scholarly journals Subthalamic Nucleus Stimulation Restores Glucose Metabolism in Associative and Limbic Cortices and in Cerebellum: Evidence from a FDG-PET Study in Advanced Parkinson's Disease

2004 ◽  
Vol 24 (1) ◽  
pp. 7-16 ◽  
Author(s):  
Ruediger Hilker ◽  
Juergen Voges ◽  
Simon Weisenbach ◽  
Elke Kalbe ◽  
Lothar Burghaus ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Basal Ganglia ◽  
Subthalamic Nucleus ◽  
Temporal Cortex ◽  
Glucose Consumption ◽  
Advanced Parkinson’S Disease ◽  
Subthalamic Nucleus Stimulation ◽  
The Impact ◽  
Stn Dbs

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a highly effective surgical treatment in patients with advanced Parkinson's disease (PD). Because the STN has been shown to represent an important relay station not only in motor basal ganglia circuits, the modification of brain areas also involved in nonmotor functioning can be expected by this intervention. To determine the impact of STN-DBS upon the regional cerebral metabolic rate of glucose (rCMRGlc), we performed positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) in eight patients with advanced PD before surgery as well as in the DBS on- and off-conditions 4 months after electrode implantation and in ten age-matched healthy controls. Before surgery, PD patients showed widespread bilateral reductions of cortical rCMRGlc versus controls but a hypermetabolic state in the left rostral cerebellum. In the STN-DBS on-condition, clusters of significantly increased rCMRGlc were found in both lower thalami reaching down to the midbrain area and remote from the stimulation site in the right frontal cortex, temporal cortex, and parietal cortex, whereas rCMRGlc significantly decreased in the left rostral cerebellum. Therefore, STN-DBS was found to suppress cerebellar hypermetabolism and to partly restore physiologic glucose consumption in limbic and associative projection territories of the basal ganglia. These data suggest an activating effect of DBS upon its target structures and confirm a central role of the STN in motor as well as associative, limbic, and cerebellar basal ganglia circuits.

scholarly journals Subthalamic Nucleus Stimulation Does Not Have Any Acute Effects on Verbal Fluency or on Speed of Word Generation in Parkinson’s Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Cyril Atkinson-Clement ◽  
Friederike Leimbach ◽  
Marjan Jahanshahi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Verbal Fluency ◽  
Time Pattern ◽  
Verbal Fluency Task ◽  
Word Generation ◽  
Subthalamic Nucleus Stimulation ◽  
Stn Dbs ◽  
Fluency Task

Background. Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been shown to be generally safe from a cognitive perspective, with consistent evidence that the major impact of STN-DBS in Parkinson’s disease (PD) is on verbal fluency. Objective. The aim of this study was first to identify the influence of acute manipulation of STN-DBS in PD on the number and time pattern of word generation on different verbal fluency (VF) tasks, phonemic, switching, and cued switching, and second to determine whether cueing improved VF and if cueing effects interacted with STN-DBS effects. Methods. Parallel versions of these three verbal fluency tasks were completed by 31 patients with Parkinson’s disease who had had bilateral DBS of the STN, twice, with DBS On and Off, with the order counterbalanced across patients. Results. There was no effect of acute STN-DBS on the total number of words generated during verbal fluency. As expected, the number of words generated significantly declined over the six 10-second intervals of the verbal fluency tasks, but this time pattern of word generation was not altered by STN-DBS. External cueing significantly increased the number of words generated relative to an uncued switching verbal fluency task, but the cueing effect on VF was not altered by STN-DBS. Conclusion. In conclusion, (i) acute STN-DBS manipulation did not alter either verbal fluency performance or the time pattern of word generation and (ii) external cueing significantly improved verbal fluency performance both with STN-DBS On and Off.

Tremor reduction by subthalamic nucleus stimulation and medication in advanced Parkinson’s disease

2007 ◽  
Vol 254 (2) ◽  
pp. 169-178 ◽  
Author(s):  
Christian Blahak ◽  
Johannes C. Wöhrle ◽  
Hans-Holger Capelle ◽  
Hansjörg Bäzner ◽  
Eva Grips ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Advanced Parkinson’S Disease ◽  
Subthalamic Nucleus Stimulation

Single Electrode and Multiple Electrode Guided Electrical Stimulation of the Subthalamic Nucleus in Advanced Parkinson's Disease

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS346-ONS357 ◽  
Author(s):  
Yasin Temel ◽  
Poldi Wilbrink ◽  
Annelien Duits ◽  
Peter Boon ◽  
Selma Tromp ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Advanced Parkinson’S Disease ◽  
Implanted Electrodes ◽  
Risk Of Bleeding ◽  
Electrophysiological Recordings ◽  
Multiple Electrodes ◽  
Neuropsychological Functions ◽  
Stn Dbs

Abstract Objective: It is still debated to what extent intraoperative electrophysiological techniques contribute to the outcome of subthalamic nucleus (STN) deep brain stimulation (DBS). Intraoperative electrophysiological recordings for identification of the STN can be made with one electrode or with multiple, simultaneously implanted electrodes. The latter provide more detailed information about the electrophysiological boundaries of the STN; however, implantation of several electrodes at one time might increase the risk of bleeding. Here we report the results of a study of patients with advanced Parkinson's disease, in which one group of patients underwent bilateral STN DBS with electrophysiological recordings from a single electrode, and the other group received STN DBS with multiple (five or fewer) simultaneously implanted electrodes. Patients and Methods: Fifty-five patients suffering from advanced Parkinson's disease who underwent bilateral STN stimulation were included in this study. Thirty-two patients underwent STN DBS guided by a single semi-microelectrode, and 23 patients underwent STN DBS guided with simultaneously implanted multiple microelectrodes. All patients were examined preoperatively and 3 and 12 months postoperatively with regard to activities of daily living, motor functions, and neuropsychological functions. Results: We found that the simultaneous implantation of multiple electrodes does not increase the risk of bleeding or any other major intracranial complication. The use of multiple electrodes resulted in better motor results when compared with patients who underwent STN DBS guided with a single recording electrode. There were significantly more improvements in patients’ tremor and rigidity, and as a consequence, a better total Unified Parkinson Disease Rating Scale, Part III score was identified during the medication-off phase. Despite better motor effects, patients treated with multiple electrodes showed subtle deterioration in neuropsychological functions, particularly in memory function. Conclusion: STN DBS performed with multiple electrophysiological recording electrodes resulted in better motor outcome but induced specific mild declines in neuropsychological functions.

Bilateral subthalamic nucleus stimulation in advanced Parkinson’s disease

2007 ◽  
Vol 254 (1) ◽  
pp. 99-106 ◽  
Author(s):  
Jing Gan ◽  
Jing Xie-Brustolin ◽  
Patrick Mertens ◽  
Gustavo Polo ◽  
Hélène Klinger ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Advanced Parkinson’S Disease ◽  
Subthalamic Nucleus Stimulation

Subthalamic Nucleus Stimulation for Advanced Parkinson's Disease: How to Find a Far Medial STN

2004 ◽  
Vol 47 (6) ◽  
pp. 373-377 ◽  
Author(s):  
V. A. Coenen ◽  
F. Gielen ◽  
I. Rohde ◽  
C. Fromm ◽  
M. Kronenbürger ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Advanced Parkinson’S Disease ◽  
Subthalamic Nucleus Stimulation

IMPLANTATION OF ELECTRODES FORDEEP BRAIN STIMULATION OF THE SUBTHALAMIC NUCLEUS IN ADVANCED PARKINSON'S DISEASE WITH THE AID OF INTRAOPERATIVE MICRORECORDING UNDERGENERAL ANESTHESIA

Neurosurgery ◽  
2006 ◽  
Vol 59 (5) ◽  
pp. E1138-E1138 ◽  
Author(s):  
Frank Hertel ◽  
Mark Züchner ◽  
Inge Weimar ◽  
Peter Gemmar ◽  
Bernhard Noll ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Current Literature ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Pulse Generator ◽  
Advanced Parkinson’S Disease ◽  
Randomized Controlled Studies ◽  
Stn Dbs

Abstract OBJECTIVE Deep brain stimulation (DBS) is widely accepted in the treatment of advanced Parkinson's disease (PD) and other movement disorders. The standard implantation procedure is performed under local anesthesia (LA). Certain groups of patients may not be eligible for surgery under LA because of clinical reasons, such as massive fear, reduced cooperativity, or coughing attacks. Microrecording (MER) has been shown to be helpful in DBS surgery. The purpose of this study was to evaluate the feasibility of MERfor DBS surgery under general anesthesia (GA) and to compare the data of intraoperative MERas well as the clinical data with that of the current literature of patients undergoing operation under LA. CLINICAL PRESENTATION The data of nine patients with advanced PD (mean Hoehn and Yahr status, 4.2) who were operated with subthalamic nucleus (STN) DBS under GA, owing to certain clinical circumstances ruling out DBS under LA, were retrospectively analyzed. All operations were performed under analgosedation with propofol or remifentanil and intraoperative MER. For MER, remifentanil was ceased completely and propofol was lowered as far as possible. INTERVENTION The STN could be identified intraoperatively in all patients with MER. The typical bursting pattern was identified, whereas a widening of the baseline noise could not be as adequately detected as in patients under LA. The daily off phases of the patients were reduced from 50 to 17%, whereas the Unified Parkinson's Disease Rating Scale III score was reduced from 43 (preoperative, medication off) to 19 (stimulation on, medication off) and 12 (stimulation on, medication on). Two patients showed a transient neuropsychological deterioration after surgery, but both also had preexisting episodes of disorientation. One implantable pulse generator infection was noticed. No further significant clinical complications were observed. CONCLUSION STN surgery for advanced PD with MERguidance is possible with good clinical results under GA. Intraoperative MERof the STN region can be performed under GA with a special anesthesiological protocol. In this setting, the typical STN bursting pattern can be identified, whereas the typical widening of the background noise baseline while entering the STN region is obviously absent. This technique may enlarge the group of patients eligible for STN surgery. Although the clinical improvements and parameter settings in this study were within the range of the current literature, further randomized controlled studies are necessary to compare the results of STN DBS under GA and LA, respectively.

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