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Moes HR, Henriksen T, Sławek J, Phokaewvarangkul O, Buskens E, van Laar T. Tools and criteria to select patients with advanced Parkinson's disease for device-aided therapies: a narrative review. J Neural Transm (Vienna) 2023; 130:1359-1377. [PMID: 37500937 PMCID: PMC10645650 DOI: 10.1007/s00702-023-02656-z] [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: 02/28/2023] [Accepted: 05/16/2023] [Indexed: 07/29/2023]
Abstract
This article provides an overview of the various screening and selection tools which have been developed over the past 25 years to identify patients with Parkinson's disease (PD) possibly eligible for device-aided therapies (DATs). For the available screening tools, we describe the target therapies (subtypes of DAT), development methods, validation data, and their use in clinical practice. In addition, the historical background and potential utility of these screening tools are discussed. The challenges in developing and validating these tools are also addressed, taking into account the differences in population, the local health care organization, and resource availability.
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Affiliation(s)
- Harmen R Moes
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands
| | - Tove Henriksen
- Department of Neurology, Movement Disorder Clinic, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jarosław Sławek
- Department of Neurology, St Adalbert Hospital Copernicus, Gdansk, Poland
- Department of Neurological and Psychiatric Nursing, Faculty of Health Sciences, Medical University of Gdansk, Gdansk, Poland
| | - Onanong Phokaewvarangkul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Erik Buskens
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, 9713 GZ, Groningen, The Netherlands.
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Lang S, Vetkas A, Conner C, Kalia LV, Lozano AM, Kalia SK. Predictors of Future Deep Brain Stimulation Surgery in de novo Parkinson's Disease. Mov Disord Clin Pract 2023; 10:933-942. [PMID: 37332645 PMCID: PMC10272891 DOI: 10.1002/mdc3.13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/12/2023] [Accepted: 04/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Deep brain stimulation (DBS) surgery is offered to a subset of Parkinson's disease (PD) patients. It is unclear if there are features at diagnosis that predict future DBS surgery. Objective To assess predictors of eventual DBS surgery in de novo PD patients. Methods Subjects from the Parkinson's Progression Marker Initiative (PPMI) database with newly diagnosed, sporadic PD (n = 416) were identified and stratified by their eventual DBS status (DBS+, n = 43; DBS-, n = 373). A total of 50 baseline clinical, imaging, and biospecimen features were extracted for each subject and cross-validated lasso regression was used for feature reduction. Multivariate logistic regression assessed their relationship with DBS status and a receiver operating characteristic curve evaluated model performance. Linear mixed effect models assessed disease progression over 4 years in DBS+ and DBS- patients. Results Age at symptom onset, Hoehn and Yahr (H&Y) stage, tremor score, and ratio of CSF Tau to amyloid-beta 1-42 (Tau: Ab) were identified as important baseline features for predicting DBS surgery. Each independently predicted DBS surgery (area under the curve = 0.83). DBS- patients had faster memory decline (P < 0.05), while DBS+ patients had faster decline in H&Y stage (P < 0.001) and motor scores (P < 0.05) prior to surgery. Conclusion The identified features may be used for early identification of patients who may be surgical candidates during the course of their disease. Disease progression in these groups reflects surgical eligibility criteria, with DBS- patients having more rapid decline in memory while DBS+ patients experienced a faster decline in motor scores prior to DBS surgery.
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Affiliation(s)
- Stefan Lang
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Artur Vetkas
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Christopher Conner
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Lorraine V. Kalia
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- KITETorontoOntarioCanada
- CRANIATorontoOntarioCanada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- CRANIATorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- KITETorontoOntarioCanada
- CRANIATorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
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Geraedts VJ, van Vugt JPP, Marinus J, Kuiper R, Middelkoop HAM, Zutt R, van der Gaag NA, Hoffmann CFE, Dorresteijn LDA, van Hilten JJ, Contarino MF. Predicting Motor Outcome and Quality of Life After Subthalamic Deep Brain Stimulation for Parkinson's Disease: The Role of Standard Screening Measures and Wearable-Data. JOURNAL OF PARKINSON'S DISEASE 2023:JPD225101. [PMID: 37182900 DOI: 10.3233/jpd-225101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Standardized screening for subthalamic deep brain stimulation (STN DBS) in Parkinson's disease (PD) patients is crucial to determine eligibility, but its utility to predict postoperative outcomes in eligible patients is inconclusive. It is unknown whether wearable data can contribute to this aim. OBJECTIVE To evaluate the utility of universal components incorporated in the DBS screening, complemented by a wearable sensor, to predict motor outcomes and Quality of life (QoL) one year after STN DBS surgery. METHODS Consecutive patients were included in the OPTIMIST cohort study from two DBS centers. Standardized assessments included a preoperative Levodopa Challenge Test (LCT), and questionnaires on QoL and non-motor symptoms including cognition, psychiatric symptoms, impulsiveness, autonomic symptoms, and sleeping problems. Moreover, an ambulatory wearable sensor (Parkinson Kinetigraph (PKG)) was used. Postoperative assessments were similar and also included a Stimulation Challenge Test to determine DBS effects on motor function. RESULTS Eighty-three patients were included (median (interquartile range) age 63 (56-68) years, 36% female). Med-OFF (Stim-OFF) motor severity deteriorated indicating disease progression, but patients significantly improved in terms of Med-ON (Stim-ON) motor function, motor fluctuations, QoL, and most non-motor domains. Motor outcomes were not predicted by preoperative tests, including covariates of either LCT or PKG. Postoperative QoL was predicted by better preoperative QoL, lower age, and more preoperative impulsiveness scores in multivariate models. CONCLUSION Data from the DBS screening including wearable data do not predict postoperative motor outcome at one year. Post-DBS QoL appears primarily driven by non-motor symptoms, rather than by motor improvement.
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Affiliation(s)
- Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roy Kuiper
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodi Zutt
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carel F E Hoffmann
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
| | | | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
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Meyer M, Colnat-Coulbois S, Frismand S, Vidailhet P, Llorca PM, Schwan R, Spitz E. Illness perceptions in pre-operative Parkinson's disease patients. J Neural Transm (Vienna) 2023; 130:647-654. [PMID: 37022502 DOI: 10.1007/s00702-023-02629-2] [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: 01/03/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease, that combines motor and non-motor disorders, and alters patients' autonomy. Even if subthalamic nucleus deep brain stimulation (STN-DBS) induces undisputable motor improvement, a post-operative social maladjustment was described by some patients. Our aim was to describe pre-operative illness perceptions in parkinsonian patients, and to determine the possible impact of cognitive restructuration over them. We analyzed 27 parkinsonian patient's candidates to DBS. The mean age was 59 ± 5.94 years, and mean disease duration was 9.89 ± 4.15 years. The patients had two pre-operative psychological interviews (DBS-45 days, DBS-25 days) and completed the Illness Perception Questionnaire-Revised (IPQ-R) before the first interview and at DBS-1 day. The CRTG group (n = 13) had cognitive restructuration during second interview, on dysfunctional cognitions about their perception of post-DBS life which emerged from the first interview. The PIG group (n = 14) benefited of two non-structured interviews. No significant differences were found between the visits (DBS-45 days, DBS-1 day) for IPQ-R dimensions, except for the perception of "personal control" over PD which appears significantly higher for CRTG than PIG group (p = .039) at DBS-1 day, whereas the scores were quite similar at DBS-45 days. Illness perceptions seem to be stable over time and mostly influenced by disease experience of PD. However, the perception of personal control over PD seemed to be modulated through cognitive restructuration, giving patients' control back over disease. Before DBS, illness perceptions investigation and restructuration constitute an interesting point to work on, to enhance perceived benefits of neurosurgery.Trial registration: Clinical Research Program, N°IDRCB 2008-A00655-50, approved by the local ethics committee (CPP EST III, N° CPP: 08.07.03, first version date: 04/01/2008), registered on the ClinicalTrials.gov website (NCT02893449).
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Affiliation(s)
- Mylène Meyer
- Service de Neurologie, Hôpital Central, CHRU Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54001, Nancy Cedex, France.
| | - Sophie Colnat-Coulbois
- Département de Neurochirurgie, Hôpital Central, CHRU de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54001, Nancy Cedex, France
- Université de Lorraine, 34 Cours Leopold, CS 25233, 54052, Nancy Cedex, France
| | - Solène Frismand
- Service de Neurologie, Hôpital Central, CHRU Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54001, Nancy Cedex, France
| | - Pierre Vidailhet
- Service de Psychiatrie I, Hôpital Civil, 1 Place de l'hôpital, BP426, 67091, Strasbourg Cedex, France
| | - Pierre-Michel Llorca
- Service de Psychiatrie Adulte B, CHU Gabriel Montpied, 58 rue Montalembert, 63000, Clermont-Ferrand, France
| | - Raymund Schwan
- Université de Lorraine, 34 Cours Leopold, CS 25233, 54052, Nancy Cedex, France
- Centre Psychothérapique de Nancy, 1 rue du Docteur Archambault, BP 11010, 54521, Laxou Cedex, France
| | - Elisabeth Spitz
- Université de Lorraine, 34 Cours Leopold, CS 25233, 54052, Nancy Cedex, France
- Laboratoire de Psychologie de la Santé de Metz-EPSAM, Université de Lorraine, EA 4360 APEMAC, Ile du Saulcy, 57000, Metz, France
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Van Hienen MM, Kuiper R, Middelkoop HA, Van Hilten JJ, Contarino MF, Geraedts VJ. Patient-Related Factors Influencing Caregiver Burden in Parkinson’s Disease Patients: Comparison of Effects Before and After Deep Brain Stimulation. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1285-1293. [PMID: 35275557 PMCID: PMC9484085 DOI: 10.3233/jpd-213093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Caregivers of Parkinson’s disease (PD) patients provide important support during the pre- and postoperative phase of deep brain stimulation (DBS). High levels of caregiver burden have been reported after DBS. However, a comparison between preoperative and postoperative burden and associated factors has been insufficiently studied. Objective: To investigate the influence of DBS on caregiver burden, and to identify the differential impact of patient-related factors on caregiver burden before and after DBS. Methods: Consecutive patients referred for DBS eligibility screening or during one-year follow-up assessments were included. Caregiver burden was measured with the short Zarit Burden Interview (ZBI-12). Inverse Probability Weighting (IPW) was used to compare caregiver burden between preoperative and postoperative assessments. Results: We included 47 patients (24 screening, 23 follow-up) (median age 65 years, 29.4% female sex). DBS did not impact caregiver burden (screening: median ZBI-12 9.5 (IQR 3.25, 16.75); follow-up median ZBI-12 6 (IQR 4, 14); IPW-coefficient 0.57 (95% CI –2.75, 3.89)). Worse caregiver burden during DBS screening was associated with worse patient-related scores on depressive symptoms, anxiety, QoL, and impulsiveness. Worse scores on depressive symptoms, anxiety, apathy, postural-instability-gait-disorder, and QoL were associated with worse caregiver burden at one-year follow-up. Conclusion: DBS appears not associated with changes in caregiver burden. Various symptoms are valued differently between screening and follow-up assessments in terms of caregiver burden. Early recognition of caregivers “at risk” may improve guidance of patient-caregiver dyads throughout the DBS process.
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Affiliation(s)
| | - Roy Kuiper
- Department of Neurology, LUMC, Leiden, the Netherlands
| | - Huub A.M. Middelkoop
- Department of Neurology, LUMC, Leiden, the Netherlands
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | | | - Maria Fiorella Contarino
- Department of Neurology, LUMC, Leiden, the Netherlands
- Department of Neurology, Haga Teaching Hospital, Den Haag, the Netherlands
| | - Victor J. Geraedts
- Department of Neurology, LUMC, Leiden, the Netherlands
- Department of Clinical Epidemiology, LUMC, Leiden, the Netherlands
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Ghodsi H, Rahimi HR, Aghili SM, Saberi A, Shoeibi A. Evaluation of curcumin as add-on therapy in patients with Parkinson's disease: A pilot randomized, triple-blind, placebo-controlled trial. Clin Neurol Neurosurg 2022; 218:107300. [DOI: 10.1016/j.clineuro.2022.107300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/25/2022] [Accepted: 05/14/2022] [Indexed: 12/24/2022]
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7
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Loftus AM, Nielsen C, Corti EJ, Starkstein S, Gasson N, Egan SJ. Measuring General Expectations of Advanced Stage Treatment Outcomes in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 11:2017-2026. [PMID: 34366376 DOI: 10.3233/jpd-212777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent research suggests that a significant number of those who receive advanced treatments for Parkinson's disease (PD) do not report improvements for some symptoms, which may relate to their pre-treatment expectations. It is important that expectations of treatment are measured and discussed prior to advanced treatment. OBJECTIVE The primary aim of this study was to develop a measure of treatment expectations of two advanced-stage treatments in PD, deep brain stimulation (DBS), and Levodopa/Carbidopa Intestinal Gel (LCIG). A secondary aim was to explore potential predictors of treatment expectations. METHODS The questionnaire-based measure was developed by researchers in conjunction with a highly experienced clinician, and evaluated treatment expectations in 189 people aged 46-91 years (M = 71.35, SD = 8.73; 61% male) with idiopathic PD. RESULTS The overall measure demonstrated excellent internal consistency (α= 0.96). Exploratory factor analysis suggested the scale was unidimensional for both DBS and LCIG. Participant expectations of the two treatments differed significantly, with expectations being higher for DBS. Perceived symptom severity was the strongest predictor of treatment expectations. CONCLUSION This scale has potential to inform clinicians about client expectations prior to advanced stage therapy for PD, with a view to the management of these expectations. Further evaluation of the scale is required across different treatment contexts.
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Affiliation(s)
- Andrea M Loftus
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Chloe Nielsen
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Emily J Corti
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Sergio Starkstein
- Faculty of Health and Medical Sciences, University of Western Australia, UWA Health Campus (QEII), Monash Avenue, Nedlands, WA, Australia
| | - Natalie Gasson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Sarah J Egan
- Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia.,enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Geraedts VJ, Koch M, Kuiper R, Kefalas M, Bäck THW, van Hilten JJ, Wang H, Middelkoop HAM, van der Gaag NA, Contarino MF, Tannemaat MR. Preoperative Electroencephalography-Based Machine Learning Predicts Cognitive Deterioration after Subthalamic Deep Brain Stimulation. Mov Disord 2021; 36:2324-2334. [PMID: 34080712 PMCID: PMC8596544 DOI: 10.1002/mds.28661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/12/2021] [Accepted: 05/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Subthalamic deep brain stimulation (STN DBS) may relieve refractory motor complications in Parkinson's disease (PD) patients. Despite careful screening, it remains difficult to determine severity of alpha‐synucleinopathy involvement which influences the risk of postoperative complications including cognitive deterioration. Quantitative electroencephalography (qEEG) reflects cognitive dysfunction in PD and may provide biomarkers of postoperative cognitive decline. Objective To develop an automated machine learning model based on preoperative EEG data to predict cognitive deterioration 1 year after STN DBS. Methods Sixty DBS candidates were included; 42 patients had available preoperative EEGs to compute a fully automated machine learning model. Movement Disorder Society criteria classified patients as cognitively stable or deteriorated at 1‐year follow‐up. A total of 16,674 EEG‐features were extracted per patient; a Boruta algorithm selected EEG‐features to reflect representative neurophysiological signatures for each class. A random forest classifier with 10‐fold cross‐validation with Bayesian optimization provided class‐differentiation. Results Tweny‐five patients were classified as cognitively stable and 17 patients demonstrated cognitive decline. The model differentiated classes with a mean (SD) accuracy of 0.88 (0.05), with a positive predictive value of 91.4% (95% CI 82.9, 95.9) and negative predictive value of 85.0% (95% CI 81.9, 91.4). Predicted probabilities between classes were highly differential (hazard ratio 11.14 [95% CI 7.25, 17.12]); the risk of cognitive decline in patients with high probabilities of being prognosticated as cognitively stable (>0.5) was very limited. Conclusions Preoperative EEGs can predict cognitive deterioration after STN DBS with high accuracy. Cortical neurophysiological alterations may indicate future cognitive decline and can be used as biomarkers during the DBS screening. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Milan Koch
- Leiden Institute of Advanced Computer Science, Leiden, The Netherlands
| | - Roy Kuiper
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Marios Kefalas
- Leiden Institute of Advanced Computer Science, Leiden, The Netherlands
| | - Thomas H W Bäck
- Leiden Institute of Advanced Computer Science, Leiden, The Netherlands
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hao Wang
- Leiden Institute of Advanced Computer Science, Leiden, The Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Neuropsychology Unit, Leiden University Institute of Psychology, Leiden, The Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurosurgery, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Martijn R Tannemaat
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Machine learning for automated EEG-based biomarkers of cognitive impairment during Deep Brain Stimulation screening in patients with Parkinson’s Disease. Clin Neurophysiol 2021; 132:1041-1048. [DOI: 10.1016/j.clinph.2021.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/19/2022]
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10
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van Hienen MM, Contarino MF, Middelkoop HAM, van Hilten JJ, Geraedts VJ. Effect of deep brain stimulation on caregivers of patients with Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2020; 81:20-27. [PMID: 33038702 DOI: 10.1016/j.parkreldis.2020.09.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Caregivers of patients with Parkinson's Disease (PD) often provide important support in the pre- and postoperative phase of Deep Brain Stimulation (DBS). DBS-associated changes of patient-functioning may affect caregiver wellbeing and impact the support system. Factors influencing caregiver-wellbeing under these circumstances are incompletely known. OBJECTIVE to systematically review studies of sufficient methodological quality on the impact of DBS on caregivers of PD patients. METHODS using PRISMA guidelines, major databases were searched up to May 2020. Five subcategories were identified: Caregiver burden, Caregiver cognitive and psychiatric functioning, Caregiver Quality of Life (QoL), Marital Satisfaction/Conflicts, and Caregiver Satisfaction. Quality was assessed using an in-house checklist. RESULTS 293 studies were identified; 12 were ultimately included. Caregiver burden, psychiatric and cognitive functioning and QoL remained relatively unchanged. Results on marital satisfaction/conflicts were contrasting: an increase in marital conflicts despite improved relationship quality scores DBS. Caregiver satisfaction with surgery was low with 50-58% of caregivers being disappointed with DBS outcomes. Concerning caregiver related factors: a higher preoperative caregiver QoL, younger age, lower scores on psychiatric rating scales, and more favourable preoperative relationship quality scores, were associated with better caregiver wellbeing. A favourable patient-profile includes younger age and age-at-onset, shorter disease duration, lower medication requirements, and lower scores on psychiatric rating scales. CONCLUSION Although most patient- and caregiver-related subdomains remained unchanged after DBS, dissatisfaction among caregivers and marital problems may constitute a large risk for a well-functioning patient-caregiver dyad. Early recognition of potential problem situations may improve post-DBS care for both patients and caregivers.
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Affiliation(s)
- Marle M van Hienen
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Department of Neurology, Haga Teaching Hospital, the Hague, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
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11
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Meyer M, Colnat-Coulbois S, Frismand S, Vidailhet P, Llorca PM, Spitz E, Schwan R. Parkinson's Disease and Bilateral Subthalamic Nuclei Deep Brain Stimulation: Beneficial Effects of Preoperative Cognitive Restructuration Therapy on Postoperative Social Adjustment. World Neurosurg 2020; 145:282-289. [PMID: 33007440 DOI: 10.1016/j.wneu.2020.09.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bilateral subthalamic nucleus deep brain stimulation improves motor symptoms and treatment-related complications in patients with Parkinson's disease. However, some patients have trouble adjusting socially after successful neurosurgery, in part because of "unrealistic" expectations and psychiatric disorders. Preoperative psychological interventions focusing on these aspects could be beneficial for such patients. METHODS We compared the outcomes of 2 psychosocial approaches-1 based on cognitive restructuration and 1 consisting of 2 interviews-with those of a control group without preoperative preparation. All patients underwent a psychometric evaluation 2 months before surgery (M-2) and again at 3 (M+3) and 6 months (M+6) after surgery. The psychometric evaluation focused on social adjustment using the social adjustment scale-self-report. The psychiatric profile of the patients was also assessed. RESULTS Of 73 patients initially enrolled, 62 performed the initial inclusion visit (M-2) and the 2 postoperative visits (M+3, M+6). For these 62 patients (52% male), the overall mean age was 59 ± 6.13 years, and the mean disease duration was 9.44 ± 3.62 years. No specific differences were observed for social adjustment between the groups or visits (M-2, M+3, M+6); however, an interaction was found in the cognitive restructuration group at M+6 for the family dimension of the social adjustment scale-self-report. CONCLUSION Our results suggest that even if no overall increase in the social adjustment score was observed, patients with Parkinson's disease eligible for neurosurgery should undergo preoperative psychosocial therapy to define their expectations and help them in their psychological restructuration. This type of therapy, complementary to psychoeducation, could represent an opportunity to prevent postoperative deception and social maladjustment.
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Affiliation(s)
- Mylène Meyer
- Service de Neurologie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France.
| | - Sophie Colnat-Coulbois
- Département de Neurochirurgie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France; Faculté de médecine, Université de Lorraine, Nancy, France
| | - Solène Frismand
- Service de Neurologie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | | | | | - Elisabeth Spitz
- Laboratoire de Psychologie de la Santé de Metz-EPSAM, EA 4360 APEMAC, UFR Sciences Humaines et Sociales, Ile du Saulcy, Université de Lorraine, Metz, France
| | - Raymund Schwan
- Faculté de médecine, Université de Lorraine, Nancy, France; Centre Psychothérapique de Nancy, Laxou, France
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Geraedts VJ, Feleus S, Marinus J, Hilten JJ, Contarino MF. What predicts quality of life after subthalamic deep brain stimulation in Parkinson’s disease? A systematic review. Eur J Neurol 2020; 27:419-428. [DOI: 10.1111/ene.14147] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022]
Affiliation(s)
- V. J. Geraedts
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
| | - S. Feleus
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
| | - J. Marinus
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
| | - J. J. Hilten
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
| | - M. F. Contarino
- Department of Neurology Leiden University Medical Center Leiden The Netherlands
- Department of Neurology Haga Teaching Hospital The Hague The Netherlands
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Geraedts V, van Hilten J, Marinus J, Mosch A, Naarding K, Hoffmann C, van der Gaag N, Contarino M. Stimulation challenge test after STN DBS improves satisfaction in Parkinson's disease patients. Parkinsonism Relat Disord 2019; 69:30-33. [DOI: 10.1016/j.parkreldis.2019.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 11/25/2022]
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