provini F. The Treatment of Sleep Disorders in Parkinson's Disease: From Research to Clinical Practice. Front Neurol 2017; 8:42. [PMID: 28261151 PMCID: PMC5311042 DOI: 10.3389/fneur.2017.00042] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 01/30/2017] [Indexed: 12/29/2022] Open
Abstract
Sleep disorders (SDs) are one of the most frequent non-motor symptoms of Parkinson’s disease (PD), usually increasing in frequency over the course of the disease and disability progression. SDs include nocturnal and diurnal manifestations such as insomnia, REM sleep behavior disorder, and excessive daytime sleepiness. The causes of SDs in PD are numerous, including the neurodegeneration process itself, which can disrupt the networks regulating the sleep–wake cycle and deplete a large number of cerebral amines possibly playing a role in the initiation and maintenance of sleep. Despite the significant prevalence of SDs in PD patients, few clinical trials on SDs treatment have been conducted. Our aim is to critically review the principal therapeutic options for the most common SDs in PD. The appropriate diagnosis and treatment of SDs in PD can lead to the consolidation of nocturnal sleep, the enhancement of daytime alertness, and the amelioration of the quality of life of the patients.
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Affiliation(s)
- Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences, University of Bologna , Bologna , Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Luisa Sambati
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Annagrazia Cecere
- Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna , Bologna , Italy
| | - Pietro Cortelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Bellaria Hospital, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
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22
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Kurtis MM, Rajah T, Delgado LF, Dafsari HS. The effect of deep brain stimulation on the non-motor symptoms of Parkinson's disease: a critical review of the current evidence. NPJ Parkinsons Dis 2017; 3:16024. [PMID: 28725706 PMCID: PMC5516616 DOI: 10.1038/npjparkd.2016.24] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/15/2016] [Accepted: 09/26/2016] [Indexed: 12/31/2022] Open
Abstract
The benefit of deep brain stimulation (DBS) in controlling the motor symptoms of Parkinson's disease is well established, however, the impact on the non-motor symptoms (NMS) remains to be elucidated, although the growing investigative efforts are promising. This article reviews the reported data and considers the level of evidence available with regard to the effect of DBS on NMS total burden and on the cognitive, neuropsychiatric, sleep, pain, dysautonomic, and weight domains. Multiple case series suggest that DBS improves the burden of NMS by reducing prevalence, intensity, and non-motor fluctuations. There is level I evidence on the effect of DBS on cognition and mood. Slight cognitive decline has been reported in most class I studies, although the functional effect is probably minimal. Two randomized prospective studies reported no change in depression while improvement of anxiety has been reported by a class I trial. Prospective cohort studies point to improvement of hyperdopaminergic behaviors, such as impulse control disorders, while others report that hypodopaminergic states, like apathy, can appear after DBS. There is only class III evidence supporting the benefit of DBS on other NMS such as nocturnal sleep, pain, dysautonomia (urinary, gastrointestinal, cardiovascular, and sweating), and weight loss. Although preliminary results are promising, randomized prospectively controlled trials with NMS as primary end points are necessary to further explore the effect of DBS on these often invalidating symptoms and offer conclusions about efficacy.
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Affiliation(s)
- Mónica M Kurtis
- Movement Disorders Unit, Neurology Department, Hospital Ruber Internacional, Madrid, Spain
| | - Thadshani Rajah
- Kings Parkinson's Centre of Excellence, Kings College and Kings College Hospital, London, UK
| | - Luisa F Delgado
- Fundación Universitaria de Ciencias de la Salud, Hospital San José—Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Haidar S Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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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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Wang XH, Zhang L, Sperry L, Olichney J, Farias ST, Shahlaie K, Chang NM, Liu Y, Wang SP, Wang C. Target Selection Recommendations Based on Impact of Deep Brain Stimulation Surgeries on Nonmotor Symptoms of Parkinson's Disease. Chin Med J (Engl) 2016; 128:3371-80. [PMID: 26668154 PMCID: PMC4797515 DOI: 10.4103/0366-6999.171464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD). DATA SOURCES We retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus. STUDY SELECTION We included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS. RESULTS In general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain. CONCLUSIONS As the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients.
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Affiliation(s)
- Xiao-Hong Wang
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, Liaoning 116033, China
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Ostrem JL, San Luciano M, Dodenhoff KA, Ziman N, Markun LC, Racine CA, de Hemptinne C, Volz MM, Heath SL, Starr PA. Subthalamic nucleus deep brain stimulation in isolated dystonia: A 3-year follow-up study. Neurology 2016; 88:25-35. [PMID: 27903810 DOI: 10.1212/wnl.0000000000003451] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report long-term safety and efficacy outcomes of a large cohort of patients with medically refractory isolated dystonia treated with subthalamic nucleus (STN) deep brain stimulation (DBS). METHODS Twenty patients (12 male, 8 female; mean age 49 ± 16.3 years) with medically refractory isolated dystonia were studied (14 were followed for 36 months). The primary endpoints were change in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor score and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score at 36 months compared to preoperative baseline. Multiple secondary outcomes were also assessed (ClinicalTrials.gov NCT00773604). RESULTS Eighteen of 20 patients showed improvement 12 months after STN DBS with sustained benefit persisting for 3 years (n = 14). At 36 months, BFMDRS motor scores improved 70.4% from a mean 17.9 ± 8.5 to 5.3 ± 5.6 (p = 0.0002) and total TWSTRS scores improved 66.6% from a mean 41.0 ± 18.9 to 13.7 ± 17.9 (p = 0.0002). Improvement at 36 months was equivalent to that seen at 6 months. Disability and quality of life measures were also improved. Three hardware-related and 24 stimulation-related nonserious adverse events occurred between years 1 and 3 (including 4 patients with dyskinesia). CONCLUSIONS This study offers support for long-term tolerability and sustained effectiveness of STN DBS in the treatment of severe forms of isolated dystonia. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that STN DBS decreases long-term dystonia severity in patients with medically refractory isolated dystonia.
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Affiliation(s)
- Jill L Ostrem
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
| | - Marta San Luciano
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Kristen A Dodenhoff
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Nathan Ziman
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Leslie C Markun
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Caroline A Racine
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Coralie de Hemptinne
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Monica M Volz
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Susan L Heath
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
| | - Philip A Starr
- From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA
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Deep brain stimulation and sleep-wake functions in Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2016; 32:12-19. [PMID: 27605426 DOI: 10.1016/j.parkreldis.2016.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 01/27/2023]
Abstract
Sleep-wake disturbances (SWD) are common nonmotor symptoms (NMS) and have a great impact on quality of life of patients with Parkinson's disease (PD). Deep brain stimulation (DBS) is an established treatment in PD. While the beneficial effects of DBS on cardinal PD motor symptoms are indisputable, the data for several NMS, including sleep-wake functions, are limited and often controversial. Our primary objective was to review the literature on the impact of DBS on sleep-wake functions in patients with PD. A systematic review of articles, published in PubMed between January 1st, 2000 and December 31st, 2015 was performed to identify studies addressing the evolution of sleep-wake functions after DBS in patients with PD. Only 38 of 208 studies, involving a total of 1443 subjects, met the inclusion criteria. Most of them reported a positive effect of subthalamic DBS on sleep quality and consequently on quality of life. Seven studies used polysomnography to objectively assess sleep parameters. The data concerning subthalamic DBS and wake functions are controversial and studies using objective, laboratory-based measures for the assessment of wake functions are lacking. Very few studies assessed the impact of other DBS targets (e.g. pallidal stimulation) on SWD. Further prospective observational DBS studies assessing subjectively and objectively specific sleep-wake parameters in patients with PD are needed.
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Deli G, Aschermann Z, Ács P, Bosnyák E, Janszky J, Faludi B, Makkos A, Kovács M, Komoly S, Balás I, Dóczi T, Kovács N. Bilateral Subthalamic Stimulation can Improve Sleep Quality in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2016; 5:361-8. [PMID: 25757828 DOI: 10.3233/jpd-150540] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sleep problems are among the most common non-motor symptoms of Parkinson's disease (PD). The PD Sleep Scale 2nd version (PDSS-2) improved the original PDSS by adding more items on different aspects of sleep problems, making it a more robust tool to evaluate the severity of sleep disturbances. However, previous studies on deep brain stimulation (DBS) have not used the PDSS-2. OBJECTIVE To determine if the PDSS-2 could detect improvement reliably in sleep problems after bilateral subthalamic nucleus DBS for PD. METHODS In this prospective study, 25 consecutive patients undergoing DBS implantation were enrolled. Patients were examined twice: 1 week prior to the DBS implantation (baseline) and 12 months postoperatively. Severity of PD symptoms were assessed by the Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Presence and severity of sleep disturbances were specifically measured by PDSS-2. RESULTS Total score of MDS-UPDRS improved from 81 (median, interquartile-range: 63-103) to 55 points (median, IQR: 46-75, p < 0.001). Health-related quality of life, measured by PDQ-39, also improved from 29 (IQR: 18-40) to 15 (IQR: 9-28) points (p = 0.002). Most domains of NMSS also improved. At baseline 13 patients reported sleep problems, but 1 year after DBS implantation only 3 did (p = 0.012). Although only 6 out of 15 items showed a significant decrease after DBS implantation, the total score of PDSS-2 decreased from 24 (IQR: 17-32) to 10 (IQR: 7-18) points (P < 0.001). CONCLUSIONS Based on our results, PDSS-2 can detect improvements in sleep quality reliably after DBS implantation.
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Affiliation(s)
- Gabriella Deli
- Doctoral School of Clinical Neuroscience, University of Pécs, Pécs, Hungary.,Department of Neurology, University of Pécs, Pécs, Hungary
| | | | - Péter Ács
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Edit Bosnyák
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - József Janszky
- Department of Neurology, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Béla Faludi
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Attila Makkos
- Doctoral School of Clinical Neuroscience, University of Pécs, Pécs, Hungary
| | - Márton Kovács
- Doctoral School of Clinical Neuroscience, University of Pécs, Pécs, Hungary
| | - Sámuel Komoly
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - István Balás
- Department of Neurosurgery, University of Pécs, Pécs, Hungary
| | - Tamás Dóczi
- MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.,Department of Neurosurgery, University of Pécs, Pécs, Hungary
| | - Norbert Kovács
- Department of Neurology, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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Tolleson CM, Bagai K, Walters AS, Davis TL. A Pilot Study Assessing the Effects of Pallidal Deep Brain Stimulation on Sleep Quality and Polysomnography in Parkinson's Patients. Neuromodulation 2016; 19:724-730. [PMID: 27186939 DOI: 10.1111/ner.12442] [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: 11/16/2015] [Revised: 02/19/2016] [Accepted: 03/16/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Deep Brain Stimulation (DBS) is an established adjunctive surgical intervention to treat poorly controlled motor symptoms in Parkinson's disease (PD). Both surgical targets (the subthalamic nucleus and globus pallidus) have proven equally efficacious in treating motor symptoms but unique differences may exist in effects on nonmotor symptoms. Sleep dysfunction, a common disabling symptom in PD, has only been examined directly in the subthalamic target, demonstrating some beneficial changes in sleep quality. We aimed to explore sleep changes after pallidal stimulation; hypothesizing similar benefits would be seen. METHODS We performed a prospective nonblinded clinical trial evaluating sleep in five PD patients already slated for pallidal DBS pre and six months postimplantation using validated sleep surveys and polysomnograms (PSGs). Surveys included the Epworth sleepiness scale, PD sleep scale, Insomnia severity index (ISI), and RLS severity scale. RESULTS Most patients had notable improvements in sleep quality as measured by PSG metrics such as sleep efficiency and latency to sleep but they did not reach statistical significance. Most surveys reflected an improvement as well with the ISI scale showing the most promising trend post pallidal DBS (14.4 ± 7.02 vs. 9.0 ± 2.55; p = 0.07). CONCLUSION In this small pilot trial, pallidal DBS failed to demonstrate statistically significant improvements in sleep metrics postimplantation but did reveal improving trends in several PSG measures including sleep efficiency and latency to sleep onset as well as sleep survey scores. A larger, blinded clinical trial is needed to more definitively determine whether pallidal DBS may benefit sleep.
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Affiliation(s)
- Christopher M Tolleson
- Department of Neurology, Movement Disorders Division, Vanderbilt University, Nashville, TN, USA.
| | - Kanika Bagai
- Department of Neurology, Sleep Division, Vanderbilt University, Nashville, TN, USA
| | - Arthur S Walters
- Department of Neurology, Sleep Division, Vanderbilt University, Nashville, TN, USA
| | - Thomas L Davis
- Department of Neurology, Movement Disorders Division, Vanderbilt University, Nashville, TN, USA
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Wichmann T, DeLong MR. Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality? Neurotherapeutics 2016; 13:264-83. [PMID: 26956115 PMCID: PMC4824026 DOI: 10.1007/s13311-016-0426-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Deep brain stimulation (DBS) is highly effective for both hypo- and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal ganglia-thalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.
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Affiliation(s)
- Thomas Wichmann
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Zhou H, Shen C, Chen J, Qian H, Zheng Y, Liu Y, Xian W, Pei Z, Chen L. Tremor and clinical fluctuation are related to sleep disorders in Chinese patients with Parkinson's disease. Transl Neurodegener 2014; 3:21. [PMID: 25349692 PMCID: PMC4209517 DOI: 10.1186/2047-9158-3-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/18/2014] [Indexed: 01/09/2023] Open
Abstract
Objective To study the relationship between sleep disturbances and symptoms in patients with Parkinson’s disease (PD). Methods The Parkinson’s Disease Sleep Scale-Chinese Version (PDSS-CV) was used to evaluate the sleep disturbances of PD patients in a cross sectional study. The Unified Parkinson’s Disease Rating Scale (UPDRS) parts II-IV, and the Hoehn & Yahr (H&Y) stage were used to determine the level of motor function in PD and the severity of PD. The Spearman correlation and a multiple regression analysis were used to identify the relationship between sleep disturbances and symptoms of PD. The quantities derived from the UPDRS and the H&Y stage and disease duration were compared between groups of patients either with or without sleep disturbances identified by the PDSS. This study was conducted from December 2011 to March 2012 at the First Affiliated Hospital of Sun Yat-sen University, in Guangzhou. Results A total of 136 PD patients were included in this study. The overall total PDSS score in PD patients was 107.58 ± 23.35 points (range: 30–146). There were significant differences in the disease duration, the H&Y stage, and the UPDRS section subscores between groups of patients either with or without sleep disturbances (Kruskal-Wallis Test, p <0.05). There were significant negative correlations between PDSS scores and the UPDRS subscores, the H&Y stage and the disease duration (Spearman correlation, p < 0.05). The multiple regression analysis indicated that sleep disturbances identified by the PDSS were only associated with daily life activity, tremor intensity and clinical fluctuation (R2 = 0.22, F(3,132) = 12.4, p < 0.001). The correlations were also significant when the contribution of the other two factors was excluded using partial correlations. Conclusions The level of daily life activity and the occurrences of tremor and clinical fluctuation are likely to be important factors that lead to PD patients’ sleep disturbances. This study may elucidate an important clue for the relationship between sleep disturbances and PD symptoms.
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Affiliation(s)
- Hongyan Zhou
- Department of Neurological Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Cunzhou Shen
- Department of Neurological Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Chen
- Department of Internal Medicine, Nansha central Hospital, Guangzhou 511457, China
| | - Hao Qian
- Department of Neurology, The Second Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510300, China
| | - Yifan Zheng
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Yanmei Liu
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Wenbiao Xian
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Zhong Pei
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, NO. 58 Zhongshan Road 2, Guangzhou 510080, China
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Abstract
PURPOSE OF REVIEW Sleep and cluster headache (CH) are believed to be interconnected but the precise relation to the other trigeminal autonomic cephalalgias (TACs) is uncertain and complex. A better understanding of these relations may eventually lead to a clarification of the underlying mechanisms and eventually to more effective therapeutic regimens. This review aims to evaluate the existing literature on the subject of TACs and sleep. An association between episodic CH and distinct macrostructural sleep phases, especially the relation to rapid eye movement (REM) sleep, has been described in some older studies but could not be confirmed in other, more recent studies. Investigations into the microstructure of sleep in these patients are lacking. Only a few case reports exist on the relation between sleep and other TACs. SUMMARY Recent studies do not find an association between CH and REM sleep. One older study suggests chronic paroxysmal hemicranias may be locked to REM sleep but otherwise the relation is unknown. Reports indicate that CH and obstructive sleep apnoea are associated in some individuals but results are diverging. Single cases show improvement of CH upon treatment of sleep apnoea, but the causal relationship remains in question. Other TACs are probably not connected to sleep and strictly nocturnal attacks should prompt investigations for secondary causes. The relation between CH and sleep is, however, fascinating and detailed sleep studies in carefully diagnosed patients are warranted.
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Affiliation(s)
| | - N Lund
- Danish Headache Center, Denmark
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Kutscher SJ, Farshidpanah S, Claassen DO. Sleep dysfunction and its management in Parkinson's disease. Curr Treat Options Neurol 2014; 16:304. [PMID: 24930678 DOI: 10.1007/s11940-014-0304-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT Sleep disorders are among the most common non-motor symptoms in Parkinson's Disease (PD). In some cases, symptoms can precede a diagnosis of PD by many years, but otherwise they are commonly encountered during the clinical care of patients. Unfortunately, sleep problems are under-recognized and subsequently inadequately addressed. In our experience, when properly addressed, physicians and patients are quickly aware of the often-debilitating nature of sleep dysfunction. This does not mean that solutions are easily attainable. Sleep in PD is held in a delicate balance, influenced by the disease process, medications, co-morbid symptoms, and a variety of other factors. For this reason, management of sleep in PD often requires an inter-disciplinary approach. Physicians should have an intimate knowledge of the many sleep problems apparent in PD, as well as appreciate the challenge presented by diverse therapeutic options that can both ameliorate and aggravate symptoms.
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Affiliation(s)
- Scott J Kutscher
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN, 37232, USA,
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Schjerling L, Hjermind LE, Jespersen B, Madsen FF, Brennum J, Jensen SR, Løkkegaard A, Karlsborg M. A randomized double-blind crossover trial comparing subthalamic and pallidal deep brain stimulation for dystonia. J Neurosurg 2013; 119:1537-45. [DOI: 10.3171/2013.8.jns13844] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors' aim was to compare the subthalamic nucleus (STN) with the globus pallidus internus (GPi) as a stimulation target for deep brain stimulation (DBS) for medically refractory dystonia.
Methods
In a prospective double-blind crossover study, electrodes were bilaterally implanted in the STN and GPi of 12 patients with focal, multifocal, or generalized dystonia. Each patient was randomly selected to undergo initial bilateral stimulation of either the STN or the GPi for 6 months, followed by bilateral stimulation of the other nucleus for another 6 months. Preoperative and postoperative ratings were assessed by using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and video recordings. Quality of life was evaluated by using questionnaires (36-item Short Form Health Survey). Supplemental Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were assessed for patients with focal dystonia (torticollis) by examining the video recordings.
Results
On average for all patients, DBS improved the BFMDRS movement scores (p < 0.05) and quality of life physical scores (p < 0.01). After stimulation of the STN, the mean 6-month improvement in BFMDRS movement score was 13.8 points; after stimulation of the GPi, this improvement was 9.1 points (p = 0.08). Quality of life did not differ significantly regardless of which nucleus was stimulated. All 12 patients accepted 6 months of stimulation of the STN, but only 7 accepted 6 months of stimulation of the GPi. Among those who rejected stimulation of the GPi, 3 accepted concomitant stimulation of both the STN and GPi for 6 months, resulting in improved quality of life physical and mental scores and BFMDRS movement scores. Among the 4 patients who were rated according to TWSTRS, after 6 months of stimulation of both the STN and GPi, TWSTRS scores improved by 4.7% after stimulation of the GPi and 50.8% after stimulation of the STN (p = 0.08).
Conclusions
The STN seems to be a well-accepted, safe, and promising stimulation target in the treatment of dystonia, but further studies are necessary before the optimal target can be concluded. Simultaneous stimulation of the STN and GPi should be further investigated. Clinical trial registration no.: KF 01-110/01 (Committees on Biomedical Research Ethics of the Capital Region of Denmark).
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Affiliation(s)
- Lisbeth Schjerling
- 1Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital
- 2Department of Emergency, Hilleroed Hospital, Copenhagen University Hospital
| | - Lena E. Hjermind
- 3Section of Neurogenetics, Memory Disorders Research Group, Department of Neurology, Rigshospitalet, Copenhagen University Hospital
- 4Department of Cellular and Molecular Medicine, Section of Neurogenetics, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Jespersen
- 1Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital
| | - Flemming F. Madsen
- 1Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital
| | - Jannick Brennum
- 1Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital
| | - Steen R. Jensen
- 5Department of Neurology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark; and
| | - Annemette Løkkegaard
- 5Department of Neurology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark; and
| | - Merete Karlsborg
- 5Department of Neurology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark; and
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Ferreira JJ, Katzenschlager R, Bloem BR, Bonuccelli U, Burn D, Deuschl G, Dietrichs E, Fabbrini G, Friedman A, Kanovsky P, Kostic V, Nieuwboer A, Odin P, Poewe W, Rascol O, Sampaio C, Schüpbach M, Tolosa E, Trenkwalder C, Schapira A, Berardelli A, Oertel WH. Summary of the recommendations of the EFNS/MDS-ES review on therapeutic management of Parkinson's disease. Eur J Neurol 2013; 20:5-15. [PMID: 23279439 DOI: 10.1111/j.1468-1331.2012.03866.x] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 08/06/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To summarize the 2010 EFNS/MDS-ES evidence-based treatment recommendations for the management of Parkinson's disease (PD). This summary includes the treatment recommendations for early and late PD. METHODS For the 2010 publication, a literature search was undertaken for articles published up to September 2009. For this summary, an additional literature search was undertaken up to December 2010. Classification of scientific evidence and the rating of recommendations were made according to the EFNS guidance. In cases where there was insufficient scientific evidence, a consensus statement ('good practice point') is made. RESULTS AND CONCLUSIONS For each clinical indication, a list of therapeutic interventions is provided, including classification of evidence.
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Affiliation(s)
- J J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics and Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Abstract
Deep brain stimulation is one of the most effective treatments of Parkinson's disease (PD). This report summarizes the state of the art as at January 2013. Stimulation of the subthalamic nucleus is the most commonly used approach. It improves the core motor symptoms better than medication in patients with advanced disease. It also improves the majority of nonmotor symptoms, such as mood, impulse control disorders, sleep, and some autonomic dysfunctions. Quality of life (QoL) is improved significantly more than with medication. Long-term data show that the treatment is effective for up to 10 years, but the late appearance of l-dopa-resistant symptoms is seemingly not influenced. Internal globus pallidus (GPi) stimulation is less well studied but seems to have similar short-term efficacy. Importantly l-dopa use cannot be reduced with GPi DBS, which is a major disadvantage for patients suffering from medication side-effects, although gait may be influenced more positively. Although short-term QoL improvement seems to be similar to that for subthalamic nucleus (STN) DBS - gait and speech may be better improved - long-term data are rare for GPi DBS. Thalamic stimulation in the ventral intermediate nucleus (VIM) is applied only in tremor-dominant elderly patients. The treatment improves the dopa-sensitive symptoms and effectively reduces fluctuations leading to an overall QoL improvement. Although most of the controlled studies have been on advanced PD, the recently published EARLYSTIM study suggests that even patients with a very short duration of their fluctuations and dyskinesia are doing significantly better with neurostimulation in terms of QoL and all major motor outcome parameters.
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Abstract
Proper selection of patients who will reliably benefit from deep brain stimulation (DBS) is critical to its success. This requires careful evaluation that should be delivered by an expert multidisciplinary team involving a movement disorder neurologist, a neurosurgeon, a neuropsychologist, and a psychiatrist. The most suitable candidates for DBS suffer from Parkinson's disease with motor fluctuations and/or dyskinesias that are not adequately controlled with optimized medical therapy, or with medication-refractory tremor. During the best on-motor periods, gait difficulties, instability, and speech problems should be minimal, reflecting an excellent response to levodopa in the ideal candidate. The cognitive, psychiatric, and behavioral status must be normal or minimally affected, with the exception of dopamine agonist drug-induced impulse control disorders, which are usually improved after successful surgery and drug withdrawal. Moreover, the patients have no serious comorbidities. Most patients corresponding to this profile suffer from a relatively young onset of Parkinson's disease, and are aged less than 70 years at the time of surgery. Indeed, most patients fall outside this ideal description, and the medical art is to appreciate for each patient the extent to which the alterations of these features can be accepted. Eventually, patients make their own decision from detailed information of their individualized risks and benefits of DBS. Patient expectations, cooperation, and familial support are also important considerations.
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Peppe A, Pierantozzi M, Baiamonte V, Moschella V, Caltagirone C, Stanzione P, Stefani A. Deep brain stimulation of pedunculopontine tegmental nucleus: role in sleep modulation in advanced Parkinson disease patients: one-year follow-up. Sleep 2012. [PMID: 23204606 DOI: 10.5665/sleep.2234] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVE Sleep disorders are frequent non-motor symptoms in Parkinson disease (PD), probably due to multifactorial pathogeneses including disease progression, dopaminergic drugs, or concomitant illness. In recent years, the pedunculopontine tegmental (PPTg) nucleus has been considered a surgical target for deep brain stimulation (DBS) in advanced PD patients. As it is involved in controlling the sleep-wake cycle, we investigated the long-lasting effects of PPTg-DBS on the sleep of five PD patients implanted in both the PPTg and the subthalamic nucleus (STN) by rating two subjective clinical scales for sleep: the Parkinson's Disease Sleep Scale (PDSS), and the Epworth Sleepiness Scale (ESS). STUDY DESIGN Sleep scales were administered a week before surgery (T0), three months after DBS (T1), and one year later (T2). In this study, STN-DBS was kept constantly in ON, and three different patterns of PPTg-DBS were investigated: STN-ON (PPTg switched off); PPTg-ON (PPTg stimulated 24 h/day); PPTg-cycle (PPTg stimulated only at night). RESULTS In post-surgery follow-up, PD patients reported a marked improvement of sleep quality in all DBS conditions. In particular, stimulation of the PPTg nucleus produced not only a remarkable long-term improvement of nighttime sleep, but unlike STN-DBS, also produced significant amelioration of daytime sleepiness. CONCLUSION Our study suggests that PPTg-DBS plays an important role in reorganizing regular sleep in PD patients.
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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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Treatment of motor and non-motor features of Parkinson's disease with deep brain stimulation. Lancet Neurol 2012; 11:429-42. [DOI: 10.1016/s1474-4422(12)70049-2] [Citation(s) in RCA: 266] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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40
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Barloese M, Jennum P, Knudsen S, Jensen R. Cluster headache and sleep, is there a connection? A review. Cephalalgia 2012; 32:481-91. [PMID: 22407656 DOI: 10.1177/0333102412441090] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE OF REVIEW Sleep and the chronobiological disease cluster headache are believed to be interconnected. Despite efforts, the precise nature of the relationship remains obscured. A better understanding of this relation may lead to more effective therapeutic regimes for patients suffering from this debilitating disease. This review aims to evaluate the existing literature on the subject of cluster headache and sleep. LATEST FINDINGS Several previous studies describe an association between episodic cluster headache and distinct macrostructural sleep phases. This association was not confirmed in a recent study of seven episodic cluster headache patients, but it was suggested that further studies into the correlation between cluster headache attacks and the microstructure of sleep are relevant. The connection between cluster headache and the hypocretins is currently under investigation. SUMMARY There is evidence in favour of an association between episodic cluster headache and REM sleep whereas no such relation to chronic cluster headache has been reported. Particular features in the microstructure of sleep and arousal mechanisms could play a role in the pathogenesis of cluster headache. Reports indicate that cluster headache and obstructive sleep apnoea are associated. Single cases show improvement upon treatment of sleep apnoea, but the causal relationship remains in question.
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41
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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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42
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Hwynn N, Ul Haq I, Malaty IA, Resnick AS, Dai Y, Foote KD, Fernandez HH, Wu SS, Oyama G, Jacobson CE, Kim SK, Okun MS. Effect of Deep Brain Stimulation on Parkinson's Nonmotor Symptoms following Unilateral DBS: A Pilot Study. PARKINSONS DISEASE 2011; 2011:507416. [PMID: 22220288 PMCID: PMC3246796 DOI: 10.4061/2011/507416] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/30/2011] [Indexed: 11/20/2022]
Abstract
Parkinson's disease (PD) management has traditionally focused largely on motor symptoms. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) are effective treatments for motor symptoms. Nonmotor symptoms (NMSs) may also profoundly affect the quality of life. The purpose of this pilot study was to evaluate NMS changes pre- and post-DBS utilizing two recently developed questionnaires. Methods. NMS-Q (questionnaire) and NMS-S (scale) were administered to PD patients before/after unilateral DBS (STN/GPi targets). Results. Ten PD patients (9 STN implants, 1 GPi implant) were included. The three most frequent NMS symptoms identified utilizing NMS-Q in pre-surgical patients were gastrointestinal (100%), sleep (100%), and urinary (90%). NMS sleep subscore significantly decreased (−1.6 points ± 1.8, P = 0.03). The three most frequent NMS symptoms identified in pre-surgical patients using NMS-S were gastrointestinal (90%), mood (80%), and cardiovascular (80%). The largest mean decrease of NMS scores was seen in miscellaneous symptoms (pain, anosmia, weight change, and sweating) (−7 points ± 8.7), and cardiovascular/falls (−1.9, P = 0.02). Conclusion. Non-motor symptoms improved on two separate questionnaires following unilateral DBS for PD. Future studies are needed to confirm these findings and determine their clinical significance as well as to examine the strengths/weaknesses of each questionnaire/scale.
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Affiliation(s)
- Nelson Hwynn
- Center for Movement Disorders & Neurorestoration, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Nazzaro JM, Lyons KE, Pahwa R, Ridings LW. The importance of testing deep brain stimulation lead impedances before final lead implantation. Surg Neurol Int 2011; 2:131. [PMID: 22059126 PMCID: PMC3205500 DOI: 10.4103/2152-7806.85473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 08/15/2011] [Indexed: 11/08/2022] Open
Abstract
Background: In the setting of a deep brain stimulation (DBS) lead with defective electrical circuitry, potential patient morbidity and additional surgery may be avoided if impedance testing of the brain lead is performed prior to final lead implantation. In the present report, detection of a short circuit upon lead placement and prior to lead anchoring was detected utilizing recently released DBS hardware and software (Medtronic, Minneapolis, MN). This report suggests that neurosurgeons need to be aware and consider the use of the newly available DBS testing equipment. Methods: During the first DBS lead placement in a 69-year-old man with advanced idiopathic Parkinson's disease undergoing bilateral subthalamic nucleus DBS over staged procedures, test stimulation and lead impedance testing were accomplished prior to lead anchoring. An external neurostimulator (ENS) was affixed to an updated clinician programmer and connected to the DBS lead with a screening cable specific for the ENS and DBS. Results: Impedance testing demonstrated a short circuit involving the 1 and 3 lead-electrode bipolar combination in a visually intact lead. The lead was replaced, repeat impedance testing and test stimulation were completed and the intact lead was secured. Subsequent DBS surgeries were completed uneventfully. The lead abnormality was verified by the manufacturer. Conclusions: This case highlights a new method to test DBS lead circuitry at the time of placement. The method may also be employed to directly test lead integrity when localizing a DBS system short or open circuit of unclear etiology. Our case suggests that the method is valuable and should be utilized.
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Affiliation(s)
- Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, KS, USA
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44
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Amara AW, Standaert DG, Guthrie S, Cutter G, Watts RL, Walker HC. Unilateral subthalamic nucleus deep brain stimulation improves sleep quality in Parkinson's disease. Parkinsonism Relat Disord 2011; 18:63-8. [PMID: 21924664 DOI: 10.1016/j.parkreldis.2011.09.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 07/31/2011] [Accepted: 09/01/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sleep disturbances are common in Parkinson's disease (PD). Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is superior to best medical therapy in the treatment of motor symptoms in advanced PD, and observational studies suggest that bilateral STN DBS improves sleep in these patients as well. Unilateral STN DBS also improves motor function in PD, but its effects on sleep have not been extensively investigated. METHODS We report the effects of unilateral STN DBS on subjective sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) in 53 consecutive PD patients. These subjects completed the PSQI prior to surgery and at 3 and 6 months post-operatively. The primary outcome measure was the change in the global PSQI at 6 months post-operatively versus the pre-operative baseline, measured with repeated measures analysis of variance (ANOVA). RESULTS Patients with PD who underwent unilateral STN DBS had a significant improvement in PSQI at 6 months post-operatively (baseline 9.30 ± 0.56 (mean ± SEM), 6 months: 7.93 ± 0.56, p = 0.013). Supplemental analyses showed that subjects selected for STN DBS placed on the right had worse baseline subjective sleep quality and more improvement in PSQI at 6 months compared to patients who received left STN DBS. CONCLUSION This prospective case series study provides evidence that unilateral STN DBS improves subjective sleep quality in patients with PD at up to 6 months post-operatively as measured by the PSQI.
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Affiliation(s)
- Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
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45
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The impact of bilateral subthalamic stimulation on non-motor symptoms of Parkinson’s disease. Parkinsonism Relat Disord 2011; 17:606-9. [DOI: 10.1016/j.parkreldis.2011.05.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/11/2011] [Accepted: 05/14/2011] [Indexed: 11/17/2022]
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Reich MM, Ray Chaudhuri K, Ashkan K, Hulse N, Costello A, Moriarty J, Samuel M. Changes in the non-motor symptom scale in Parkinson’s disease after deep brain stimulation. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.baga.2011.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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47
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Abstract
SUMMARY Parkinson’s disease (PD) patients demonstrate a variety of sleep/wake complaints. Some of these are associated with dopaminergic dysfunction, some presumed to arise from nondopaminergic PD pathology, some from PD treatments and, in some, the etiologies are multifactorial or unknown. Optimal management of sleep/wake problems requires a good understanding of sleep/wake principals in the PD population, as there are few controlled trials to dictate therapy. In this article, we review the main causes of sleep/wake disorders in PD patients, namely sleep fragmentation, excessive daytime sleepiness, restless legs syndrome, periodic limb movement of sleep, rapid eye movement sleep behavioral disorder and sleep apnea. Available therapies and management recommendations for each disorder are given particular emphasis.
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Affiliation(s)
- Raja Mehanna
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Amara AW, Watts RL, Walker HC. The effects of deep brain stimulation on sleep in Parkinson's disease. Ther Adv Neurol Disord 2011; 4:15-24. [PMID: 21339905 DOI: 10.1177/1756285610392446] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sleep dysfunction is a common nonmotor symptom experienced by patients with Parkinson's disease (PD). Symptoms, including excessive daytime sleepiness, sleep fragmentation, rapid eye movement (REM) sleep behavior disorder and others, can significantly affect quality of life and daytime functioning in these patients. Recent studies have evaluated the effects of deep brain stimulation (DBS) at various targets on sleep in patients with advanced PD. Several of these studies have provided evidence that subthalamic nucleus DBS improves subjective and objective measures of sleep, including sleep efficiency, nocturnal mobility, and wake after sleep onset (minutes spent awake after initial sleep onset). Although fewer studies have investigated the effects of bilateral internal globus pallidus and thalamic ventral intermedius DBS on sleep, pallidal stimulation does appear to improve subjective sleep quality. Stimulation of the pedunculopontine nucleus has recently been proposed for selected patients with advanced PD to treat severe gait and postural dysfunction. Owing to the role of the pedunculopontine nucleus in modulating behavioral state, the impact of stimulation at this target on sleep has also been evaluated in a small number of patients, showing that pedunculopontine nucleus DBS increases REM sleep. In this review, we discuss the effects of stimulation at these various targets on sleep in patients with PD. Studying the effects of DBS on sleep can enhance our understanding of the pathophysiology of sleep disorders, provide strategies for optimizing clinical benefit from DBS, and may eventually guide novel therapies for sleep dysfunction.
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Affiliation(s)
- Amy W Amara
- Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, SC 360, 1530 3rd Avenue South, Birmingham, AL 35294-0017, USA
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Nishida N, Murakami T, Kadoh K, Tohge R, Yamanegi M, Saiki H, Ueda K, Matsumoto S, Ishikawa M, Takahashi JA, Toda H. Subthalamic nucleus deep brain stimulation restores normal rapid eye movement sleep in Parkinson's disease. Mov Disord 2011; 26:2418-22. [PMID: 22109851 DOI: 10.1002/mds.23862] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 05/14/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND In Parkinson's disease, sleep disturbance is a common occurrence. METHODS We evaluated sleep in 10 patients with Parkinson's disease (age, 57.5 ± 9.8 years; disease duration, 12.3 ± 2.7 years) before and after subthalamic nucleus deep brain stimulation using the Parkinson's disease sleep scale and polysomnography. RESULTS Their total sleep scale scores and daytime sleepiness subscale scores significantly improved after subthalamic nucleus-deep brain stimulation. The novel findings from this study significantly increased normal rapid eye movement sleep, and decreased abnormal rapid eye movement sleep without atonia after deep brain stimulation in patients with Parkinson's disease. The improved total sleep scale score correlated with decreased wakefulness after sleep onset. Moreover, improved daytime sleepiness correlated with increased normal rapid eye movement sleep time. Sleep improvement did not significantly correlate with resolution of motor complication or reduced dopaminergic dosages. CONCLUSIONS Subthalamic nucleus-deep brain stimulation may have beneficial effects on sleep disturbance in advanced Parkinson's disease by restoring sleep architecture and normal rapid eye movement sleep.
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Affiliation(s)
- Namiko Nishida
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan
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Abstract
The realization that medications used to treat movement disorders and psychiatric conditions of basal ganglia origin have significant shortcomings, as well as advances in the understanding of the functional organization of the brain, has led to a renaissance in functional neurosurgery, and particularly the use of deep brain stimulation (DBS). Movement disorders are now routinely being treated with DBS of 'motor' portions of the basal ganglia output nuclei, specifically the subthalamic nucleus and the internal pallidal segment. These procedures are highly effective and generally safe. Use of DBS is also being explored in the treatment of neuropsychiatric disorders, with targeting of the 'limbic' basal ganglia-thalamocortical circuitry. The results of these procedures are also encouraging, but many unanswered questions remain in this emerging field. This review summarizes the scientific rationale and practical aspects of using DBS for neurologic and neuropsychiatric disorders.
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