Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates

OBJECTIVERecent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, and historical cohorts undergoing “awake” DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution.METHODSPD patients undergoing awake or asleep bilateral GPi or STN DBS were prospectively monitored. The primary outcome measure was stimulation-induced change in motor function off medication 6 months postoperatively, measured using the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Secondary outcomes included change in quality of life, measured by the 39-item Parkinson’s Disease Questionnaire (PDQ-39), change in levodopa equivalent daily dosage (LEDD), stereotactic accuracy, stimulation parameters, and adverse events.RESULTSSix-month outcome data were available for 133 patients treated over 45 months (78 GPi [16 awake, 62 asleep] and 55 STN [14 awake, 41 asleep]). UPDRS-III score improvement with stimulation did not differ between awake and asleep groups for GPi (awake, 20.8 points [38.5%]; asleep, 18.8 points [37.5%]; p = 0.45) or STN (awake, 21.6 points [40.3%]; asleep, 26.1 points [48.8%]; p = 0.20) targets. The percentage improvement in PDQ-39 and LEDD was similar for awake and asleep groups for both GPi (p = 0.80 and p = 0.54, respectively) and STN cohorts (p = 0.85 and p = 0.49, respectively).CONCLUSIONSIn PD patients, bilateral GPi and STN DBS using the asleep method resulted in motor, quality-of-life, and medication reduction outcomes that were comparable to those of the awake method.

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Programming for Stimulation-Induced Transient Nonmotor Psychiatric Symptoms after Bilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2017/2615619 ◽

2017 ◽

Vol 2017 ◽

pp. 1-14

Author(s):

Xi Wu ◽

Yiqing Qiu ◽

Keith Simfukwe ◽

Jiali Wang ◽

Jianchun Chen ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Psychiatric Symptoms ◽

Flow Diagram ◽

Stimulation Parameter ◽

Stn Dbs ◽

Deep Brain

Background. Stimulation-induced transient nonmotor psychiatric symptoms (STPSs) are side effects following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD) patients. We designed algorithms which (1) determine the electrode contacts that induce STPSs and (2) provide a programming protocol to eliminate STPS and maintain the optimal motor functions. Our objective is to test the effectiveness of these algorithms. Materials and Methods. 454 PD patients who underwent programming sessions after STN-DBS implantations were retrospectively analyzed. Only STPS patients were enrolled. In these patients, the contacts inducing STPS were found and the programming protocol algorithms used. Results. Eleven patients were diagnosed with STPS. Of these patients, two had four episodes of crying, and two had four episodes of mirthful laughter. In one patient, two episodes of abnormal sense of spatial orientation were observed. Hallucination episodes were observed twice in one patient, while five patients recorded eight episodes of hypomania. There were no statistical differences between the UPDRS-III under the final stimulation parameter (without STPS) and previous optimum UPDRS-III under the STPSs (p=1.000). Conclusion. The flow diagram used for determining electrode contacts that induce STPS and the programming protocol employed in the treatment of these symptoms are effective.

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Deep Brain Stimulation for Parkinson’s Disease: Association between Stimulation Parameters and Cognitive Performance

Stereotactic and Functional Neurosurgery ◽

10.1159/000082208 ◽

2004 ◽

Vol 82 (4) ◽

pp. 191-193 ◽

Cited By ~ 16

Author(s):

P. Francel ◽

K. Ryder ◽

J. Wetmore ◽

A. Stevens ◽

K. Bharucha ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Cognitive Performance ◽

Brain Stimulation ◽

Disease Association ◽

Stimulation Parameters ◽

Deep Brain

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217 Clinical Outcomes Following Awake and Asleep Deep Brain Stimulation for Parkinson's Disease

Neurosurgery ◽

10.1093/neuros/nyx417.217 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 259-259

Author(s):

Tsinsue Chen ◽

Zaman Mirzadeh ◽

Kristina Chapple ◽

Margaret Lambert ◽

Holly Shill ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Clinical Outcomes ◽

Brain Stimulation ◽

Rating Scale ◽

Stn Dbs ◽

Deep Brain

Abstract INTRODUCTION Recent studies show similar clinical outcomes in Parkinson's disease (PD) patients treated by deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called “asleep” DBS, compared to historical cohorts undergoing “awake” DBS with MER guidance. Very few studies, however, include internal controls. This study compares clinical outcomes following globus pallidus interna (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution. METHODS PD patients undergoing awake or asleep bilateral GPi or STN DBS were prospectively followed. The primary outcome measure was stimulation-induced change in motor function 6 months postoperatively, measured by the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) with the patient off medication. Secondary outcomes included change in quality of life, measured by the 39-item Parkinson's Disease Questionnaire (PDQ-39), change in levodopa daily equivalent dose (LEDD), stereotactic accuracy, stimulation parameters, and adverse events. RESULTS >Six-month outcome data were available for 133 patients treated over 45 months (78 GPi [16 awake, 62 asleep] and 55 STN [14 awake and 41 asleep]). UPDRS-III score improvement with stimulation did not differ between awake and asleep groups for GPi (awake = 20.8 points [38.5%], asleeP = 18.8 points [37.5%], P = 0.45) or STN (awake = 21.6 points [40.3%], asleeP = 26.1 points [48.8%], P = 0.20) targets. The percentage improvement in PDQ-39 and LEDD was similar for awake and asleep groups for both GPi (P = 0.80, P = 0.54, respectively) and STN cohorts (P = 0.85, P = 0.49, respectively). CONCLUSION In PD patients, bilateral GPi and STN DBS utilizing the asleep method resulted in motor, quality-of-life, and medication reduction outcomes comparable to the awake method.

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Suicide in Parkinson’s Disease: A Systematic Review

CNS & Neurological Disorders - Drug Targets ◽

10.2174/1871527318666190703093345 ◽

2019 ◽

Vol 18 (6) ◽

pp. 466-477 ◽

Cited By ~ 2

Author(s):

Isabella Berardelli ◽

Daniele Belvisi ◽

Adele Nardella ◽

Giulia Falcone ◽

Dorian A. Lamis ◽

...

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Suicidal Ideation ◽

Brain Stimulation ◽

Suicide Risk ◽

Psychiatric Symptoms ◽

Search Terms ◽

Deep Brain

: Psychiatric disorders and suicide have been reported in patients suffering from Parkinson’s disease. The aims of the present paper were to determine whether patients with Parkinson’s disease have an increased rate of suicide and to identify the clinical features possibly associated with suicide risk in Parkinson’s disease. We also reviewed the studies on suicide risk in Parkinson’s disease in patients after deep brain stimulation. We performed a Medline, Excerpta Medica, PsycLit, PsycInfo and Index Medicus search to identify all articles published on this topic from 1970 to 2019. The following search terms were used: suicide OR suicide attempt OR suicidal ideation OR suicide risk AND Parkinson’s disease AND Parkinson’s disease and deep brain stimulation. The studies we identified that assessed the suicide rate associated with Parkinson’s disease yielded contrasting results, although an increase in suicidal ideation did emerge. The studies on the effect of deep brain stimulation on suicide risk in Parkinson’s disease also reported mixed findings. Psychiatric symptoms, including depression, appear to be associated with suicide risk in patients with Parkinson’s disease undergoing medical and after surgical treatment. The studies reviewed suggest that suicidal ideation is increased in Parkinson’s disease. Further longitudinal studies designed to assess suicidality in this condition are still needed.

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Psychopharmacology for Patients with Parkinson’s Disease and Deep Brain Stimulation: Lessons Learned in an Academic Center

Current Psychopharmacologye ◽

10.2174/2211556007666180328142953 ◽

2019 ◽

Vol 8 (1) ◽

pp. 41-54 ◽

Cited By ~ 1

Author(s):

Andreea L. Seritan ◽

Peter Ureste ◽

Tammy Duong ◽

Jill L. Ostrem

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Advanced Disease ◽

Psychiatric Symptoms ◽

Functional Improvement ◽

Current Evidence ◽

Psychiatric Comorbidities ◽

Deep Brain

Background:Deep brain stimulation (DBS) is a modern neuromodulation method used in the treatment of advanced movement disorders such as Parkinson’s disease (PD) and dystonia. Patients with PD may have multiple psychiatric comorbidities, notably anxiety, depression, mania or hypomania, and psychosis. DBS surgery may indirectly alleviate psychiatric symptoms by allowing reduction of dopaminergic medications, or as a result of functional improvement. Patients who are considering DBS for PD often have more advanced disease and may be more vulnerable to perioperative psychiatric decline. Albeit infrequently, increased depression, apathy, irritability, hypomania or mania, and suicidal behavior have been observed after DBS surgery. </P><P> Objective: This review aimed to present current evidence and empirical recommendations for the management of the psychiatric symptoms in patients with PD treated with DBS. </P><P> Method: Relevant literature was reviewed and synthesized, along with recommendations informed by the authors’ clinical experience in a large, academic DBS center.Results:Careful evaluation of DBS candidacy, including assessing the risk for perioperative psychiatric decompensation is advised. Maintaining at least eight weeks of psychiatric stability prior to DBS surgery is strongly recommended. Postoperative management can be challenging due to advanced disease, concurrent psychiatric comorbidities, and possible DBS stimulation-related effects on mood and impulse control. Stimulation-induced elevated mood states (mania, hypomania) have started to be recognized as distinct clinical entities, although not included in the current psychiatric nomenclature.Conclusion:Insufficient evidence-based strategies for managing psychiatric symptoms in PD patients with DBS exist at this time. Further research is necessary to uncover best practices in this complex, expanding field.

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Simultaneous bilateral stereotactic procedure for deep brain stimulation implants: a significant step for reducing operation time

Journal of Neurosurgery ◽

10.3171/2015.7.jns151026 ◽

2016 ◽

Vol 125 (1) ◽

pp. 85-89 ◽

Cited By ~ 2

Author(s):

Erich Talamoni Fonoff ◽

Angelo Azevedo ◽

Jairo Silva dos Angelos ◽

Raquel Chacon Ruiz Martinez ◽

Jessie Navarro ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Clinical Outcomes ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Operating Time ◽

Operation Time ◽

Total Operating Time ◽

Deep Brain

OBJECT Currently, bilateral procedures involve 2 sequential implants in each of the hemispheres. The present report demonstrates the feasibility of simultaneous bilateral procedures during the implantation of deep brain stimulation (DBS) leads. METHODS Fifty-seven patients with movement disorders underwent bilateral DBS implantation in the same study period. The authors compared the time required for the surgical implantation of deep brain electrodes in 2 randomly assigned groups. One group of 28 patients underwent traditional sequential electrode implantation, and the other 29 patients underwent simultaneous bilateral implantation. Clinical outcomes of the patients with Parkinson's disease (PD) who had undergone DBS implantation of the subthalamic nucleus using either of the 2 techniques were compared. RESULTS Overall, a reduction of 38.51% in total operating time for the simultaneous bilateral group (136.4 ± 20.93 minutes) as compared with that for the traditional consecutive approach (220.3 ± 27.58 minutes) was observed. Regarding clinical outcomes in the PD patients who underwent subthalamic nucleus DBS implantation, comparing the preoperative off-medication condition with the off-medication/on-stimulation condition 1 year after the surgery in both procedure groups, there was a mean 47.8% ± 9.5% improvement in the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) score in the simultaneous group, while the sequential group experienced 47.5% ± 15.8% improvement (p = 0.96). Moreover, a marked reduction in the levodopa-equivalent dose from preoperatively to postoperatively was similar in these 2 groups. The simultaneous bilateral procedure presented major advantages over the traditional sequential approach, with a shorter total operating time. CONCLUSIONS A simultaneous stereotactic approach significantly reduces the operation time in bilateral DBS procedures, resulting in decreased microrecording time, contributing to the optimization of functional stereotactic procedures.

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Caregiver burden and caregiver appraisal of psychiatric symptoms are not modulated by subthalamic deep brain stimulation for Parkinson’s disease

npj Parkinson s Disease ◽

10.1038/s41531-018-0048-2 ◽

2018 ◽

Vol 4 (1) ◽

Cited By ~ 11

Author(s):

Philip E. Mosley ◽

Michael Breakspear ◽

Terry Coyne ◽

Peter Silburn ◽

David Smith

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Caregiver Burden ◽

Brain Stimulation ◽

Psychiatric Symptoms ◽

Caregiver Appraisal ◽

Deep Brain

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Caregiver Burden and Caregiver Appraisal of Psychiatric Symptoms are not Modulated by Subthalamic Deep Brain Stimulation for Parkinson’s Disease

10.31234/osf.io/upnms ◽

2017 ◽

Author(s):

Philip E Mosley ◽

Michael Breakspear ◽

Terry Coyne ◽

Peter Silburn ◽

David Smith

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Caregiver Burden ◽

Brain Stimulation ◽

Postoperative Period ◽

Psychiatric Symptoms ◽

Substantial Contribution ◽

Baseline Values ◽

Deep Brain

Subthalamic deep brain stimulation is an advanced therapy that typically improves quality of life for persons with Parkinson’s disease (PD). However, the effect on caregiver burden is unclear. We recruited sixty-four persons with PD and their caregivers from a movement disorders clinic during the assessment of eligibility for subthalamic DBS. We used clinician, patient and caregiver-rated instruments to follow the patient-caregiver dyad from pre- to postoperative status, sampling repeatedly in the postoperative period to ascertain fluctuations in phenotypic variables. We employed multivariate models to identify key drivers of burden. We clustered caregiver-rated variables into ‘high’ and ‘low’ symptom groups and examined whether postoperative cluster assignment could be predicted from baseline values. Psychiatric symptoms in the postoperative period made a substantial contribution to longitudinal caregiver burden. The development of stimulation-dependent mood changes was also associated with increased burden. However, caregiver burden and caregiver-rated psychiatric symptom clusters were temporally stable and thus predicted only by their baseline values. We confirmed this finding using frequentist and Bayesian statistics, concluding that in our sample, subthalamic DBS for PD did not significantly influence caregiver burden or caregiver-rated psychiatric symptoms. Specifically, patient-caregiver dyads with high burden and high levels of psychiatric symptoms at baseline were likely to maintain this profile during follow up. These findings support the importance of assessing caregiver burden prior to functional neurosurgery. Furthermore, they suggest that interventions addressing caregiver burden in this population should target those with greater symptomatology at baseline and may usefully prioritise psychiatric symptoms reported by the caregiver.

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