scholarly journals Coronavirus Disease 20 19 and Management of Advanced Therapies in Parkinson's Disease; Peculiar Needs for Deep Brain Stimulation Patients?

2020 ◽  
Vol 7 (7) ◽  
pp. 875-876
Author(s):  
Rocco Cerroni ◽  
Simona Scalise ◽  
Alessandro Stefani
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Advanced Therapies ◽  
Deep Brain

scholarly journals Combined subthalamic and nucleus basalis of Meynert deep brain stimulation for Parkinson’s disease with dementia (DEMPARK-DBS): protocol of a randomized, sham-controlled trial

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Christine Daniels ◽  
Frank Steigerwald ◽  
Philipp Capetian ◽  
Cordula Matthies ◽  
Uwe Malzahn ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Cognitive Decline ◽  
Brain Stimulation ◽  
Nucleus Basalis ◽  
Nucleus Basalis Of Meynert ◽  
Advanced Therapies ◽  
Stn Dbs ◽  
Deep Brain

Abstract Introduction Dementia in Parkinson’s disease (PDD) is a common non-motor symptom of advanced disease, associated with pronounced neocortical cholinergic deficits due to neurodegeneration of the nucleus basalis of Meynert (NBM) and its cholinergic terminals. In advanced PD, patients often require advanced therapies such as infusion therapy or deep brain stimulation (DBS) to improve motor control. However, patients with associated dementia are commonly excluded from DBS because of potential deterioration of cognitive functions. Yet marked reductions in dopaminergic medication and the subsequent risk of side effects (e.g., cognitive decline, psychosis, delirium) suggest that critical re-consideration of DBS of the subthalamic nucleus (STN-DBS) for advanced stages of PD and PDD is worthwhile. In this Phase 1b study, we will provide STN-DBS to a cohort of PDD patients with severe motor fluctuations and combine two additional electrodes for augmentative neurostimulation of the NBM. Methods We aim to include 12 patients with mild-to-moderately severe PDD who fulfill indication criteria regarding motor symptoms for STN-DBS. Eligible patients will undergo implantation of a neurostimulation system with bilateral electrodes in both the STN and NBM. After 12 weeks of STN-DBS (visit 1/V1), participants will be randomized to receive either effective neurostimulation of the NBM (group 1) or sham stimulation of the NBM (group 2). NBM-DBS will be activated in all participants after 24 weeks of blinded treatment (visit 2/V2). The primary outcome will be the safety of combined bilateral STN- and NBM-DBS, determined by spontaneously-reported adverse events. Other outcome measures will comprise changes on scales evaluating cognition, activities of daily living functioning and clinical global impression, as well as motor functions, mood, behavior, caregiver burden and health economic aspects, and several domain-specific cognitive tests. Changes in scores (V1 – V2) for both treatment arms will undergo analysis of covariances, with baseline scores as covariates. Perspective The feasibility and safety of combined STN-NBM-DBS in patients with PDD will be assessed to determine whether additional NBM-DBS improves or slows the progression of cognitive decline. Positive results would provide a basic concept for future studies evaluating the efficacy of NBM-DBS in larger PDD cohorts. Indirectly, proof-of-safety of STN-DBS in PDD might influence patient selection for this standard treatment option in advanced PD. Trial registration ClinicalTrials.gov identifier (NCT number): NCT02589925.

scholarly journals Estimulación cerebral profunda para la enfermedad de Parkinson: criterios de selección, abordaje quirúrgico, efectos secundarios y controversias.

2021 ◽  
Vol 32 (2) ◽  
Author(s):  
Roberto Leal Ortega
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Pulse Generator ◽  
Selection Process ◽  
Cell Physiology ◽  
Advanced Therapies ◽  
Ablative Surgery ◽  
Deep Brain

La enfermedad de Parkinson (EP) es la segunda enfermedad neurodegenerativa más frecuente. Afecta a 6 millones de personas en el mundo y esta cifra incrementará en los próximos años. El manejo consiste en la combinación de fármacos, fisioterapia y terapias avanzadas que incluyen dispositivos de uso parenteral (bombas de apomorfina y levodopa intestinal), cirugía ablativa y cirugía funcional. La estimulación cerebral profunda (ECP) consiste en la aplicación de estímulos eléctricos a través de electrodos implantados en núcleos profundos del cerebro que van conectados a un generador de impulsos (“marcapasos cerebral”); es una técnica aprobada mundialmente con más de 150 000 pacientes intervenidos. La cirugía puede controlar los síntomas motores (y algunos no motores) que han fallado al control por el tratamiento médico. En general, un candidato a ECP es aquel que tiene EP durante al menos 5 años, buena respuesta a la levodopa, complicaciones motoras por el tratamiento y perfil cognitivo-psiquiátrico adecuado. Durante el procedimiento el neurocirujano dirige por medio de estereotaxia los electrodos al núcleo seleccionado mientras el neurólogo monitorea la fisiología celular para que queden implantados en el sitio exacto. Existen complicaciones significativas, pero prevenibles y tratables, durante el procedimiento y en el postoperatorio. En el año 2016 nuestro equipo realizó con éxito la primera cirugía de ECP en Mérida, Yucatán. El objetivo de este trabajo es realizar una revisión descriptiva del proceso de selección, el procedimiento quirúrgico, los efectos secundarios y las controversias de esta técnica.  Palabras clave: enfermedad de Parkinson, estimulación cerebral profunda, núcleo subtalámico, globo pálido interno.Abstract Parkinson’s disease (PD) is the second most common neurodegenerative disease. It affects 6 million people worldwide and this amount will increase in the upcoming years. Management consists of a combination of drugs, physical therapy, and advanced therapies that include devices for parenteral use (apomorphine pumps and intestinal levodopa), ablative surgery, and functional surgery. Deep brain stimulation (DBS) is a modality in which electrical stimuli is delivered through electrodes implanted in deep nuclei of the brain that are connected to a pulse generator (“brain pacemaker”); it is a technique used worldwide with more than 150 000 operated patients. This procedure can control motor (and some non-motor) symptoms that have been failed to control by medical treatment. Briefly, a good candidate for DBS is one who has had PD for at least 5 years, a good response to levodopa, motor complications from treatment, and an adequate cognitive-psychiatric profile. During the procedure, the neurosurgeon uses stereotactic coordinates to direct the electrodes to the selected nucleus while the neurologist monitors cell physiology so they can be placed in the exact site. There are significant but preventable and treatable complications during the procedure and postoperatively. In 2016, our team performed the first surgery of this type in Mérida, Yucatán with successful results. The aim of this paper is to do a descriptive review of the selection process, the surgical intervention, complications, and the controversies on the use of DBS for PD.Key words: Parkinson’s disease, deep brain stimulation, subthalamic nucleus, globus pallidus interna.

Deep brain stimulation for Parkinson’s disease in Pakistan: current status, opportunities and challenges

2020 ◽  
pp. 1-18
Author(s):  
Nabeel Muzaffar Syed ◽  
John Bertoni ◽  
Danish Ejaz Bhatti
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Selection Process ◽  
Current Status ◽  
Effective Control ◽  
Advanced Therapies ◽  
Excellent Control ◽  
Deep Brain

Abstract Parkinson’s disease is a slowly progressive neurodegenerative disease that commonly affects people aged 60 years and above. So far, no treatment has been shown to halt or slow the progression of the disease and our options are limited to symptomatic management. Levodopa is the most preferred antiparkinsonian medication that provides excellent control of symptoms early in the disease. However, in most patients the response declines over time and complications of motor fluctuations and dyskinesia arise. Other medical therapies play an adjunctive role in the management, as they are not as effective as levodopa. Advanced therapies like deep brain stimulation (DBS) can provide effective control of symptoms in moderate to advanced disease. Deep brain stimulation surgery has recently been started in Pakistan. This review provides an overview of deep brain stimulation, its indications, patient selection process and details of surgery, Continuous......  

Changes in thalamic blood flow caused by subthalamic deep brain stimulation in Parkinson's disease

2005 ◽  
Vol 25 (1_suppl) ◽  
pp. S333-S333
Author(s):  
Kenichi Yamamoto ◽  
Atsushi Umemura ◽  
Kazuo Yamada
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Blood Flow ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Deep Brain

Influence of deep brain stimulation and levodopa on signs and symptoms in Parkinson's disease

2009 ◽  
Vol 36 (S 02) ◽  
Author(s):  
J Gierthmühlen ◽  
P Arning ◽  
G Wasner ◽  
A Binder ◽  
J Herzog ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Signs And Symptoms ◽  
Deep Brain

Fear and Depression as Side Effect of Deep Brain Stimulation of the Subthalmic Nucleus in Parkinson's Disease

2004 ◽  
Vol 35 (03) ◽  
Author(s):  
M Sabolek ◽  
I Uttner ◽  
K Seitz ◽  
A Storch
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Side Effect ◽  
Deep Brain ◽  
Stimulation Of

The effects of subthalamic nucleus deep brain stimulation on precision grip abnormalities in Parkinson's disease

2005 ◽  
Vol 32 (S 4) ◽  
Author(s):  
S Fellows ◽  
M Kronenbürger ◽  
N Allert ◽  
C Fromm ◽  
J Noth ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Precision Grip ◽  
Deep Brain
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