scholarly journals Patient, Caregiver, and Decliner Perspectives on Whether to Enroll in Adaptive Deep Brain Stimulation Research

2021 ◽  
Vol 15 ◽  
Author(s):  
Simon Outram ◽  
Katrina A. Muñoz ◽  
Kristin Kostick-Quenet ◽  
Clarissa E. Sanchez ◽  
Lavina Kalwani ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Study Design ◽  
Brain Stimulation ◽  
Research Study ◽  
New Technology ◽  
Innovative Technology ◽  
Theoretical Perspectives ◽  
Potential Risks ◽  
Deep Brain

This research study provides patient and caregiver perspectives as to whether or not to undergo adaptive deep brain stimulation (aDBS) research. A total of 51 interviews were conducted in a multi-site study including patients undergoing aDBS and their respective caregivers along with persons declining aDBS. Reasons highlighted for undergoing aDBS included hopes for symptom alleviation, declining quality of life, desirability of being in research, and altruism. The primary reasons for not undergoing aDBS issues were practical rather than specific to aDBS technology, although some persons highlighted a desire to not be the first to trial the new technology. These themes are discussed in the context of “push” factors wherein any form of surgical intervention is preferable to none and “pull” factors wherein opportunities to contribute to science combine with hopes and/or expectations for the alleviation of symptoms. We highlight the significance of study design in decision making. aDBS is an innovative technology and not a completely new technology. Many participants expressed value in being part of research as an important consideration. We suggest that there are important implications when comparing patient perspectives vs. theoretical perspectives on the choice for or against aDBS. Additionally, it will be important how we communicate with patients especially in reference to the complexity of study design. Ultimately, this study reveals that there are benefits and potential risks when choosing a research study that involves implantation of a medical device.

Deep Brain Stimulation Improves Medication Related Addictive Behavior and Associated Quality of Life

2009 ◽  
Author(s):  
Hunter Covert ◽  
Pennie S. Seibert ◽  
Caitlin C. Otto ◽  
Missy Coblentz ◽  
Nicole Whitener ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Addictive Behavior ◽  
Deep Brain

Clinical outcomes of asleep vs awake deep brain stimulation for Parkinson disease

Neurology ◽  
2017 ◽  
Vol 89 (19) ◽  
pp. 1944-1950 ◽  
Author(s):  
Matthew A. Brodsky ◽  
Shannon Anderson ◽  
Charles Murchison ◽  
Mara Seier ◽  
Jennifer Wilhelm ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Electrode Placement ◽  
Microelectrode Recording ◽  
Imaging Guidance ◽  
Motor Outcomes ◽  
Deep Brain

Objective:To compare motor and nonmotor outcomes at 6 months of asleep deep brain stimulation (DBS) for Parkinson disease (PD) using intraoperative imaging guidance to confirm electrode placement vs awake DBS using microelectrode recording to confirm electrode placement.Methods:DBS candidates with PD referred to Oregon Health & Science University underwent asleep DBS with imaging guidance. Six-month outcomes were compared to those of patients who previously underwent awake DBS by the same surgeon and center. Assessments included an “off”-levodopa Unified Parkinson’s Disease Rating Scale (UPDRS) II and III, the 39-item Parkinson's Disease Questionnaire, motor diaries, and speech fluency.Results:Thirty participants underwent asleep DBS and 39 underwent awake DBS. No difference was observed in improvement of UPDRS III (+14.8 ± 8.9 vs +17.6 ± 12.3 points, p = 0.19) or UPDRS II (+9.3 ± 2.7 vs +7.4 ± 5.8 points, p = 0.16). Improvement in “on” time without dyskinesia was superior in asleep DBS (+6.4 ± 3.0 h/d vs +1.7 ± 1.2 h/d, p = 0.002). Quality of life scores improved in both groups (+18.8 ± 9.4 in awake, +8.9 ± 11.5 in asleep). Improvement in summary index (p = 0.004) and subscores for cognition (p = 0.011) and communication (p < 0.001) were superior in asleep DBS. Speech outcomes were superior in asleep DBS, both in category (+2.77 ± 4.3 points vs −6.31 ± 9.7 points (p = 0.0012) and phonemic fluency (+1.0 ± 8.2 points vs −5.5 ± 9.6 points, p = 0.038).Conclusions:Asleep DBS for PD improved motor outcomes over 6 months on par with or better than awake DBS, was superior with regard to speech fluency and quality of life, and should be an option considered for all patients who are candidates for this treatment.Clinicaltrials.gov identifier:NCT01703598.Classification of evidence:This study provides Class III evidence that for patients with PD undergoing DBS, asleep intraoperative CT imaging–guided implantation is not significantly different from awake microelectrode recording–guided implantation in improving motor outcomes at 6 months.

scholarly journals A Meta-Analysis of the Effect of Subthalamic Nucleus-Deep Brain Stimulation in Parkinson's Disease-Related Pain

2021 ◽  
Vol 15 ◽  
Author(s):  
Yu Diao ◽  
Yutong Bai ◽  
Tianqi Hu ◽  
Zixiao Yin ◽  
Huangguang Liu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Motor Symptom ◽  
Stn Dbs ◽  
Deep Brain

Pain from Parkinson's disease (PD) is a non-motor symptom affecting the quality of life and has prevalence of 20–80%. However, it is unclear whether subthalamic nucleus deep brain stimulation (STN–DBS), a well-established treatment for PD, is effective forPD-related pain. Thus, the objective of this meta-analysis was to investigate the efficacy of STN-DBS on PD-related pain and explore how its duration affects the efficacy of STN-DBS. A systematic search was performed using PubMed, Embase, and the Cochrane Library. Nine studies included numerical rating scale (NRS), visual analog scale (VAS), or non-motor symptom scale (NMSS) scores at baseline and at the last follow-up visit and therefore met the inclusion criteria of the authors. These studies exhibited moderate- to high-quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. Random effect meta-analysis revealed a significant change in PD-related pain as assessed by NMSS, NRS, and VAS (P &lt;0.01). Analysis of the short and long follow-up subgroups indicated delayed improvement in PD-related pain. These findings (a) show the efficacy of STN-DBS on PD-related pain and provide higher-level evidence, and (b) implicate delayed improvement in PD-related pain, which may help programming doctors with supplement selecting target and programming.Systematic Review Registration: This study is registered in Open Science Framework (DOI: 10.17605/OSF.IO/DNM6K).

Subthalamic Nucleus Deep Brain Stimulation May Improve Pain in the Setting of Parkinson Disease

2020 ◽  
pp. 85-88
Author(s):  
Anjali Gera ◽  
Gian Pal
Keyword(s):  
Chronic Pain ◽  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Foot Deformities ◽  
Common Source ◽  
Constant Pain ◽  
Deep Brain

More than 50% of patients with Parkinson disease (PD) can have chronic pain. PD pain has been associated with reduced quality of life scores on validated measures. The most common source of PD pain is musculoskeletal in origin. This pain may manifest as rigidity, cramps, shoulder discomfort, spinal or hand and foot deformities, dystonic pain, or nonradicular back pain. Our case illustrates improvement in chronic pain following bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) surgery in a 45-year-old patient with PD. Approximately 1 year after PD onset, he developed constant pain and tremor in his left upper extremity, which gradually worsened over time. Initially, carbidopa/levodopa completely alleviated both his arm tremor and pain. Over the next several years, he developed off periods that were associated with bothersome tremor and pain, and on periods that were associated with prominent neck and left arm dyskinesia, both of which were associated with significant pain. At age 60 years, after 15 years of PD, he underwent bilateral STN DBS implantation. Following DBS, he had significant improvement in his left arm tremor, rigidity, motor fluctuations, and pain. He also had a 70% reduction in his dopaminergic medication and complete resolution of dyskinesia and neck pain.

scholarly journals Deep Brain Stimulation as a Treatment Approach for Anorexia Nervosa: a Systematic Literature Review

2019 ◽  
Vol 38 (03) ◽  
pp. 175-182 ◽  
Author(s):  
Ledismar José da Silva ◽  
Tâmara Husein Naciff ◽  
Maria Flávia Vaz de Oliveira
Keyword(s):  
Anorexia Nervosa ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Anterior Cingulate ◽  
Stria Terminalis ◽  
Electrode Implantation ◽  
Bed Nucleus ◽  
Negative Impacts ◽  
Deep Brain

AbstractAnorexia nervosa is a psychiatric disorder characterized by distortions of body size, weight, and shape perception, as well as by food restriction and/or binge and purging behaviors. It mostly affects young women and causes severe negative impacts on their physical, psychological, and social health. Recent studies have analyzed deep brain stimulation (DBS), a neurosurgical procedure that involves electrode implantation in strategical brain areas, to obtain remission of the symptoms of anorexia nervosa. The results showed that the stimulation of areas associated to the neurocircuitry of anorexia nervosa, such as nucleus accumbens, anterior cingulate cortex, ventral striatum, and bed nucleus of the stria terminalis, provokes beneficial responses in terms of body mass index, quality of life, social functioning, and psychiatric comorbidities. Nevertheless, broader investigations are needed to endorse the clinical usage of DBS in the management of anorexia nervosa.

Sustained quality-of-life improvements over 10 years after deep brain stimulation for dystonia

2018 ◽  
Vol 33 (7) ◽  
pp. 1160-1167 ◽  
Author(s):  
Elliot Hogg ◽  
Emmanuel During ◽  
Echo E. Tan ◽  
Kishore Athreya ◽  
Jonathan Eskenazi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Deep Brain

scholarly journals Quality of life predicts outcome of deep brain stimulation in early Parkinson disease

Neurology ◽  
2019 ◽  
Vol 92 (10) ◽  
pp. e1109-e1120 ◽  
Author(s):  
W.M. Michael Schuepbach ◽  
Lisa Tonder ◽  
Alfons Schnitzler ◽  
Paul Krack ◽  
Joern Rau ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Motor Complications ◽  
Baseline Characteristics ◽  
Stn Dbs ◽  
Disease Specific ◽  
Deep Brain

ObjectiveTo investigate predictors for improvement of disease-specific quality of life (QOL) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) with early motor complications.MethodsWe performed a secondary analysis of data from the previously published EARLYSTIM study, a prospective randomized trial comparing STN-DBS (n = 124) to best medical treatment (n = 127) after 2 years follow-up with disease-specific QOL (39-item Parkinson's Disease Questionnaire summary index [PDQ-39-SI]) as the primary endpoint. Linear regression analyses of the baseline characteristics age, disease duration, duration of motor complications, and disease severity measured at baseline with the Unified Parkinson’s Disease Rating Scale (UPDRS) (UPDRS-III “off” and “on” medications, UPDRS-IV) were conducted to determine predictors of change in PDQ-39-SI.ResultsPDQ-39-SI at baseline was correlated to the change in PDQ-39-SI after 24 months in both treatment groups (p < 0.05). The higher the baseline score (worse QOL) the larger the improvement in QOL after 24 months. No correlation was found for any of the other baseline characteristics analyzed in either treatment group.ConclusionImpaired QOL as subjectively evaluated by the patient is the most important predictor of benefit in patients with PD and early motor complications, fulfilling objective gold standard inclusion criteria for STN-DBS. Our results prompt systematically including evaluation of disease-specific QOL when selecting patients with PD for STN-DBS.Clinicaltrials.gov identifierNCT00354133.

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