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Ricci A, Rubino E, Serra GP, Wallén-Mackenzie Å. Concerning neuromodulation as treatment of neurological and neuropsychiatric disorder: Insights gained from selective targeting of the subthalamic nucleus, para-subthalamic nucleus and zona incerta in rodents. Neuropharmacology 2024; 256:110003. [PMID: 38789078 DOI: 10.1016/j.neuropharm.2024.110003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/26/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Neuromodulation such as deep brain stimulation (DBS) is advancing as a clinical intervention in several neurological and neuropsychiatric disorders, including Parkinson's disease, dystonia, tremor, and obsessive-compulsive disorder (OCD) for which DBS is already applied to alleviate severely afflicted individuals of symptoms. Tourette syndrome and drug addiction are two additional disorders for which DBS is in trial or proposed as treatment. However, some major remaining obstacles prevent this intervention from reaching its full therapeutic potential. Side-effects have been reported, and not all DBS-treated individuals are relieved of their symptoms. One major target area for DBS electrodes is the subthalamic nucleus (STN) which plays important roles in motor, affective and associative functions, with impact on for example movement, motivation, impulsivity, compulsivity, as well as both reward and aversion. The multifunctionality of the STN is complex. Decoding the anatomical-functional organization of the STN could enhance strategic targeting in human patients. The STN is located in close proximity to zona incerta (ZI) and the para-subthalamic nucleus (pSTN). Together, the STN, pSTN and ZI form a highly heterogeneous and clinically important brain area. Rodent-based experimental studies, including opto- and chemogenetics as well as viral-genetic tract tracings, provide unique insight into complex neuronal circuitries and their impact on behavior with high spatial and temporal precision. This research field has advanced tremendously over the past few years. Here, we provide an inclusive review of current literature in the pre-clinical research fields centered around STN, pSTN and ZI in laboratory mice and rats; the three highly heterogeneous and enigmatic structures brought together in the context of relevance for treatment strategies. Specific emphasis is placed on methods of manipulation and behavioral impact.
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Affiliation(s)
- Alessia Ricci
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Eleonora Rubino
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Gian Pietro Serra
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Åsa Wallén-Mackenzie
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA.
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Krugliakova E, Karpovich A, Stieglitz L, Huwiler S, Lustenberger C, Imbach L, Bujan B, Jedrysiak P, Jacomet M, Baumann CR, Fattinger S. Exploring the local field potential signal from the subthalamic nucleus for phase-targeted auditory stimulation in Parkinson's disease. Brain Stimul 2024; 17:769-779. [PMID: 38906529 DOI: 10.1016/j.brs.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/26/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Enhancing slow waves, the electrophysiological (EEG) manifestation of non-rapid eye movement (NREM) sleep, could potentially benefit patients with Parkinson's disease (PD) by improving sleep quality and slowing disease progression. Phase-targeted auditory stimulation (PTAS) is an approach to enhance slow waves, which are detected in real-time in the surface EEG signal. OBJECTIVE We aimed to test whether the local-field potential of the subthalamic nucleus (STN-LFP) can be used to detect frontal slow waves and assess the electrophysiological changes related to PTAS. METHODS We recruited patients diagnosed with PD and undergoing Percept™ PC neurostimulator (Medtronic) implantation for deep brain stimulation of STN (STN-DBS) in a two-step surgery. Patients underwent three full-night recordings, including one between-surgeries recording and two during rehabilitation, one with DBS+ (on) and one with DBS- (off). Surface EEG and STN-LFP signals from Percept PC were recorded simultaneously, and PTAS was applied during sleep in all three recording sessions. RESULTS Our results show that during NREM sleep, slow waves of the cortex and STN are time-locked. PTAS application resulted in power and coherence changes, which can be detected in STN-LFP. CONCLUSION Our findings suggest the feasibility of implementing PTAS using solely STN-LFP signal for slow wave detection, thus without a need for an external EEG device alongside the implanted neurostimulator. Moreover, we propose options for more efficient STN-LFP signal preprocessing, including different referencing and filtering to enhance the reliability of cortical slow wave detection in STN-LFP recordings.
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Affiliation(s)
- Elena Krugliakova
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Artyom Karpovich
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Huwiler
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Caroline Lustenberger
- Neural Control of Movement Lab, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Lukas Imbach
- Swiss Epilepsy Center, Clinic Lengg, Zurich, Switzerland
| | - Bartosz Bujan
- Neurorehabilitation, Clinic Lengg, Zurich, Switzerland
| | | | - Maria Jacomet
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sara Fattinger
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Shaheen N, Shaheen A, Elgendy A, Bezchlibnyk YB, Zesiewicz T, Dalm B, Jain J, Green AL, Aziz TZ, Flouty O. Deep brain stimulation for chronic pain: a systematic review and meta-analysis. Front Hum Neurosci 2023; 17:1297894. [PMID: 38098761 PMCID: PMC10719838 DOI: 10.3389/fnhum.2023.1297894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Background Deep brain stimulation (DBS) has shown promise in effectively treating chronic pain. This study aimed to assess the efficacy of DBS in this context. Methods We conducted a systematic literature search using PubMed, Scopus, and Web of Science, following the PRISMA guidelines. A well-constructed search strategy was utilized. Our literature search identified two groups of subjects: one group underwent DBS specifically for chronic pain treatment (DBS-P), while the second group received DBS for other indications (DBS-O), such as Parkinson's disease or dystonia, with pain perception investigated as a secondary outcome in this population. Meta-analysis was performed using R version 4.2.3 software. Heterogeneity was assessed using the tau^2 and I^2 indices, and Cochran's Q-test was conducted. Results The analysis included 966 patients in 43 original research studies with chronic pain who underwent DBS (340 for DBS-P and 625 for DBS-O). Subgroup analysis revealed that DBS-P exhibited a significant effect on chronic pain relief, with a standardized mean difference (SMD) of 1.65 and a 95% confidence interval (CI) of [1.31; 2.00]. Significant heterogeneity was observed among the studies, with an I^2 value of 85.8%. However, no significant difference was found between DBS-P and DBS-O subgroups. Subgroup analyses based on study design, age, pain diseases, and brain targets demonstrated varying levels of evidence for the effectiveness of DBS across different subgroups. Additionally, meta-regression analyses showed no significant relationship between age or pain duration and DBS effectiveness for chronic pain. Conclusion These findings significantly contribute to the expanding body of knowledge regarding the utility of DBS in the management of chronic pain. The study underscores the importance of conducting further research to enhance treatment outcomes and elucidate patient-specific factors that are associated with treatment response. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=428442, identifier CRD42023428442.
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Affiliation(s)
- Nour Shaheen
- Alexandria Faculty of Medicine, Alexandria, Egypt
| | | | | | - Yarema B. Bezchlibnyk
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Theresa Zesiewicz
- Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Brian Dalm
- Department of Neurosurgery, The Ohio State University, Columbus, OH, United States
| | - Jennifer Jain
- Department of Neurology, University of South Florida, Tampa, FL, United States
| | - Alexander L. Green
- Oxford Functional Neurosurgery, Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Tipu Z. Aziz
- Oxford Functional Neurosurgery, Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Oliver Flouty
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
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Haddish K, Yun JW. L-Dihydroxyphenylalanine (L-Dopa) Induces Brown-like Phenotype in 3T3-L1 White Adipocytes via Activation of Dopaminergic and β3-adrenergic Receptors. BIOTECHNOL BIOPROC E 2022. [DOI: 10.1007/s12257-021-0361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zheng JH, Sun WH, Ma JJ, Wang ZD, Chang QQ, Dong LR, Shi XX, Li MJ. Differences in Brain Activity Between Dopa-Responsive and -Unresponsive Pain in Parkinson's Disease. Pain Ther 2022; 11:959-970. [PMID: 35751780 PMCID: PMC9314530 DOI: 10.1007/s40122-022-00404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/10/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Pain in Parkinson's disease is poorly understood, and most patients with pain do not respond to dopaminergic drugs. We aimed to explore the mechanisms of dopa-responsive and -unresponsive pain by comparing such patients against patients without pain in terms of neural activity and functional connectivity in the brain. METHODS We prospectively examined 31 Parkinson's patients with dopa-responsive pain, 51 with dopa-unresponsive pain and 93 without pain using resting-state functional magnetic resonance imaging. Neural activity was assessed in terms of the amplitude of low-frequency fluctuation, while functional connectivity was assessed based on analysis of regions of interest. RESULTS Patients with dopa-unresponsive pain showed significantly higher amplitude of low-frequency fluctuation in the right parahippocampal/lingual region than patients with no pain. However, there was no amplitude difference between the dopa-responsive pain group and the no pain group. Patients with dopa-unresponsive pain also differed significantly from patients with no pain in their functional connections between the superior temporal gyrus and other areas of cerebral cortex, between amygdala and thalamus and between the amygdala and putamen. Patients with dopa-responsive pain differed significantly from patients with no pain in their functional connections between temporal fusiform cortex and cerebellum, between precentral gyrus and temporal fusiform cortex and between precentral gyrus and cerebellum. CONCLUSIONS Regional neural activity and functional connectivity in the brain differ substantially among Parkinson's patients with dopa-unresponsive pain, dopa-responsive pain or no pain. Our results suggest that dopa-responsive and -unresponsive pain may arise through different mechanisms, which may help guide the development of targeted therapies.
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Affiliation(s)
- Jin Hua Zheng
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Henan University, Zhengzhou, Henan Province, People's Republic of China
| | - Wen Hua Sun
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Jian Jun Ma
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China.
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China.
- Department of Neurology, People's Hospital of Henan University, Zhengzhou, Henan Province, People's Republic of China.
| | - Zhi Dong Wang
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Qing Qing Chang
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Lin Rui Dong
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Xiao Xue Shi
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Ming Jian Li
- Department of Neurology, Henan Provincial People's Hospital, Weiwu Road, Building 7, Zhengzhou, 450003, Henan Province, People's Republic of China
- Department of Neurology, People's Hospital of Henan University, Zhengzhou, Henan Province, People's Republic of China
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Mostofi A, Morgante F, Edwards MJ, Brown P, Pereira EAC. Pain in Parkinson's disease and the role of the subthalamic nucleus. Brain 2021; 144:1342-1350. [PMID: 34037696 DOI: 10.1093/brain/awab001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
Pain is a frequent and poorly treated symptom of Parkinson's disease, mainly due to scarce knowledge of its basic mechanisms. In Parkinson's disease, deep brain stimulation of the subthalamic nucleus is a successful treatment of motor symptoms, but also might be effective in treating pain. However, it has been unclear which type of pain may benefit and how neurostimulation of the subthalamic nucleus might interfere with pain processing in Parkinson's disease. We hypothesized that the subthalamic nucleus may be an effective access point for modulation of neural systems subserving pain perception and processing in Parkinson's disease. To explore this, we discuss data from human neurophysiological and psychophysical investigations. We review studies demonstrating the clinical efficacy of deep brain stimulation of the subthalamic nucleus for pain relief in Parkinson's disease. Finally, we present some of the key insights from investigations in animal models, healthy humans and Parkinson's disease patients into the aberrant neurobiology of pain processing and consider their implications for the pain-relieving effects of subthalamic nucleus neuromodulation. The evidence from clinical and experimental studies supports the hypothesis that altered central processing is critical for pain generation in Parkinson's disease and that the subthalamic nucleus is a key structure in pain perception and modulation. Future preclinical and clinical research should consider the subthalamic nucleus as an entry point to modulate different types of pain, not only in Parkinson's disease but also in other neurological conditions associated with abnormal pain processing.
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Affiliation(s)
- Abteen Mostofi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, SW17 0RE, London, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, SW17 0RE, London, UK
- Department of Experimental and Clinical Medicine, University of Messina, 98125, Messina, Italy
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, SW17 0RE, London, UK
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, OX1 3TH, Oxford, UK
| | - Erlick A C Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's, University of London, SW17 0RE, London, UK
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7
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Lu CW, Harper DE, Askari A, Willsey MS, Vu PP, Schrepf AD, Harte SE, Patil PG. Stimulation of zona incerta selectively modulates pain in humans. Sci Rep 2021; 11:8924. [PMID: 33903611 PMCID: PMC8076305 DOI: 10.1038/s41598-021-87873-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
Stimulation of zona incerta in rodent models has been shown to modulate behavioral reactions to noxious stimuli. Sensory changes observed in Parkinsonian patients with subthalamic deep brain stimulation suggest that this effect is translatable to humans. Here, we utilized the serendipitous placement of subthalamic deep brain stimulation leads in 6 + 5 Parkinsonian patients to directly investigate the effects of zona incerta stimulation on human pain perception. We found that stimulation at 20 Hz, the physiological firing frequency of zona incerta, reduces experimental heat pain by a modest but significant amount, achieving a 30% reduction in one fifth of implants. Stimulation at higher frequencies did not modulate heat pain. Modulation was selective for heat pain and was not observed for warmth perception or pressure pain. These findings provide a mechanistic explanation of sensory changes seen in subthalamic deep brain stimulation patients and identify zona incerta as a potential target for neuromodulation of pain.
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Affiliation(s)
- Charles W Lu
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Daniel E Harper
- Department of Anesthesiology, Emory University, Atlanta, GA, USA
| | - Asra Askari
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA
| | - Matthew S Willsey
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Philip P Vu
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Andrew D Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA.,Division of Rheumatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Drive, SPC 5338, Ann Arbor, MI, 48109-5338, USA. .,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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DiMarzio M, Madhavan R, Hancu I, Fiveland E, Prusik J, Joel S, Gillogly M, Telkes I, Staudt MD, Durphy J, Shin D, Pilitsis JG. Use of Functional MRI to Assess Effects of Deep Brain Stimulation Frequency Changes on Brain Activation in Parkinson Disease. Neurosurgery 2021; 88:356-365. [PMID: 32985661 DOI: 10.1093/neuros/nyaa397] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/27/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Models have been developed for predicting ideal contact and amplitude for subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD). Pulse-width is generally varied to modulate the size of the energy field produced. Effects of varying frequency in humans have not been systematically evaluated. OBJECTIVE To examine how altered frequencies affect blood oxygen level-dependent activation in PD. METHODS PD subjects with optimized DBS programming underwent functional magnetic resonance imaging (fMRI). Frequency was altered and fMRI scans/Unified Parkinson Disease Rating Scale motor subunit (UPDRS-III) scores were obtained. Analysis using DBS-OFF data was used to determine which regions were activated during DBS-ON. Peak activity utilizing T-values was obtained and compared. RESULTS At clinically optimized settings (n = 14 subjects), thalamic, globus pallidum externa (GPe), and posterior cerebellum activation were present. Activation levels significantly decreased in the thalamus, anterior cerebellum, and the GPe when frequency was decreased (P < .001). Primary somatosensory cortex activation levels significantly decreased when frequency was increased by 30 Hz, but not 60 Hz. Sex, age, disease/DBS duration, and bilaterality did not significantly affect the data. Retrospective analysis of fMRI activation patterns predicted optimal frequency in 11/14 subjects. CONCLUSION We show the first data with fMRI of STN DBS-ON while synchronizing cycling with magnetic resonance scanning. At clinically optimized settings, an fMRI signature of thalamic, GPe, and posterior cerebellum activation was seen. Reducing frequency significantly decreased thalamic, GPe, and anterior cerebellum activation. Current standard-of-care programming can take up to 6 mo using UPDRS-III testing alone. We provide preliminary evidence that using fMRI signature of frequency may have clinical utility and feasibility.
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Affiliation(s)
- Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | | | | | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
| | | | - Michael Gillogly
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Damian Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurology, Albany Medical Center, Albany, New York
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
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Holmes SA, Kim A, Borsook D. The brain and behavioral correlates of motor-related analgesia (MRA). Neurobiol Dis 2020; 148:105158. [PMID: 33157210 DOI: 10.1016/j.nbd.2020.105158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/03/2023] Open
Abstract
The human motor system has the capacity to act as an internal form of analgesia. Since the discovery of the potential influence of motor systems on analgesia in rodent models, clinical applications of targeting the motor system for analgesia have been implemented. However, a neurobiological basis for motor activation's effects on analgesia is not well defined. Motor-related analgesia (MRA) is a phenomenon wherein a decrease in pain symptoms can be achieved through either indirect or direct activation of the motor axis. To date, research has focused on (a) evaluating the pain-motor interaction as one focused on the acute protection from painful stimuli; (b) motor cortex stimulation for chronic pain; or (c) exercise as a method of improving chronic pain in animal and human models. This review evaluates (1) current knowledge surrounding how pain interferes with canonical neurological performance throughout the motor axis; and (2) the physiological basis for motor-related analgesia as a means to reduce pain symptom loads for patients. A proposal for future research directions is provided.
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Affiliation(s)
- S A Holmes
- Center for Pain and the Brain, Boston Childrens Hospital and Harvard Medical School, 1-Department of Anesthesiology Critical Care and Pain Medicine, Boston Children's Hospital- Harvard Medical School, Boston, United States.
| | - A Kim
- Center for Pain and the Brain, Boston Childrens Hospital and Harvard Medical School, 1-Department of Anesthesiology Critical Care and Pain Medicine, Boston Children's Hospital- Harvard Medical School, Boston, United States.
| | - D Borsook
- Center for Pain and the Brain, Boston Childrens Hospital and Harvard Medical School, 1-Department of Anesthesiology Critical Care and Pain Medicine, Boston Children's Hospital- Harvard Medical School, Boston, United States.
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10
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DiMarzio M, Rashid T, Hancu I, Fiveland E, Prusik J, Gillogly M, Madhavan R, Joel S, Durphy J, Molho E, Hanspal E, Shin D, Pilitsis JG. Functional MRI Signature of Chronic Pain Relief From Deep Brain Stimulation in Parkinson Disease Patients. Neurosurgery 2020; 85:E1043-E1049. [PMID: 31313816 DOI: 10.1093/neuros/nyz269] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/16/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic pain occurs in 83% of Parkinson disease (PD) patients and deep brain stimulation (DBS) has shown to result in pain relief in a subset of patients, though the mechanism is unclear. OBJECTIVE To compare functional magnetic resonance imaging (MRI) data in PD patients with chronic pain without DBS, those whose pain was relieved (PR) with DBS and those whose pain was not relieved (PNR) with DBS. METHODS Functional MRI (fMRI) with blood oxygen level-dependent activation data was obtained in 15 patients in control, PR, and PNR patients. fMRI was obtained in the presence and absence of a mechanical stimuli with DBS ON and DBS OFF. Voxel-wise analysis using pain OFF data was used to determine which regions were altered during pain ON periods. RESULTS At the time of MRI, pain was scored a 5.4 ± 1.2 out of 10 in the control, 4.25 ± 1.18 in PNR, and 0.8 ± 0.67 in PR cohorts. Group analysis of control and PNR groups showed primary somatosensory (SI) deactivation, whereas PR patients showed thalamic deactivation and SI activation. DBS resulted in more decreased activity in PR than PNR (P < .05) and more activity in anterior cingulate cortex (ACC) in PNR patients (P < .05). CONCLUSION Patients in the control and PNR groups showed SI deactivation at baseline in contrast to the PR patients who showed SI activation. With DBS ON, the PR cohort had less activity in SI, whereas the PNR had more anterior cingulate cortex activity. We provide pilot data that patients whose pain responds to DBS may have a different fMRI signature than those who do not, and PR and PNR cohorts produced different brain responses when DBS is employed.
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Affiliation(s)
- Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Tanweer Rashid
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | | | | | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Michael Gillogly
- Department of Neurosurgery, Albany Medical Center, Albany, New York
| | | | | | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Eric Molho
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Era Hanspal
- Department of Neurology, Albany Medical Center, Albany, New York
| | - Damian Shin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurology, Albany Medical Center, Albany, New York
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.,Department of Neurosurgery, Albany Medical Center, Albany, New York
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Gong S, Xu M, Tao Y, Jin H, Liu Y, Sun X, Wang S, Yang X, Wang Y, Yuan L, Song W. Comparison of Subthalamic Nucleus and Globus Pallidus Internus Deep Brain Stimulation Surgery on Parkinson Disease-Related Pain. World Neurosurg 2019; 135:e94-e99. [PMID: 31733388 DOI: 10.1016/j.wneu.2019.11.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To analyze and compare the effects of subthalamic nucleus (STN) deep brain stimulation (DBS) and globus pallidus internus (GPi)-DBS on Parkinson disease (PD)-related pain. METHODS A retrospective study was performed of 64 patients (28 who underwent GPi-DBS and 36 who underwent STN-DBS) with PD-related pain in our hospital between January 2017 and July 2019. A numerical rating scale (NRS) was used to evaluate the degree of pain preoperatively and 4 months after operation, and the unified PD scale III (UPDRS-III) was completed simultaneously to assess motor symptoms. RESULTS The average NRS score of all 64 patients after surgery was 1.09 ± 1.39, which was significantly lower than that before operation (4.44 ± 1.67; P < 0.0001). The improvement rate of NRS was 75 ± 27% in the 28 GPi-DBS patients and 79 ± 27% in the 36 STN-DBS patients, with no significant difference (P = 0.577). The improvements in NRS and UPDRS-III were significantly correlated in the STN-DBS group (r = 0.3707, P = 0.026) but not significantly correlated in the GPi-DBS group (P = 0.516). CONCLUSIONS Both GPi-DBS and STN-DBS were effective for analyzing PD-related pain and seemed to have similar efficacy. This study provides an important first-step toward determining different DBS targets for controlling PD-related pain. Follow-up prospective research is an appropriate next step on the path to multicenter clinical trials.
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Affiliation(s)
- Shun Gong
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Menting Xu
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Yingqun Tao
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China.
| | - Hai Jin
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Yang Liu
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Xiao Sun
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Shimiao Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Xingwang Yang
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Yu Wang
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Lijia Yuan
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
| | - Weilong Song
- Department of Neurosurgery, The General Hospital of Northern Theater Command (The Original General Hospital of Shenyang Military Area Command), PLA Institute of Neurology, Shenyang, China
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13
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Pautrat A, Rolland M, Barthelemy M, Baunez C, Sinniger V, Piallat B, Savasta M, Overton PG, David O, Coizet V. Revealing a novel nociceptive network that links the subthalamic nucleus to pain processing. eLife 2018; 7:36607. [PMID: 30149836 PMCID: PMC6136891 DOI: 10.7554/elife.36607] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022] Open
Abstract
Pain is a prevalent symptom of Parkinson's disease, and is effectively treated by deep brain stimulation of the subthalamic nucleus (STN). However, the link between pain and the STN remains unclear. In the present work, using in vivo electrophysiology in rats, we report that STN neurons exhibit complex tonic and phasic responses to noxious stimuli. We also show that nociception is altered following lesions of the STN, and characterize the role of the superior colliculus and the parabrachial nucleus in the transmission of nociceptive information to the STN, physiologically from both structures and anatomically in the case of the parabrachial nucleus. We show that STN nociceptive responses are abnormal in a rat model of PD, suggesting their dependence on the integrity of the nigrostriatal dopaminergic system. The STN-linked nociceptive network that we reveal is likely to be of considerable clinical importance in neurological diseases involving a dysfunction of the basal ganglia.
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Affiliation(s)
- Arnaud Pautrat
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Marta Rolland
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Margaux Barthelemy
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Christelle Baunez
- Institut de Neurosciences de la Timone, Aix-Marseille Université, Marseille, France
| | - Valérie Sinniger
- Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France.,Service d'Hépato-Gastroentérologie, CHU Grenoble Alpes, Grenoble, France
| | - Brigitte Piallat
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Marc Savasta
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Paul G Overton
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Olivier David
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
| | - Veronique Coizet
- Inserm, Grenoble, France.,Grenoble Institute of Neurosciences, Université Grenoble Alpes, Grenoble, France
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14
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DiMarzio M, Pilitsis JG, Gee L, Peng S, Prusik J, Durphy J, Ramirez-Zamora A, Hanspal E, Molho E, McCallum SE. King's Parkinson's Disease Pain Scale for Assessment of Pain Relief Following Deep Brain Stimulation for Parkinson's Disease. Neuromodulation 2018; 21:617-622. [PMID: 29608802 DOI: 10.1111/ner.12778] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/08/2018] [Accepted: 02/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pain is a prevalent and debilitating nonmotor symptom of Parkinson's disease (PD) that is often inadequately managed. Deep brain stimulation (DBS) has been shown to relieve pain in PD but an effective method of identifying which types of PD pain respond to DBS has not been established. We examine the effects of DBS on different types of PD pain using the King's Parkinson's disease pain scale (KPDPS), the only validated scale of PD pain. METHODS We prospectively followed 18 PD patients undergoing subthalamic nucleus (STN) or Globus pallidus interna (GPi) DBS. Subjects completed the KPDPS, low back disability index (LBDI), and McGill pain questionnaire (MPQ), preoperatively and at six months postoperatively. Subjects underwent the unified Parkinson's disease rating scale-III (UPDRS-III) with preoperative scores ON medication and postoperative scores ON medication/DBS stimulation. RESULTS Of the 18 patients, a total of 12 subjects had STN DBS and 6 had GPi DBS. As a group, subjects showed improvement in total KPDPS score at six-month postoperative follow-up (p = 0.004). Fluctuation and nocturnal pain were most significantly improved (p = 0.006, 0.01, respectively). Significant improvements were found in fluctuation-related pain domain following GPi DBS. CONCLUSIONS In this pilot study, we are the first group to employ KPDPS to monitor pain relief following DBS in PD patients. We demonstrate that fluctuation-related pain and nocturnal pain significantly improve with DBS. Use of the KPDPS in the future will allow better understanding of how STN and GPi DBS treat PD pain over time.
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Affiliation(s)
- Marisa DiMarzio
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Lucy Gee
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Sophia Peng
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Julia Prusik
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | | | - Era Hanspal
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Eric Molho
- Department of Neurology, Albany Medical Center, Albany, NY, USA
| | - Sarah E McCallum
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA
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15
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Gandolfi M, Geroin C, Antonini A, Smania N, Tinazzi M. Understanding and Treating Pain Syndromes in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:827-858. [PMID: 28805585 DOI: 10.1016/bs.irn.2017.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pain affects many people with Parkinson's disease (PD) and diminishes their quality of life. Different types of pain have been described, but their related pathophysiological mechanisms remain unclear. The aim of this chapter is to provide movement disorders specialists an update about the pathophysiology of pain and a practical guide for the management of pain syndromes in clinical practice. This chapter reviews current knowledge on the pathophysiological mechanisms of sensory changes and pain in PD, as well as assessment and treatment procedures to manage these symptoms. In summary, changes in peripheral and central pain processing have been demonstrated in PD patients. A decrease in pain threshold and tolerance to several stimuli, a reduced nociceptive withdrawal reflex, a reduced pain threshold, and abnormal pain-induced activation in cortical pain-related areas have been reported. There is no direct association between improvement of motor symptoms and sensory/pain changes, suggesting that motor and nonmotor symptoms do not inevitably share the same mechanisms. Special care in pain assessment in PD is warranted by the specific pathophysiological aspects and the complexity of motor and nonmotor symptoms associated with pain symptoms. Rehabilitation may represent a valid option to manage pain syndromes in PD. However, further research in this field is needed. An integrated approach to pain involving a multidisciplinary team of medical specialists and rehabilitation experts should allow a comprehensive approach to pain in PD.
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Affiliation(s)
- Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy; Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Christian Geroin
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy
| | - Angelo Antonini
- University of Padua and Hospital San Camillo IRCCS, Venice, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center (CRRNC), University of Verona, Verona, Italy; Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Movement Disorders Division, University of Verona, Verona, Italy.
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16
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Hogg E, Wertheimer J, Graner S, Tagliati M. Deep Brain Stimulation and Nonmotor Symptoms. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 134:1045-1089. [DOI: 10.1016/bs.irn.2017.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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17
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UMEMURA A, OYAMA G, SHIMO Y, NAKAJIMA M, NAKAJIMA A, JO T, SEKIMOTO S, ITO M, MITSUHASHI T, HATTORI N, ARAI H. Current Topics in Deep Brain Stimulation for Parkinson Disease. Neurol Med Chir (Tokyo) 2016; 56:613-625. [PMID: 27349658 PMCID: PMC5066082 DOI: 10.2176/nmc.ra.2016-0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 05/04/2016] [Indexed: 01/30/2023] Open
Abstract
There is a long history of surgical treatment for Parkinson disease (PD). After pioneering trials and errors, the current primary surgical treatment for PD is deep brain stimulation (DBS). DBS is a promising treatment option for patients with medically refractory PD. However, there are still many problems and controversies associated with DBS. In this review, we discuss current issues in DBS for PD, including patient selection, clinical outcomes, complications, target selection, long-term outcomes, management of axial symptoms, timing of surgery, surgical procedures, cost-effectiveness, and new technology.
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Affiliation(s)
- Atsushi UMEMURA
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Genko OYAMA
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasushi SHIMO
- Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Madoka NAKAJIMA
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Asuka NAKAJIMA
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takayuki JO
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoko SEKIMOTO
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masanobu ITO
- Department of Psychiatry, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takumi MITSUHASHI
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka HATTORI
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hajime ARAI
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Polli A, Weis L, Biundo R, Thacker M, Turolla A, Koutsikos K, Chaudhuri KR, Antonini A. Anatomical and functional correlates of persistent pain in Parkinson's disease. Mov Disord 2016; 31:1854-1864. [DOI: 10.1002/mds.26826] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/29/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023] Open
Affiliation(s)
- Andrea Polli
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
- Laboratory of Robotics and Kinematics, Neurorehabilitation Department, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Hospital Foundation; Venice Italy
| | - Luca Weis
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
| | - Roberta Biundo
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
| | - Michael Thacker
- Centre for Human and Aerospace Physiological Sciences, Pain Section, Neuroimaging, Institute of Psychiatry, Kings College London; London United Kingdom
| | - Andrea Turolla
- Laboratory of Robotics and Kinematics, Neurorehabilitation Department, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Hospital Foundation; Venice Italy
- Department of Neuroscience; The University of Sheffield; Sheffield United Kingdom
| | - Kostantinos Koutsikos
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
| | - K. Ray Chaudhuri
- Neuroscience Research and Development, Denmark Hill Campus, King's College Hospital, King's College London; London United Kingdom
| | - Angelo Antonini
- Parkinson Unit, Institute for Research, Hospitalization and Health Care (IRCCS) San Camillo Rehabilitation Hospital; Venice Italy
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19
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Martínez-Fernández R, Schmitt E, Martinez-Martin P, Krack P. The hidden sister of motor fluctuations in Parkinson's disease: A review on nonmotor fluctuations. Mov Disord 2016; 31:1080-94. [PMID: 27431515 DOI: 10.1002/mds.26731] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/13/2016] [Accepted: 06/19/2016] [Indexed: 12/29/2022] Open
Abstract
Only a few years after the introduction of levodopa, the first descriptions of motor fluctuations and dyskinesia related to dopaminergic therapy appeared. In PD, attention turned to their management, that had dampened the euphoria of the "levodopa miracle." It soon became clear that neuropsychiatric, autonomic, and sensory features also tend to develop fluctuations after chronic exposure to l-dopa. The diversity of fluctuating nonmotor symptoms, their largely subjective nature, coupled with a frequent lack of insight led to difficulties in identification and quantification. This may explain why, despite the high impact of nonmotor symptoms on patient autonomy and quality of life, evaluation of nonmotor fluctuations is not part of clinical routine. In view of the lack of specific validated assessment tools, detailed anamnesis should ideally be coupled with an evaluation in both ON and OFF drug conditions. The mechanisms of nonmotor fluctuations are not well understood. It is thought that they share dopaminergic presynaptic pharmacokinetic and postsynaptic pharmacodynamic mechanisms with the classical motor complications, but involve different neural pathways. Although symptoms fluctuate with dopaminergic treatment, serotonine and norepinephrine denervation, as well as interactions between neurotransmitter systems, probably contribute to their diversity. The lack of validated tools for assessment of these phenomena explains the almost complete absence of treatment studies. Management, largely resulting from expert opinion, includes psychiatric follow-up, nondopaminergic drugs, and advanced dopaminergic treatment, including drug delivery pumps and DBS. This review aims to provide a starting point for the understanding, diagnosis, and management of nonmotor fluctuations. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes and Grenoble Institut des Neurosciences, INSERM U386, Grenoble, France
| | - Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health and CIBERNED, Madrid, Spain
| | - Paul Krack
- Neurology Division, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland
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20
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Belasen A, Rizvi K, Gee LE, Yeung P, Prusik J, Ramirez-Zamora A, Hanspal E, Paiva P, Durphy J, Argoff CE, Pilitsis JG. Effect of low-frequency deep brain stimulation on sensory thresholds in Parkinson's disease. J Neurosurg 2016; 126:397-403. [PMID: 27104841 DOI: 10.3171/2016.2.jns152231] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic pain is a major distressing symptom of Parkinson's disease (PD) that is often undertreated. Subthalamic nucleus (STN) deep brain stimulation (DBS) delivers high-frequency stimulation (HFS) to patients with PD and has been effective in pain relief in a subset of these patients. However, up to 74% of patients develop new pain concerns while receiving STN DBS. Here the authors explore whether altering the frequency of STN DBS changes pain perception as measured through quantitative sensory testing (QST). METHODS Using QST, the authors measured thermal and mechanical detection and pain thresholds in 19 patients undergoing DBS via HFS, low-frequency stimulation (LFS), and off conditions in a randomized order. Testing was performed in the region of the body with the most pain and in the lower back in patients without chronic pain. RESULTS In the patients with chronic pain, LFS significantly reduced heat detection thresholds as compared with thresholds following HFS (p = 0.029) and in the off state (p = 0.010). Moreover, LFS resulted in increased detection thresholds for mechanical pressure (p = 0.020) and vibration (p = 0.040) compared with these thresholds following HFS. Neither LFS nor HFS led to changes in other mechanical thresholds. In patients without chronic pain, LFS significantly increased mechanical pain thresholds in response to the 40-g pinprick compared with thresholds following HFS (p = 0.032). CONCLUSIONS Recent literature has suggested that STN LFS can be useful in treating nonmotor symptoms of PD. Here the authors demonstrated that LFS modulates thermal and mechanical detection to a greater extent than HFS. Low-frequency stimulation is an innovative means of modulating chronic pain in PD patients receiving STN DBS. The authors suggest that STN LFS may be a future option to consider when treating Parkinson's patients in whom pain remains the predominant complaint.
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Affiliation(s)
| | | | - Lucy E Gee
- Departments of 1 Neurosurgery and.,Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, New York
| | | | | | | | | | | | | | | | - Julie G Pilitsis
- Departments of 1 Neurosurgery and.,Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, New York
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22
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Mylius V, Ciampi de Andrade D, Cury RG, Teepker M, Ehrt U, Eggert KM, Beer S, Kesselring J, Stamelou M, Oertel WH, Möller JC, Lefaucheur JP. Pain in Parkinson's Disease: Current Concepts and a New Diagnostic Algorithm. Mov Disord Clin Pract 2015; 2:357-364. [PMID: 30363602 DOI: 10.1002/mdc3.12217] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 12/30/2022] Open
Abstract
Background Pain is a significant burden for patients with Parkinson's disease (PD) with a high impact on quality of life. The present article aims at summarizing epidemiological, pathophysiological, clinical, and neurophysiological data regarding pain in PD. Methods In this domain, a procedure of systematic assessment is still lacking for the syndromic diagnosis and should take into account pain characteristics, effects of dopaminergic treatment, motor fluctuations, and non-PD-associated pain. Findings We propose an original questionnaire addressing an algorithm suitable for daily clinical practice. The questionnaire is based on a three-step approach addressing first the relationship between pain and PD (including temporal relationship with the course of the disease, association with motor fluctuations, and impact of antiparkinsonian treatment), before classifying pain into one of three main syndromes (i.e., musculoskeletal pain, psychomotor restlessness pain, and neuropathic pain). Conclusions The proposed questionnaire allows the characteristics of each pain type to be determined according to its relationship with the disease and its treatment. The validation of the clinical use of this questionnaire will be the goal of a forthcoming work.
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Affiliation(s)
- Veit Mylius
- Department of Neurology Philipps University Marburg Germany.,Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | | | - Rubens Gisbert Cury
- Pain Center Department of Neurology University of São Paulo São Paulo SP Brazil
| | | | - Uwe Ehrt
- Psychiatric Clinic Fachklinikum Bernburg Bernburg Germany
| | | | - Serafin Beer
- Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | - Jürg Kesselring
- Department of Neurology Center for Neurorehabilitation Valens Switzerland
| | - Maria Stamelou
- Department of Neurology Philipps University Marburg Germany.,Movement Disorders Clinic Second Department of Neurology University of Athens Athens Greece
| | | | - Jens Carsten Möller
- Parkinson Center Center for Neurological Rehabilitation Zihlschlacht Switzerland
| | - Jean-Pascal Lefaucheur
- Faculté de Médecine Université Paris Est Créteil Créteil France.,Service de Physiologie-Explorations Fonctionnelles Hôpital Henri Mondor Assistance Publique-Hôpitaux de Paris Créteil France
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23
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Gee LE, Chen N, Ramirez-Zamora A, Shin DS, Pilitsis JG. The effects of subthalamic deep brain stimulation on mechanical and thermal thresholds in 6OHDA-lesioned rats. Eur J Neurosci 2015; 42:2061-9. [PMID: 26082992 DOI: 10.1111/ejn.12992] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 12/21/2022]
Abstract
Chronic pain is a major complaint for up to 85% of Parkinson's disease patients; however, it often not identified as a symptom of Parkinson's disease. Adequate treatment of motor symptoms often provides analgesic effects in Parkinson's patients but how this occurs remains unclear. Studies have shown both Parkinson's patients and 6-hydroxydopamine-lesioned rats exhibit decreased sensory thresholds. In humans, some show improvements in these deficits after subthalamic deep brain stimulation, while others report no change. Differing methods of testing and response criteria may explain these varying results. We examined this effect in 6-hydroxydopamine-lesioned rats. Sprague-Dawley rats were unilaterally implanted with subthalamic stimulating electrodes in the lesioned right hemisphere and sensory thresholds were tested using von Frey, tail-flick and hot-plate tests. Tests were done during and off subthalamic stimulation at 50 and 150 Hz to assess its effects on sensory thresholds. The 6-hydroxydopamine-lesioned animals exhibited lower mechanical (left paw, P < 0.01) and thermal thresholds than shams (hot plate, P < 0.05). Both 50 and 150 Hz increased mechanical (left paw; P < 0.01) and thermal thresholds in 6-hydroxydopamine-lesioned rats (hot-plate test: 150 Hz, P < 0.05, 50 Hz, P < 0.01). Interestingly, during von Frey testing, low-frequency stimulation provided a more robust improvement in some 6OHDA lesioned rats, while in others, the magnitude of improvement on high-frequency stimulation was greater. This study shows that subthalamic deep brain stimulation improves mechanical allodynia and thermal hyperalgesia in 6-hydroxydopamine-lesioned animals at both high and low frequencies. Furthermore, we suggest considering using low-frequency stimulation when treating Parkinson's patients where pain remains the predominant complaint.
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Affiliation(s)
- Lucy E Gee
- Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, AMC Neurosurgery Group, Albany Medical Center, 47 New Scotland Ave, MC 10, Physicians Pavilion, 1st Floor, Albany, NY, 12208, USA
| | - Nita Chen
- Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, NY, USA
| | | | - Damian S Shin
- Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, NY, USA
| | - Julie G Pilitsis
- Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, NY, USA.,Department of Neurosurgery, AMC Neurosurgery Group, Albany Medical Center, 47 New Scotland Ave, MC 10, Physicians Pavilion, 1st Floor, Albany, NY, 12208, USA
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24
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Cury R, Galhardoni R, Fonoff E, Perez Lloret S, dos Santos Ghilardi M, Barbosa E, Teixeira M, Ciampi de Andrade D. Sensory abnormalities and pain in Parkinson disease and its modulation by treatment of motor symptoms. Eur J Pain 2015; 20:151-65. [DOI: 10.1002/ejp.745] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2015] [Indexed: 01/07/2023]
Affiliation(s)
- R.G. Cury
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Pain Center; Instituto do Câncer do Estado de São Paulo; São Paulo Brazil
- Movement Disorders Group; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - R. Galhardoni
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - E.T. Fonoff
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Transcranial Magnetic Stimulation Laboratory; Psychiatry Institute; University of São Paulo; São Paulo Brazil
- Neurosurgery Division; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - S. Perez Lloret
- Laboratory of Clinical Pharmacology and Epidemiology; Catholic University; Buenos Aires Argentina
| | | | - E.R. Barbosa
- Movement Disorders Group; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - M.J. Teixeira
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Pain Center; Instituto do Câncer do Estado de São Paulo; São Paulo Brazil
- Movement Disorders Group; Department of Neurology; University of São Paulo; São Paulo Brazil
- Transcranial Magnetic Stimulation Laboratory; Psychiatry Institute; University of São Paulo; São Paulo Brazil
- Neurosurgery Division; Department of Neurology; University of São Paulo; São Paulo Brazil
| | - D. Ciampi de Andrade
- Pain Center; Department of Neurology; University of São Paulo; São Paulo Brazil
- Pain Center; Instituto do Câncer do Estado de São Paulo; São Paulo Brazil
- Transcranial Magnetic Stimulation Laboratory; Psychiatry Institute; University of São Paulo; São Paulo Brazil
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Kim HJ, Jeon BS, Paek SH. Nonmotor Symptoms and Subthalamic Deep Brain Stimulation in Parkinson's Disease. J Mov Disord 2015; 8:83-91. [PMID: 26090080 PMCID: PMC4460544 DOI: 10.14802/jmd.15010] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 12/24/2022] Open
Abstract
Subthalamic deep brain stimulation (STN DBS) is an established treatment for the motor symptoms in patients with advanced Parkinson’s disease (PD). In addition to improvements in motor symptoms, many studies have reported changes in various nonmotor symptoms (NMSs) after STN DBS in patients with PD. Psychiatric symptoms, including depression, apathy, anxiety, and impulsivity, can worsen or improve depending on the electrical stimulation parameters, the locations of the stimulating contacts within the STN, and changes in medications after surgery. Global cognitive function is not affected by STN DBS, and there is no increase in the incidence of dementia after STN DBS compared to that after medical treatment, although clinically insignificant declines in verbal fluency have been consistently reported. Pain, especially PD-related pain, improves with STN DBS. Evidence regarding the effects of STN DBS on autonomic symptoms and sleep-related problems is limited and remains conflicting. Many symptoms of nonmotor fluctuations, which are occasionally more troublesome than motor fluctuations, improve with STN DBS. Although it is clear that NMSs are not target symptoms for STN DBS, NMSs have a strong influence on the quality of life of patients with PD, and clinicians should thus be aware of these NMSs when deciding whether to perform surgery and should pay attention to changes in these symptoms after STN DBS to ensure the optimal care for patients.
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology, Movement Disorder Center, Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, Korea
| | - Beom S Jeon
- Department of Neurology, Movement Disorder Center, Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Movement Disorder Center, Neuroscience Research Institute, College of Medicine, Seoul National University, Seoul, Korea
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Smith H, Gee L, Kumar V, Ramirez-Zamora A, Durphy J, Hanspal E, Barba A, Molho E, Shin D, Pilitsis JG. Deep brain stimulation significantly decreases disability from low back pain in patients with advanced Parkinson's disease. Stereotact Funct Neurosurg 2015; 93:206-11. [PMID: 25895600 DOI: 10.1159/000380827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/10/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Up to 60% of Parkinson's disease (PD) patients suffer from low back pain (LBP) during the course of their disease. How LBP affects daily functional status and how to manage this aspect of PD has not been adequately explored. METHODS We examined 16 patients undergoing bilateral subthalamic nucleus deep brain stimulation (STN DBS) who met the inclusion criteria for moderate disability from LBP, as classified by the Oswestry Low Back Pain Disability Index (OLBPD). RESULTS Thirteen of 16 patients had attempted additional treatments for LBP, including medical management, massage, chiropractic, epidural steroid injections and/or surgery, with minimal relief. Following DBS, there was a significant improvement in the OLBPD at both the 6-month and 1-year time points (p < 0.02, p < 0.005, respectively). A mean improvement of 31.7% on the OLBPD score was noted. The Visual Analogue Scale (VAS) similarly decreased significantly at 1 year (p = 0.015). There was no correlation between the OLBPD score and other measures, including the Unified Parkinson's Disease Rating Scale (UPDRS), age and other nonmotor symptoms. CONCLUSION Given the prevalent yet undertreated disability associated with LBP in PD, these results are novel in that they show that STN DBS has a significant positive effect on disability associated with LBP.
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Affiliation(s)
- Heather Smith
- Department of Neurosurgery, Albany Medical College, Albany, N.Y., USA
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