Alternate Subthalamic Nucleus Deep Brain Stimulation Parameters to Manage Motor Symptoms of Parkinson's Disease: Systematic Review and Meta-analysis

ABSTRACT Deep brain stimulation (DBS) has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD). Recently, DBS in the subthalamic nucleus (STN) has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms. Objective: To evaluate the influence of DBS in the STN on cognition, mood and quality of life. Methods: We studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); and the Hospital Anxiety and Depression Scale (HAD), were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test. Results: A total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively). No significant difference was found on the cognitive battery or mood scale. Conclusion: DBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood.

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Syncope Associated with Subthalamic Nucleus Deep Brain Stimulation in a Patient with Parkinson’s Disease

Case Reports in Neurological Medicine ◽

10.1155/2013/371929 ◽

2013 ◽

Vol 2013 ◽

pp. 1-2

Author(s):

Dursun Aygun ◽

Ersoy Kocabicak ◽

Onur Yildiz ◽

Musa Kazim Onar ◽

Hatice Guz ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Early Period ◽

Motor Symptoms ◽

The Right ◽

Stn Dbs ◽

Deep Brain

In advanced Parkinson's disease (PD), deep brain stimulation (DBS) may be an alternative option for the treatment of motor symptoms. Side effects associated with subthalamic nucleus (STN) DBS in patients with PD are emerging as the most frequent sensory and motor symptoms. DBS-related syncope is reported as extremely rare. We wanted to discuss the mechanisms of syncope associated with STN DBS in a patient with Parkinson's disease.Case report.Sixty-three-year-old female patient is followed up with diagnosis of idiopathic Parkinson's disease for 6 years in our clinic. The patient has undergone STN DBS due to painful dystonia and drug resistant tremor. During the operation, when the left STN was stimulated at 5 milliampere (mAmp), the patient developed presyncopal symptoms. However, when the stimulation was stopped symptoms improved. During the early period after the operation, when the right STN was stimulated at 1.3 millivolts (mV), she developed the pre-yncopal symptoms and then syncope. Our case shows that STN DBS may lead to directly autonomic symptoms resulting in syncope during stimulation-on (stim-on).

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Deep Brain Stimulation Does Not Silence Neurons in Subthalamic Nucleus in Parkinson's Patients

Journal of Neurophysiology ◽

10.1152/jn.00363.2009 ◽

2010 ◽

Vol 103 (2) ◽

pp. 962-967 ◽

Cited By ~ 57

Author(s):

Jonathan D. Carlson ◽

Daniel R. Cleary ◽

Justin S. Cetas ◽

Mary M. Heinricher ◽

Kim J. Burchiel

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Basal Ganglia ◽

Firing Rate ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Animal Studies ◽

Stimulation Parameters ◽

Deep Brain

Two broad hypotheses have been advanced to explain the clinical efficacy of deep brain stimulation (DBS) in the subthalamic nucleus (STN) for treatment of Parkinson's disease. One is that stimulation inactivates STN neurons, producing a functional lesion. The other is that electrical stimulation activates the STN output, thus “jamming” pathological activity in basal ganglia-corticothalamic circuits. Evidence consistent with both concepts has been adduced from modeling and animal studies, as well as from recordings in patients. However, the stimulation parameters used in many recording studies have not been well matched to those used clinically. In this study, we recorded STN activity in patients with Parkinson's disease during stimulation delivered through a clinical DBS electrode using standard therapeutic stimulus parameters. A microelectrode was used to record the firing of a single STN neuron during DBS (3–5 V, 80–200 Hz, 90- to 200-μs pulses; 33 neurons/11 patients). Firing rate was unchanged during the stimulus trains, and the recorded neurons did not show prolonged (s) changes in firing rate on termination of the stimulation. However, a brief (∼1 ms), short-latency (6 ms) postpulse inhibition was seen in 10 of 14 neurons analyzed. A subset of neurons displayed altered firing patterns, with a predominant shift toward random firing. These data do not support the idea that DBS inactivates the STN and are instead more consistent with the hypothesis that this stimulation provides a null signal to basal ganglia-corticothalamic circuitry that has been altered as part of Parkinson's disease.

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Apathy Induced by Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A Meta‐Analysis

Movement Disorders ◽

10.1002/mds.28390 ◽

2020 ◽

Author(s):

Thomas J.C. Zoon ◽

Geeske Rooijen ◽

Georgina M.F.C. Balm ◽

Isidoor O. Bergfeld ◽

Joost G. Daams ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Meta Analysis ◽

Deep Brain

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Deep brain stimulation in the treatment of Parkinson’s disease

10.5327/1516-3180.444 ◽

2021 ◽

Author(s):

Bruna Alves Rocha ◽

Lucas Oliveira Braga ◽

Julia Beatriz Xavier do Nascimento ◽

Angela dos Santos Avakian

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Meta Analysis ◽

Postural Instability ◽

Motor Symptoms ◽

Subcortical Structures ◽

Pubmed Database ◽

Deep Brain

Introduction: Parkinson’s disease (PD) is neurodegenerative and has bradykinesia, rest tremor, stiffnes and postural instability. These changes come from the degeneration of dopaminergic neurons. The treatment, carried out based on levodopa, provides improvements in the condition of the patients, however, they provide side effects. Based on this, the Deep Brain Stimulation (DBS) technique - stimulation of subcortical structures with electrodes - is a good treatment option. Methods: A narrative review of the literature was carried out, using the PubMed database with the keywords “Deep brain stimulation”, “Therapeutic use” and “Parkinson’s disease”. Included articles of meta-analysis, systematic review and review published in the last year. Results: The DBS offers a significant improvement in motor symptoms, gait, postural instability, reduction in tremors and in their progression. However, DBS can offer risks to the patient. Comparing the effectiveness of DBS with other therapies for Parkinson’s, such as levodopa/ carbidopa intestinal infusion gel (LCIG) and best medical therapy (BMT), it was found that BMT is botton. The cost-effectiveness comparison of these techniques, showed that DBS is the most costly procedure. It stands out comparisons can have intrinsic biases, such as the conflict of interest with pharmaceutical companies. Conclusion: DBS is a beneficial intervention for patients with PD who have important motor symptoms. Performed only in cases with indication, due to the possibility of complications.

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