Resting state functional MRI in Parkinson’s disease: the impact of deep brain stimulation on ‘effective’ connectivity

: Sleep-wake disturbances (SWD) are one of the most common non-motor symptoms in Parkinson's disease (PD) and can appear in the early stage even before the onset of motor symptoms. Deep brain stimulation (DBS) is an established treatment for the motor symptoms in patients with advanced PD. However, the effect of DBS on SWD and its specific mechanisms are not widely understood and remain controversial. In addition to the circuit-mediated direct effect, DBS may improve SWD by an indirect effect such as the resolution of nocturnal motor complications and a reduction of dopaminergic medication. Here, the authors review the recent literatures regarding the impact of DBS on SWD in patients with PD. Furthermore, the selection of the DBS targets and the specific effects of applying DBS to each target on SWD in PD are also discussed.

Download Full-text

An Update of the Impact of Deep Brain Stimulation on Non Motor Symptoms in Parkinson's Disease

Journal of Parkinson s Disease ◽

10.3233/jpd-130273 ◽

2014 ◽

Vol 4 (2) ◽

pp. 289-300 ◽

Cited By ~ 16

Author(s):

Lisa Klingelhoefer ◽

Michael Samuel ◽

K. Ray Chaudhuri ◽

Keyoumars Ashkan

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Motor Symptoms ◽

The Impact ◽

Non Motor Symptoms ◽

Deep Brain

Download Full-text

Differential effects of deep brain stimulation and levodopa on brain activity in Parkinson’s disease

Brain Communications ◽

10.1093/braincomms/fcaa005 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Karsten Mueller ◽

Dušan Urgošík ◽

Tommaso Ballarini ◽

Štefan Holiga ◽

Harald E Möller ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Functional Mri ◽

Brain Stimulation ◽

Significant Interaction ◽

Brain Activity ◽

Finger Tapping ◽

Levodopa Treatment ◽

Deep Brain

Abstract Levodopa is the first-line treatment for Parkinson’s disease, although the precise mechanisms mediating its efficacy remain elusive. We aimed to elucidate treatment effects of levodopa on brain activity during the execution of fine movements and to compare them with deep brain stimulation of the subthalamic nuclei. We studied 32 patients with Parkinson’s disease using functional MRI during the execution of finger-tapping task, alternating epochs of movement and rest. The task was performed after withdrawal and administration of a single levodopa dose. A subgroup of patients (n = 18) repeated the experiment after electrode implantation with stimulator on and off. Investigating levodopa treatment, we found a significant interaction between both factors of treatment state (off, on) and experimental task (finger tapping, rest) in bilateral putamen, but not in other motor regions. Specifically, during the off state of levodopa medication, activity in the putamen at rest was higher than during tapping. This represents an aberrant activity pattern probably indicating the derangement of basal ganglia network activity due to the lack of dopaminergic input. Levodopa medication reverted this pattern, so that putaminal activity during finger tapping was higher than during rest, as previously described in healthy controls. Within-group comparison with deep brain stimulation underlines the specificity of our findings with levodopa treatment. Indeed, a significant interaction was observed between treatment approach (levodopa, deep brain stimulation) and treatment state (off, on) in bilateral putamen. Our functional MRI study compared for the first time the differential effects of levodopa treatment and deep brain stimulation on brain motor activity. We showed modulatory effects of levodopa on brain activity of the putamen during finger movement execution, which were not observed with deep brain stimulation.

Download Full-text

The impact of subthalamic deep brain stimulation on sleep and other non-motor symptoms in Parkinson's disease

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2019.04.001 ◽

2019 ◽

Vol 64 ◽

pp. 138-144 ◽

Cited By ~ 7

Author(s):

Jarosław Dulski ◽

Michał Schinwelski ◽

Agnieszka Konkel ◽

Karol Grabowski ◽

Witold Libionka ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Motor Symptoms ◽

The Impact ◽

Non Motor Symptoms ◽

Deep Brain

Download Full-text

The Impact of Deep Brain Stimulation on Sleep in Parkinson’s Disease: An update

Journal of Parkinson s Disease ◽

10.3233/jpd-191862 ◽

2020 ◽

Vol 10 (2) ◽

pp. 393-404 ◽

Cited By ~ 1

Author(s):

José Rafael P. Zuzuárregui ◽

Jill L. Ostrem

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

The Impact ◽

Deep Brain

Download Full-text

Cognitive Impact of Deep Brain Stimulation on Parkinson’s Disease Patients

Parkinson s Disease ◽

10.1155/2017/3085140 ◽

2017 ◽

Vol 2017 ◽

pp. 1-15 ◽

Cited By ~ 7

Author(s):

Raja Mehanna ◽

Jawad A. Bajwa ◽

Hubert Fernandez ◽

Aparna Ashutosh Wagle Shukla

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Negative Impact ◽

Cognitive Outcome ◽

Cognitive Domains ◽

The Impact ◽

Deep Brain

Subthalamic nucleus (STN) or globus pallidus interna (GPi) deep brain stimulation (DBS) is considered a robust therapeutic tool in the treatment of Parkinson’s disease (PD) patients, although it has been reported to potentially cause cognitive decline in some cases. We here provide an in-depth and critical review of the current literature regarding cognition after DBS in PD, summarizing the available data on the impact of STN and GPi DBS as monotherapies and also comparative data across these two therapies on 7 cognitive domains. We provide evidence that, in appropriately screened PD patients, worsening of one or more cognitive functions is rare and subtle after DBS, without negative impact on quality of life, and that there is very little data supporting that STN DBS has a worse cognitive outcome than GPi DBS.

Download Full-text

Intraoperative functional MRI as a new approach to monitor deep brain stimulation in Parkinson's disease

European Radiology ◽

10.1007/s00330-003-2051-0 ◽

2004 ◽

Vol 14 (4) ◽

pp. 686-690 ◽

Cited By ~ 29

Author(s):

Bettina Sorger ◽

Ralf Girnus ◽

Oliver Schulte ◽

Barbara Krug ◽

Klaus Lackner ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Functional Mri ◽

Brain Stimulation ◽

New Approach ◽

Deep Brain

Download Full-text

Intraoperative Neurophysiologic Assessment in Deep Brain Stimulation Surgery and its Impact on Lead Placement

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1716329 ◽

2020 ◽

Vol 82 (01) ◽

pp. 018-026

Author(s):

Philipp Krauss ◽

Markus Florian Oertel ◽

Heide Baumann-Vogel ◽

Lukas Imbach ◽

Christian Rainer Baumann ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Published Data ◽

Number Needed To Treat ◽

Lead Placement ◽

Surgical Methods ◽

The Impact ◽

Deep Brain

Abstract Objectives While the efficacy of deep brain stimulation (DBS) to treat various neurological disorders is undisputed, the surgical methods differ widely and the importance of intraoperative microelectrode recording (MER) or macrostimulation (MS) remains controversially debated. The objective of this study is to evaluate the impact of MER and MS on intraoperative lead placement. Patients and Methods We included 101 patients who underwent awake bilateral implantation of electrodes in the subthalamic nucleus with MER and MS for Parkinson's disease from 2009 to 2017 in a retrospective observational study. We analyzed intraoperative motor outcomes between anatomically planned stimulation point (PSP) and definite stimulation point (DSP), lead adjustments and Unified Parkinson's Disease Rating Scale Item III (UPDRS-III), levodopa equivalent daily dose (LEDD), and adverse events (AE) after 6 months. Results We adjusted 65/202 leads in 47/101 patients. In adjusted leads, MS results improved significantly when comparing PSP and DSP (p < 0.001), resulting in a number needed to treat of 9.6. After DBS, UPDRS-III and LEDD improved significantly after 6 months in adjusted and nonadjusted patients (p < 0.001). In 87% of leads, the active contact at 6 months still covered the optimal stimulation point during surgery. In total, 15 AE occurred. Conclusion MER and MS have a relevant impact on the intraoperative decision of final lead placement and prevent from a substantial rate of poor stimulation outcome. The optimal stimulation points during surgery and chronic stimulation strongly overlap. Follow-up UPDRS-III results, LEDD reductions, and DBS-related AE correspond well to previously published data.

Download Full-text

L-DOPA-INDUCED DYSKINESIA AND STEREOTACTIC SURGERY FOR PARKINSON'S DISEASE

Neurosurgery ◽

10.1227/01.neu.0000315998.58022.55 ◽

2008 ◽

Vol 62 (2) ◽

pp. 311-325 ◽

Cited By ~ 36

Author(s):

Jorge Guridi ◽

Jose A. Obeso ◽

Maria C. Rodriguez-Oroz ◽

Andres M. Lozano ◽

Miguel Manrique

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Globus Pallidus ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Globus Pallidus Internus ◽

The Impact ◽

Deep Brain ◽

Stimulation Of

Abstract OBJECTIVE To assess the impact of different surgical targets and techniques, such as ablation and deep brain stimulation, to treat patients with L-dopa-induced dyskinesia (LID), a major therapeutic complication of Parkinson's disease. METHODS This review analyzes the effects of early surgical procedures to treat hyperkinesia and the current methods and targets used to combat LID in Parkinson's disease, which are mainly thalamotomy, pallidotomy, and deep brain stimulation of the globus pallidus internus and the subthalamic nucleus. RESULTS Available information indicates that surgery of the globus pallidus internus and thalamus (the pallidal receiving area) and of the subthalamic nucleus has a pronounced antidyskinetic effect. This effect is associated with a concomitant improvement in the parkinsonian (“off”-medication) state. Although it is more profound with pallidal and subthalamic surgery, such an effect can also be observed to some extent with thalamic surgery. The latter is attributable to the fact that surgery of the ventralis intermedius is primarily effective for treating tremor. An integral pallidothalamic pathway is needed for dyskinesia to be expressed. Thus, LID is less frequent after subthalamotomy or deep brain stimulation of the subthalamic nucleus through a functional effect mediated by the physiological normalization of the motor system and by an indirect effect associated with a reduction in the daily dose of L-dopa. CONCLUSION Surgery is the only treatment available for Parkinson's disease that can predictably improve both the parkinsonian motor syndrome and LID. The exact mechanisms involved in these effects are not well understood. Pallidal and thalamic surgery affecting pallidal relays reduce LID frequency by disrupting the pallidothalamic circuit, probably eliminating the neuronal activity associated with dyskinesia. Alternatively, the antidyskinetic effect of subthalamic nucleus surgery may in part be attributable to a reduction in the L-dopa dose as well as to the stabilization of the basal ganglia circuits after the surgical procedure.

Download Full-text