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Armengou-Garcia L, Sanchez-Catasus CA, Aviles-Olmos I, Jiménez-Huete A, Montoya-Murillo G, Gorospe A, Martin-Bastida A, Gonzalez-Quarante LH, Guridi J, Rodriguez-Oroz MC. Unilateral Magnetic Resonance-Guided Focused Ultrasound Lesion of the Subthalamic Nucleus in Parkinson's Disease: A Prospective Study. Mov Disord 2024. [PMID: 39295191 DOI: 10.1002/mds.30020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/26/2024] [Accepted: 09/04/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Unilateral subthalamic nucleus (STN) ablation using magnetic resonance-guided focused ultrasound (MRgFUS) is being explored as a new treatment for asymmetric Parkinson's disease (PD). OBJECTIVES The aims were to study the efficacy and safety of this treatment in asymmetric PD patients and to characterize the lesions. METHODS This prospective, single-center, open-label study evaluated asymmetric PD patients at 6 (n = 20) and 12 months (n = 12) after MRgFUS lesion of the STN. The primary outcome was the change in the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Part III (MDS-UPDRS III), score in off medication on the treated side and the adverse events (AEs) at 6-month follow-up. We also evaluated cognitive-neuropsychological changes, self-assessment of clinical improvement, and the correlation of the lesion volume with the motor outcomes. RESULTS On the treated side, the MDS-UPDRS III score (mean difference = 13.8) and the scores in rigidity, bradykinesia, and tremor improved (P < 0.001) throughout the follow-up compared to baseline (at 6 months: rigidity mean difference = 2.8, improvement: 83.5%; bradykinesia mean difference = 6.0, improvement: 69.4%; tremor mean difference = 4.7, improvement: 91.5%). One patient had severe weakness in the treated hemibody, 1 had moderate dyskinesia, and 1 was in moderate confusional state that became mild (weakness) or completely resolved (dyskinesia and confusional state) at 6 months. The rest of the AEs were mild. We observed no clinically relevant changes in cognitive-neuropsychological tests. The percentage of ablation of the STN correlated with the improvement in the total MDS-UPDRS III and contralateral tremor scores (P < 0.05). CONCLUSION Unilateral MRgFUS lesion of the STN resulted in a significant motor improvement. We observed no persistent severe AEs, although mild, mostly transient AEs were frequent. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Carlos A Sanchez-Catasus
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iciar Aviles-Olmos
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neuroscience, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | | | - Arantza Gorospe
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - Jorge Guridi
- Department of Neurosurgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria C Rodriguez-Oroz
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neuroscience, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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2
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Zhao G, Cheng Y, Li G, Li L, Li F, Wu Y, Du C, Yan J, Cong G, Zhao Q, Wang M, Feng K, Yin S. Unveiling the Dominant Factors in Subthalamic Stimulation for Improving Depression in Parkinson's Disease. Mov Disord Clin Pract 2024. [PMID: 39262097 DOI: 10.1002/mdc3.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/07/2024] [Accepted: 08/05/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Currently, the conclusions of studies on subthalamic nucleus (STN) deep brain stimulation (DBS) for improving Parkinson's disease (PD) with depression are inconsistent, and the reasons for improvement or deterioration remain unclear. METHODS The aim was to investigate the prognosis of PD with depression after bilateral STN-DBS and the factors related to the improvement in depression. The local and network effects of DBS on depression in PD (DPD) were further explored based on the volume of tissue activation (VTA). The study analyzed 80 primary PD patients who had undergone bilateral STN-DBS, comprising 47 patients with improved depression and 33 patients without improvement. Two groups of clinical profiles and stimulation parameters were compared, and the network models for improving depression were constructed. RESULTS The improvement in depression was closely associated with improvement in anxiety (odd rate [OR] = 1.067, P = 0.006) and the standardized space left y-coordinate (OR = 0.253, P = 0.005). The VTA overlapping with the left motor STN subregion is most significantly associated with improvement in depression (RSpearman = 0.53, P < 0.001; RPearson = 0.43, P < 0.001). The y-coordinates in the improvement group were closer to the optimal stimulation site for improving motor symptoms. Finally, both the structural and functional network models indicate a positive correlation between depression improvement and the connectivity of the sensorimotor cortex. CONCLUSION The amelioration of DPD is primarily attributed to the stimulation of bilateral motor STN, particularly on the left. However, this stimulatory effect manifests as an indirect influence.
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Affiliation(s)
- Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, China
| | - Yifeng Cheng
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Guangfeng Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Lanxin Li
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Feng Li
- Department of Neurology, Drum Tower Clinical College, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Yuzhang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Chuan Du
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Jingtao Yan
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Guangyan Cong
- Department of Neurology, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, China
| | - Qiyuan Zhao
- Department of Neurology, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, China
| | - Min Wang
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Keke Feng
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
| | - Shaoya Yin
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, China
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3
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Del Prete E, Vadi G, Bellini G, Di Carlo DT, Frosini D, Ceravolo R. Weight gain after Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: is there a role for GLP-1 agonists? Neurol Sci 2024:10.1007/s10072-024-07720-4. [PMID: 39126445 DOI: 10.1007/s10072-024-07720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Eleonora Del Prete
- Department of Neuroscience, Neurology Unit, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.
| | - Gabriele Vadi
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Gabriele Bellini
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Davide Tiziano Di Carlo
- Department of Neuroscience, Neurosurgery Unit, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniela Frosini
- Department of Neuroscience, Neurology Unit, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
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4
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Li T, Wang J, Liu C, Li S, Wang K, Chang S. Adaptive fuzzy iterative learning control based neurostimulation system and in-silico evaluation. Cogn Neurodyn 2024; 18:1767-1778. [PMID: 39104687 PMCID: PMC11297872 DOI: 10.1007/s11571-023-10040-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 08/07/2024] Open
Abstract
Closed-loop neural stimulation has been an effective treatment for epilepsy patients. Currently, most closed-loop neural stimulation strategies are designed based on accurate neural models. However, the uncertainty and complexity of the neural system make it difficult to build an accurate neural model, which poses a significant challenge to the design of the controller. This paper proposes an Adaptive Fuzzy Iterative Learning Control (AFILC) framework for closed-loop neural stimulation, which can realize neuromodulation with no model or model uncertainty. Recognizing the periodic characteristics of neural stimulation and neuronal firing, Iterative Learning Control (ILC) is employed as the primary controller. Furthermore, a fuzzy optimization module is established to update the internal parameters of the ILC controller in real-time. This module enhances the anti-interference ability of the control system and reduces the influence of initial controller parameters on the control process. The efficacy of this strategy is evaluated using a neural computational model. The simulation results validate the capability of the AFILC strategy to suppress epileptic states. Compared with ILC-based closed-loop neurostimulation schemes, the AFILC-based neurostimulation strategy has faster convergence speed and stronger anti-interference ability. Moreover, the control algorithm is implemented based on a digital signal processor, and the hardware-in-the-loop experimental platform is implemented. The experimental results show that the control method has good control performance and computational efficiency, which provides the possibility for future application in clinical research.
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Affiliation(s)
- Tong Li
- School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072 China
| | - Jiang Wang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072 China
| | - Chen Liu
- School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072 China
| | - Shanshan Li
- School of Automation and Electrical Engineering, Tianjin University of Technology and Educations, Tianjin, 300222 China
| | - Kuanchuan Wang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072 China
| | - Siyuan Chang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072 China
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5
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Carlino MF, Gielen G. Brain Feature Extraction With an Artifact-Tolerant Multiplexed Time-Encoding Neural Frontend for True Real-Time Closed-Loop Neuromodulation. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2024; 18:511-522. [PMID: 38117616 DOI: 10.1109/tbcas.2023.3344889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Closed-loop neuromodulation is emerging as a more effective and targeted solution for the treatment of neurological symptoms compared to traditional open-loop stimulation. The majority of the present designs lack the ability to continuously record brain activity during electrical stimulation; hence they cannot fully monitor the treatment's effectiveness. This is due to the large stimulation artifacts that can saturate the sensitive readout circuits. To overcome this challenge, this work presents a rapid-artifact-recovery time-multiplexed neural readout frontend in combination with backend linear interpolation to reconstruct the artifact-corrupted local field potentials' (LFP) features. Our hybrid technique is an alternative approach to avoid power-hungry large-dynamic-range readout architectures or large and complex artifact template subtraction circuits. We discuss the design and measurements of a prototype implementation of the proposed readout frontend in 180-nm CMOS. It combines time multiplexing and time-domain conversion in a novel 13-bit incremental ADC, requiring only 0.0018 mm2/channel of readout area despite the large 180-nm CMOS process used, while consuming only 4.51 μW/channel. This is the smallest reported area for stimulation-voltage-compatible technologies (i.e. ≥ 65 nm). The frontend also yields a best-in-class peak total harmonic distortion of -72.6 dB @2.5-mVpp input, thanks to its implicit DAC mismatch-error shaping property. We employ the chip to measure brain LFP signals corrupted with artifacts, then perform linear interpolation and feature extraction on the measured signals and evaluate the reconstruction quality, using a set of sixteen commonly used features and three stimulation scenarios. The results show relative accuracies above 95% with respect to the situation without artifacts. This work is an ideal candidate for integration in high-channel-count true closed-loop neuromodulation systems.
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Maher S, Donlon E, Mullane G, Walsh R, Lynch T, Fearon C. Treatment of Apathy in Parkinson's Disease and Implications for Underlying Pathophysiology. J Clin Med 2024; 13:2216. [PMID: 38673489 PMCID: PMC11051068 DOI: 10.3390/jcm13082216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Apathy is a prevalent and highly debilitating non-motor symptom of Parkinson's disease (PD) that is often overlooked in clinical practice due to its subtle nature. This review aims to provide a comprehensive overview of the current evidence for the treatment of apathy in PD, highlighting recent advancements and emerging therapeutic avenues. In this review, we analyse a diverse array of treatment strategies for apathy in PD, including pharmacological interventions, non-pharmacological approaches, and emerging neuromodulation techniques. We evaluate the efficacy, safety, and limitations of established pharmacotherapies, such as dopaminergic agents, antidepressants, and cognitive enhancers. Additionally, we examine the promising role of non-pharmacological interventions, encompassing psychotherapies and behavioural interventions, in ameliorating apathetic symptoms. Furthermore, this review explores the effects of neuromodulation techniques on apathy, including the modulation of apathy via deep brain stimulation and emerging data on the potential influence of transcranial magnetic stimulation (TMS) on apathy in PD. Ultimately, a deeper understanding of effective treatment strategies for apathy has the potential to significantly improve the quality of life and overall well-being of individuals living with PD.
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Affiliation(s)
- Senan Maher
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Eoghan Donlon
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Gerard Mullane
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
| | - Richard Walsh
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Tim Lynch
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Conor Fearon
- Dublin Neurological Institute, Mater Misericordiae Hospital, D07 W7XF Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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7
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Moscovich M, Aquino CHD, Marinho MM, Barcelos LB, Felício AC, Halverson M, Hamani C, Ferraz HB, Munhoz RP. Fundamentals of deep brain stimulation for Parkinson's disease in clinical practice: part 2. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38653486 PMCID: PMC11039109 DOI: 10.1055/s-0044-1786037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/30/2023] [Indexed: 04/25/2024]
Abstract
The field of neuromodulation has evolved significantly over the past decade. Developments include novel indications and innovations of hardware, software, and stimulation techniques leading to an expansion in scope and role of these techniques as powerful therapeutic interventions. In this review, which is the second part of an effort to document and integrate the basic fundamentals and recent successful developments in the field, we will focus on classic paradigms for electrode placement as well as new exploratory targets, mechanisms of neuromodulation using this technique and new developments, including focused ultrasound driven ablative procedures.
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Affiliation(s)
- Mariana Moscovich
- Christian-Albrechts University, Department of Neurology, Kiel, Germany.
| | - Camila Henriques de Aquino
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences, Calgary, AB, Canada.
- University of Calgary, Hotchkiss Brain Institute, Calgary, AB, Canada.
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | - Murilo Martinez Marinho
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | - Lorena Broseghini Barcelos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | | | - Matthew Halverson
- University of Utah, Department of Neurology, Salt Lake City, Utah, United States.
| | - Clement Hamani
- University of Toronto, Sunnybrook Hospital, Toronto, ON, Canada.
| | - Henrique Ballalai Ferraz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
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8
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Aquino CHD, Moscovich M, Marinho MM, Barcelos LB, Felício AC, Halverson M, Hamani C, Ferraz HB, Munhoz RP. Fundamentals of deep brain stimulation for Parkinson's disease in clinical practice: part 1. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38653485 PMCID: PMC11039067 DOI: 10.1055/s-0044-1786026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024]
Abstract
Deep brain stimulation (DBS) is recognized as an established therapy for Parkinson's disease (PD) and other movement disorders in the light of the developments seen over the past three decades. Long-term efficacy is established for PD with documented improvement in the cardinal motor symptoms of PD and levodopa-induced complications, such as motor fluctuations and dyskinesias. Timing of patient selection is crucial to obtain optimal benefits from DBS therapy, before PD complications become irreversible. The objective of this first part review is to examine the fundamental concepts of DBS for PD in clinical practice, discussing the historical aspects, patient selection, potential effects of DBS on motor and non-motor symptoms, and the practical management of patients after surgery.
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Affiliation(s)
- Camila Henriques de Aquino
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences, Calgary, AB, Canada.
- University of Calgary, Hotchkiss Brain Institute, Calgary, AB, Canada.
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | - Mariana Moscovich
- Christian-Albrechts University, Department of Neurology, Kiel, Germany.
| | - Murilo Martinez Marinho
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | - Lorena Broseghini Barcelos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | | | - Matthew Halverson
- University of Utah, Department of Neurology, Salt Lake City, Utah, United States.
| | - Clement Hamani
- University of Toronto, Sunnybrook Hospital, Toronto, ON, Canada.
| | - Henrique Ballalai Ferraz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
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Martínez Fernández R, Natera Villalba E, Rodriguez-Rojas R, Del Álamo M, Pineda-Pardo JA, Obeso I, Mata-Marín D, Guida P, Jimenez-Castellanos T, Pérez-Bueno D, Duque A, Máñez Miró JU, Gasca-Salas C, Matarazzo M, Obeso JA. Unilateral focused ultrasound subthalamotomy in early Parkinson's disease: a pilot study. J Neurol Neurosurg Psychiatry 2024; 95:206-213. [PMID: 37673642 DOI: 10.1136/jnnp-2023-331211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Unilateral focused ultrasound subthalamotomy (FUS-STN) improves motor features of Parkinson's disease (PD) in moderately advanced patients. The less invasive nature of FUS makes its early application in PD feasible. We aim to assess the safety and efficacy of unilateral FUS-STN in patients with PD of less than 5 years from diagnosis (early PD). METHODS Prospective, open-label study. Eligible patients with early PD had highly asymmetrical cardinal features. The primary outcome was safety, defined as treatment-related adverse events at 6 months. Secondary outcomes included efficacy, assessed as motor improvement in the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), motor fluctuations, non-motor symptoms, daily living activities, quality of life, medication and patients' impression of change. RESULTS Twelve patients with PD (median age 52.0 (IQR 49.8-55.3) years, median time from diagnosis 3.0 (2.1-3.9) years) underwent unilateral FUS-STN. Within 2 weeks after treatment, five patients developed dyskinesia on the treated side, all resolved after levodopa dose adjustment. One patient developed mild contralateral motor weakness which fully resolved in 4 weeks. One patient developed dystonic foot and another hand and foot dystonia. The latter impaired gait and became functionally disabling initially. Both cases were well controlled with botulinum toxin injections. The off-medication motor MDS-UPDRS score for the treated side improved at 12 months by 68.7% (from 14.5 to 4.0, p=0.002), and the total motor MDS-UPDRS improved by 49.0% (from 26.5 to 13.0, p=0.002). Eleven patients (92%) reported global improvement 12 months after treatment. CONCLUSION Unilateral FUS-STN may be safe and effective to treat motor manifestations in patients with early PD. A larger confirmatory trial is warranted. TRIAL REGISTRATION NUMBER NCT04692116.
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Affiliation(s)
- Raúl Martínez Fernández
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
| | - Elena Natera Villalba
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- PhD Medicine Program, Universidad Autonoma de Madrid, Madrid, Spain
| | - Rafael Rodriguez-Rojas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
| | - Marta Del Álamo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Jose A Pineda-Pardo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
| | - Ignacio Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - David Mata-Marín
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- PhD Neuroscience Program, Universidad Autonoma de Madrid, Madrid, Spain
| | - Pasqualina Guida
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- PhD Neuroscience Program, Universidad Autonoma de Madrid, Madrid, Spain
| | - Tamara Jimenez-Castellanos
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- PhD Epidemiology and Public Health Program, Universidad Autonoma de Madrid, Madrid, Spain
| | - Diana Pérez-Bueno
- Anesthesia Department, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Alicia Duque
- Neuroradiology Department, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Jorge U Máñez Miró
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- PhD Neuroscience Program, Universidad Autonoma de Madrid, Madrid, Spain
| | - Carmen Gasca-Salas
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
| | - Michele Matarazzo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
| | - Jose A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto Carlos III, CIBERNED, Madrid, Spain
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10
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Béreau M, Kibleur A, Servant M, Clément G, Dujardin K, Rolland AS, Wirth T, Lagha-Boukbiza O, Voirin J, Santin MDN, Hainque E, Grabli D, Comte A, Drapier S, Durif F, Marques A, Eusebio A, Azulay JP, Giordana C, Houeto JL, Jarraya B, Maltete D, Rascol O, Rouaud T, Tir M, Moreau C, Danaila T, Prange S, Tatu L, Tranchant C, Corvol JC, Devos D, Thobois S, Desmarets M, Anheim M. Motivational and cognitive predictors of apathy after subthalamic nucleus stimulation in Parkinson's disease. Brain 2024; 147:472-485. [PMID: 37787488 DOI: 10.1093/brain/awad324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 10/04/2023] Open
Abstract
Postoperative apathy is a frequent symptom in Parkinson's disease patients who have undergone bilateral deep brain stimulation of the subthalamic nucleus. Two main hypotheses for postoperative apathy have been suggested: (i) dopaminergic withdrawal syndrome relative to postoperative dopaminergic drug tapering; and (ii) direct effect of chronic stimulation of the subthalamic nucleus. The primary objective of our study was to describe preoperative and 1-year postoperative apathy in Parkinson's disease patients who underwent chronic bilateral deep brain stimulation of the subthalamic nucleus. We also aimed to identify factors associated with 1-year postoperative apathy considering: (i) preoperative clinical phenotype; (ii) dopaminergic drug management; and (iii) volume of tissue activated within the subthalamic nucleus and the surrounding structures. We investigated a prospective clinical cohort of 367 patients before and 1 year after chronic bilateral deep brain stimulation of the subthalamic nucleus. We assessed apathy using the Lille Apathy Rating Scale and carried out a systematic evaluation of motor, cognitive and behavioural signs. We modelled the volume of tissue activated in 161 patients using the Lead-DBS toolbox and analysed overlaps within motor, cognitive and limbic parts of the subthalamic nucleus. Of the 367 patients, 94 (25.6%) exhibited 1-year postoperative apathy: 67 (18.2%) with 'de novo apathy' and 27 (7.4%) with 'sustained apathy'. We observed disappearance of preoperative apathy in 22 (6.0%) patients, who were classified as having 'reversed apathy'. Lastly, 251 (68.4%) patients had neither preoperative nor postoperative apathy and were classified as having 'no apathy'. We identified preoperative apathy score [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.10, 1.22; P < 0.001], preoperative episodic memory free recall score (OR 0.93; 95% CI 0.88, 0.97; P = 0.003) and 1-year postoperative motor responsiveness (OR 0.98; 95% CI 0.96, 0.99; P = 0.009) as the main factors associated with postoperative apathy. We showed that neither dopaminergic dose reduction nor subthalamic stimulation were associated with postoperative apathy. Patients with 'sustained apathy' had poorer preoperative fronto-striatal cognitive status and a higher preoperative action initiation apathy subscore. In these patients, apathy score and cognitive status worsened postoperatively despite significantly lower reduction in dopamine agonists (P = 0.023), suggesting cognitive dopa-resistant apathy. Patients with 'reversed apathy' benefited from the psychostimulant effect of chronic stimulation of the limbic part of the left subthalamic nucleus (P = 0.043), suggesting motivational apathy. Our results highlight the need for careful preoperative assessment of motivational and cognitive components of apathy as well as executive functions in order to better prevent or manage postoperative apathy.
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Affiliation(s)
- Matthieu Béreau
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Astrid Kibleur
- LIP/PC2S, Université Grenoble Alpes, Université Savoie Mont Blanc, 38040 Grenoble Cedex 9, France
| | - Mathieu Servant
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Gautier Clément
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Kathy Dujardin
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Anne-Sophie Rolland
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Thomas Wirth
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Marie des Neiges Santin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Elodie Hainque
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Grabli
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - Alexandre Comte
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
| | - Sophie Drapier
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Rennes, 35000 Rennes, France
| | - Franck Durif
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Ana Marques
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Jean-Philippe Azulay
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Caroline Giordana
- Department of Neurology, NS-Park/F-CRIN network, Centre Hospitalier Universitaire de Nice, 06002 Nice, France
| | - Jean-Luc Houeto
- Department of Neurology, NS-Park/F-CRIN network, Limoges University Hospital, Inserm, U1094, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges University Hospital,87042 Limoges, France
| | - Béchir Jarraya
- Neuroscience Pole, NS-Park/F-CRIN network, Hôpital Foch, Suresnes, University of Versailles Paris-Saclay, INSERM-CEA NeuroSpin, 91191 Gif-sur-Yvette, France
| | - David Maltete
- Department of Neurology, NS-Park/F-CRIN network, Rouen University Hospital and University of Rouen, 76000 Rouen, France
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, 76130 Mont-Saint-Aignan, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neuroscience, CIC1436, NS-Park/F-CRIN network, NeuroToul Center of Excellence, Toulouse University Hospital, INSERM, CHU of Toulouse, 31000 Toulouse, France
| | - Tiphaine Rouaud
- Department of Neurology, Centre Expert Parkinson, NS-Park/F-CRIN network, CHU Nantes, 44093 Nantes, France
| | - Mélissa Tir
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Caroline Moreau
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Teodor Danaila
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Stéphane Prange
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
| | - Laurent Tatu
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Christine Tranchant
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jean-Christophe Corvol
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Devos
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Stephane Thobois
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
- Institut des Sciences Cognitives Marc Jeannerot, CNRS, UMR5229, 69675 Bron, France
| | - Maxime Desmarets
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, 25000 Besançon, France
| | - Mathieu Anheim
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
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11
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Debove I, Paschen S, Amstutz D, Cardoso F, Corvol JC, Fung VSC, Lang AE, Martinez Martin P, Rodríguez-Oroz MC, Weintraub D, Krack P, Deuschl G. Management of Impulse Control and Related Disorders in Parkinson's Disease: An Expert Consensus. Mov Disord 2024; 39:235-248. [PMID: 38234035 DOI: 10.1002/mds.29700] [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: 08/08/2023] [Revised: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Impulse-control and related behavioral disorders (ICBDs) significantly impact the lives of Parkinson's disease (PD) patients and caregivers, with lasting consequences if undiagnosed and untreated. While ICBD pathophysiology and risk factors are well-studied, a standardized severity definition and treatment evidence remain elusive. OBJECTIVE This work aimed to establish international expert consensus on ICBD treatment strategies. To comprehensively address diverse treatment availabilities, experts from various continents were included. METHODS From 2021 to 2023, global movement disorders specialists engaged in a Delphi process. A core expert group initiated surveys, involving a larger panel in three iterations, leading to refined severity definitions and treatment pathways. RESULTS Experts achieved consensus on defining ICBD severity, emphasizing regular PD patient screenings for early detection. General treatment recommendations focused on continuous monitoring, collaboration with significant others, and seeking specialist advice for legal or financial challenges. For mild to severe ICBDs, gradual reduction in dopamine agonists was endorsed, followed by reductions in other PD medications. Second-line treatment strategies included diverse approaches like reversing the last medication change, cognitive behavior therapy, subthalamic nucleus deep brain stimulation, and specific medications like quetiapine, clozapine, and antidepressants. The panel reached consensus on distinct treatment pathways for punding and dopamine dysregulation syndrome, formulating therapy recommendations. Comprehensive discussions addressed management strategies for the exacerbation of either motor or non-motor symptoms following the proposed treatments. CONCLUSION The consensus offers in-depth insights into ICBD management, presenting clear severity criteria and expert consensus treatment recommendations. The study highlights the critical need for further research to enhance ICBD management. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ines Debove
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Paschen
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Deborah Amstutz
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Francisco Cardoso
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, The Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jean-Christophe Corvol
- Department of Neurology, Sorbonne Université, Paris Brain Institute (ICM), Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony E Lang
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Pablo Martinez Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease Research, Education and Clinical Center (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
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12
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Hong J, Xie H, Chen Y, Liu D, Wang T, Xiong K, Mao Z. Effects of STN-DBS on cognition and mood in young-onset Parkinson's disease: a two-year follow-up. Front Aging Neurosci 2024; 15:1177889. [PMID: 38292047 PMCID: PMC10824910 DOI: 10.3389/fnagi.2023.1177889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024] Open
Abstract
Background The effects of subthalamic nucleus deep brain stimulation (STN-DBS) on the cognition and mood of patients with PD are still not uniformly concluded, and young-onset Parkinson's disease (YOPD) is even less explored. Objective To observe the effectiveness of STN-DBS on the cognition and mood of YOPD patients. Methods A total of 27 subjects, with a mean age at onset of 39.48 ± 6.24 and age at surgery for STN-DBS of 48.44 ± 4.85, were followed up preoperatively and for 2 years postoperatively. Using the Unified Parkinson disease rating scale (UPDRS), H&Y(Hoehn and Yahr stage), 39-Item Parkinson's Disease Questionnaire (PDQ-39), Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) to assess motor, cognition, and mood. Results At the 2-year follow-up after STN-DBS, YOPD patients showed significant improvements in motor and quality of life (UPDRS III: p < 0.001, PDQ-39: p < 0.001); overall cognition was not significantly different from preoperative (MMSE: p = 0.275, MoCA: p = 0.913), although language function was significantly impaired compared to preoperative (MMSE: p = 0.004, MoCA: p = 0.009); depression and anxiety symptoms also improved significantly (HAMD: p < 0.001, HAMA: p < 0.001) and the depression score correlated significantly with motor (preoperative: r = 0.493, p = 0.009), disease duration (preoperative: r = 0.519, p = 0.006; postoperative: r = 0.406, p = 0.036) and H&Y (preoperative: r = 0.430, p = 0.025; postoperative: r = 0.387, p = 0.046); total anxiety scores were also significantly correlated with motor (preoperative: r = 0.553, p = 0.003; postoperative: r = 0.444, p = 0.020), disease duration (preoperative: r = 0.417, p = 0.031), PDQ-39 (preoperative: r = 0.464, p = 0.015) and H&Y (preoperative: r = 0.440, p = 0.022; postoperative: r = 0.526, p = 0.005). Conclusion STN-DBS is a safe and effective treatment for YOPD. The mood improved significantly, and overall cognition was not impaired, were only verbal fluency decreased but did not affect the improvement in quality of life.
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Affiliation(s)
- Jun Hong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Huimin Xie
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuhua Chen
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
| | - Di Liu
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Tianyu Wang
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
- Hebei Key Laboratory of Nerve Injury and Repair, Chengde Medical University, Chengde, China
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, China
- Hunan Key Laboratory of Ophthalmology, Central South University, Changsha, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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13
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Magalhães AD, Amstutz D, Petermann K, Debove I, Sousa M, Maradan-Gachet ME, Lachenmayer ML, Waskönig J, Murcia-Carretero S, Diamantaras AA, Tinkhauser G, Nowacki A, Pollo C, Rodriguez-Blazquez C, Martinez-Martin P, Krack P. Subthalamic stimulation has acute psychotropic effects and improves neuropsychiatric fluctuations in Parkinson's disease. BMJ Neurol Open 2024; 6:e000524. [PMID: 38196982 PMCID: PMC10773312 DOI: 10.1136/bmjno-2023-000524] [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] [Accepted: 10/24/2023] [Indexed: 01/11/2024] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) is a well-established treatment for motor complications in Parkinson's disease (PD). However, its effects on neuropsychiatric symptoms remain disputed. The aim of this study was to evaluate the effects of STN-DBS on neuropsychiatric symptoms in PD. Methods We retrospectively assessed 26 patients with PD who underwent a preoperative levodopa challenge and postoperative levodopa and stimulation challenges 1 year after STN-DBS. Based on the Neuropsychiatric Fluctuations Scale, Neuropsychiatric State Scores and Neuropsychiatric Fluctuation Indices (NFIs) were calculated. Mixed-effects models with random effects for intercept were used to examine the association of Neuropsychiatric State Score and NFI with the different assessment conditions. Results In acute challenge conditions, there was an estimated increase of 15.9 points in the Neuropsychiatric State Score in stimulation ON conditions (95% CI 11.4 to 20.6, p<0.001) and 7.6 points in medication ON conditions (95% CI 3.3 to 11.9, p<0.001). Neuropsychiatric fluctuations induced by levodopa, quantified with NFI, decreased by 35.54% (95% CI 49.3 to 21.8, p<0.001) 1 year after STN-DBS. Conclusions Bilateral STN-DBS at therapeutic parameters has acute psychotropic effects similar to levodopa and can modulate and decrease levodopa-induced neuropsychiatric fluctuations.
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Affiliation(s)
- Andreia D Magalhães
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Deborah Amstutz
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Katrin Petermann
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Ines Debove
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Mário Sousa
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Marie E Maradan-Gachet
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | | | - Julia Waskönig
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | | | | | - Gerd Tinkhauser
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Andreas Nowacki
- Department of Neurosurgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital University Hospital Bern, Bern, Switzerland
| | - Carmen Rodriguez-Blazquez
- National Epidemiology Center, Carlos III Health Institute, Madrid, Spain
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Health Institute, Madrid, Spain
| | - Paul Krack
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
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14
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Pal G, Corcos DM, Metman LV, Israel Z, Bergman H, Arkadir D. Cognitive Effects of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease with GBA1 Pathogenic Variants. Mov Disord 2023; 38:2155-2162. [PMID: 37916476 PMCID: PMC10990226 DOI: 10.1002/mds.29647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 11/03/2023] Open
Abstract
Genetic subtyping of patients with Parkinson's disease (PD) may assist in predicting the cognitive and motor outcomes of subthalamic deep brain stimulation (STN-DBS). Practical questions were recently raised with the emergence of new data regarding suboptimal cognitive outcomes after STN-DBS in individuals with PD associated with pathogenic variants in glucocerebrosidase gene (GBA1-PD). However, a variety of gaps and controversies remain. (1) Does STN-DBS truly accelerate cognitive deterioration in GBA1-PD? If so, what is the clinical significance of this acceleration? (2) How should the overall risk-to-benefit ratio of STN-DBS in GBA1-PD be established? (3) If STN-DBS has a negative effect on cognition in GBA1-PD, how can this effect be minimized? (4) Should PD patients be genetically tested before STN-DBS? (5) How should GBA1-PD patients considering STN-DBS be counseled? We aim to summarize the currently available relevant data and detail the gaps and controversies that exist pertaining to these questions. In the absence of evidence-based data, all authors strongly agree that clinicians should not categorically deny DBS to PD patients based solely on genotype (GBA1 status). We suggest that PD patients considering DBS may be offered genetic testing for GBA1, where available and feasible, so the potential risks and benefits of STN-DBS can be properly weighed by both the patient and clinician. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Gian Pal
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States
| | - Leo Verhagen Metman
- Parkinson’s Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zvi Israel
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Medical Neurobiology, Institute of Medical Research Israel–Canada (IMRIC), The Hebrew University–Hadassah Medical School, Jerusalem, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - David Arkadir
- Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Jerusalem, Israel
- Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
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15
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Zhao G, Cheng Y, Wang M, Wu Y, Yan J, Feng K, Yin S. Exploring the network effects of deep brain stimulation for rapid eye movement sleep behavior disorder in Parkinson's disease. Acta Neurochir (Wien) 2023; 165:3375-3384. [PMID: 37770797 DOI: 10.1007/s00701-023-05806-0] [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: 07/03/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The research findings on the effects of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) with Rapid Eye Movement Sleep Behavior Disorder (RBD) are inconsistent, and there is a lack of research on DBS electrode sites and their network effects for the explanation of the differences. Our objective is to explore the optimal stimulation sites (that is the sweet spot) and the brain network effects of STN-DBS for RBD in PD. METHODS In this study, among the 50 PD patients who underwent STN-DBS treatment, 24 PD patients with RBD were screened. According to clinical scores and imaging data, the sweet spot of STN-DBS was analyzed in PD patients with RBD, and the optimal structure and functional network models of subthalamic stimulation were constructed. RESULTS Bilateral STN-DBS can effectively improve the symptoms of RBD and other non-motor symptoms in 24 PD patients with RBD. RBD Questionnaire-Hong Kong (RBDQ-HK) score was 41.33 ± 17.45 at baseline and 30.83 ± 15.83 at 1-year follow-up, with statistical significance between them (P < 0.01). However, the MoCA score was an exception with a baseline of 22.04 ± 4.28 and a 1-year follow-up of 21.58 ± 4.33, showing no statistical significance (P = 0.12). The sweet spot and optimal network connectivity models for RBD improvement have been validated as effective. CONCLUSIONS Bilateral STN-DBS can improve the symptoms of RBD in PD. There exist the sweet spot and brain network effects of bilateral STN-DBS in the treatment of PD with RBD. Our study also demonstrates that RBD is a brain network disease.
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Affiliation(s)
- Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
- Department of Neurosurgery, Lu'an Hospital Affiliated to Anhui Medical University, Lu'an, 237000, China
| | - Yifeng Cheng
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Min Wang
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Yuzhang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Jingtao Yan
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China
| | - Keke Feng
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
| | - Shaoya Yin
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300070, China.
- Department of Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
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16
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Jia T, Chen J, Wang YD, Xiao C, Zhou CY. A subthalamo-parabrachial glutamatergic pathway is involved in stress-induced self-grooming in mice. Acta Pharmacol Sin 2023; 44:2169-2183. [PMID: 37322164 PMCID: PMC10618182 DOI: 10.1038/s41401-023-01114-6] [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: 12/14/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
Excessive self-grooming is an important behavioral phenotype of the stress response in rodents. Elucidating the neural circuit that regulates stress-induced self-grooming may suggest potential treatment to prevent maladaptation to stress that is implicated in emotional disorders. Stimulation of the subthalamic nucleus (STN) has been found to induce strong self-grooming. In this study we investigated the role of the STN and a related neural circuit in mouse stress-related self-grooming. Body-restraint and foot-shock stress-induced self-grooming models were established in mice. We showed that both body restraint and foot shock markedly increased the expression of c-Fos in neurons in the STN and lateral parabrachial nucleus (LPB). Consistent with this, the activity of STN neurons and LPB glutamatergic (Glu) neurons, as assessed with fiber photometry recording, was dramatically elevated during self-grooming in the stressed mice. Using whole-cell patch-clamp recordings in parasagittal brain slices, we identified a monosynaptic projection from STN neurons to LPB Glu neurons that regulates stress-induced self-grooming in mice. Enhanced self-grooming induced by optogenetic activation of the STN-LPB Glu pathway was attenuated by treatment with fluoxetine (18 mg·kg-1·d-1, p.o., for 2 weeks) or in the presence of a cage mate. Furthermore, optogenetic inhibition of the STN-LPB pathway attenuated stress-related but not natural self-grooming. Taken together, these results suggest that the STN-LPB pathway regulates the acute stress response and is a potential target for intervention in stress-related emotional disorders.
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Affiliation(s)
- Tao Jia
- Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, China
| | - Jing Chen
- Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, China
| | - Ying-di Wang
- Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, China
| | - Cheng Xiao
- Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, China.
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, 221004, China.
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, China.
| | - Chun-Yi Zhou
- Jiangsu Province Key Laboratory in Anesthesiology, School of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, China.
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, 221004, China.
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, School of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, China.
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17
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Wang L, Li J, Pan Y, Huang P, Li D, Voon V. Subacute alpha frequency (10Hz) subthalamic stimulation for emotional processing in Parkinson's disease. Brain Stimul 2023; 16:1223-1231. [PMID: 37567462 DOI: 10.1016/j.brs.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/21/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Psychiatric comorbidities are common in Parkinson's disease (PD) and may change with high-frequency stimulation targeting the subthalamic nucleus. Numerous accounts indicate subthalamic alpha-frequency oscillation is implicated in emotional processing. While intermittent alpha-frequency (10Hz) stimulation induces positive emotional effects, with more ventromedial contacts inducing larger effects, little is known about the subacute effect of ventral 10Hz subthalamic stimulation on emotional processing. OBJECTIVE/HYPOTHESIS To evaluate the subacute effect of 10Hz stimulation at bilateral ventral subthalamic nucleus on emotional processing in PD patients using an affective task, compared to that of clinical-frequency stimulation and off-stimulation. METHODS Twenty PD patients with bilateral subthalamic deep brain stimulation for more than six months were tested with the affective task under three stimulation conditions (10Hz, 130Hz, and off-stimulation) in a double-blinded randomized design. RESULTS While 130Hz stimulation reduced arousal ratings in all patients, 10Hz stimulation increased arousal selectively in patients with higher depression scores. Furthermore, 10Hz stimulation induced a positive shift in valence rating to negative emotional stimuli in patients with lower apathy scores, and 130Hz stimulation led to more positive valence to emotional stimuli in the patients with higher apathy scores. Notably, we found correlational relationships between stimulation site and affective rating: arousal ratings increase with stimulation from anterior to posterior site, and positive valence ratings increase with stimulation from dorsal to ventral site of the ventral subthalamic nucleus. CONCLUSIONS Our findings highlight the distinctive role of 10Hz stimulation on subjective emotional experience and unveil the spatial organization of the stimulation effect.
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Affiliation(s)
- Linbin Wang
- Institute of Science and Technology for Brain-Inspired Intelligence (ISTBI), Fudan University, Shanghai, China; Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Li
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Valerie Voon
- Institute of Science and Technology for Brain-Inspired Intelligence (ISTBI), Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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18
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Steinhardt J, Lokowandt L, Rasche D, Koch A, Tronnier V, Münte TF, Meyhöfer SM, Wilms B, Brüggemann N. Mechanisms and consequences of weight gain after deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease. Sci Rep 2023; 13:14202. [PMID: 37648732 PMCID: PMC10468527 DOI: 10.1038/s41598-023-40316-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Body weight gain in combination with metabolic alterations has been observed after deep brain stimulation (DBS) of subthalamic nucleus (STN) in patients with Parkinson's disease (PD), which potentially counteracts the positive effects of motor improvement. We aimed to identify stimulation-dependent effects on motor activities, body weight, body composition, energy metabolism, and metabolic blood parameters and to determine if these alterations are associated with the local impact of DBS on different STN parcellations. We assessed 14 PD patients who underwent STN DBS (PD-DBS) before as well as 6- and 12-months post-surgery. For control purposes, 18 PD patients under best medical treatment (PD-CON) and 25 healthy controls (H-CON) were also enrolled. Wrist actigraphy, body composition, hormones, and energy expenditure measurements were applied. Electrode placement in the STN was localized, and the local impact of STN DBS was estimated. We found that STN DBS improved motor function by ~ 40% (DBS ON, Med ON). Weight and fat mass increased by ~ 3 kg and ~ 3% in PD-DBS (all P ≤ 0.005). fT3 (P = 0.001) and insulin levels (P = 0.048) increased solely in PD-DBS, whereas growth hormone levels (P = 0.001), daily physical activity, and VO2 during walking were decreased in PD-DBS (all P ≤ 0.002). DBS of the limbic part of the STN was associated with changes in weight and body composition, sedentary activity, insulin levels (all P ≤ 0.040; all r ≥ 0.56), and inversely related to HOMA-IR (P = 0.033; r = - 0.62). Daily physical activity is decreased after STN DBS, which can contribute to weight gain and an unfavorable metabolic profile. We recommend actigraphy devices to provide feedback on daily activities to achieve pre-defined activity goals.
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Affiliation(s)
- Julia Steinhardt
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Laura Lokowandt
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Dirk Rasche
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Andreas Koch
- Section Maritime Medicine, Naval Medical Institute, Kiel, Germany
| | - Volker Tronnier
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Sebastian M Meyhöfer
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Britta Wilms
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Section Maritime Medicine, Naval Medical Institute, Kiel, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany.
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19
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Béreau M, Van Waes V, Servant M, Magnin E, Tatu L, Anheim M. Apathy in Parkinson's Disease: Clinical Patterns and Neurobiological Basis. Cells 2023; 12:1599. [PMID: 37371068 DOI: 10.3390/cells12121599] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Apathy is commonly defined as a loss of motivation leading to a reduction in goal-directed behaviors. This multidimensional syndrome, which includes cognitive, emotional and behavioral components, is one of the most prevalent neuropsychiatric features of Parkinson's disease (PD). It has been established that the prevalence of apathy increases as PD progresses. However, the pathophysiology and anatomic substrate of this syndrome remain unclear. Apathy seems to be underpinned by impaired anatomical structures that link the prefrontal cortex with the limbic system. It can be encountered in the prodromal stage of the disease and in fluctuating PD patients receiving bilateral chronic subthalamic nucleus stimulation. In these stages, apathy may be considered as a disorder of motivation that embodies amotivational behavioral syndrome, is underpinned by combined dopaminergic and serotonergic denervation and is dopa-responsive. In contrast, in advanced PD patients, apathy may be considered as cognitive apathy that announces cognitive decline and PD dementia, is underpinned by diffuse neurotransmitter system dysfunction and Lewy pathology spreading and is no longer dopa-responsive. In this review, we discuss the clinical patterns of apathy and their treatment, the neurobiological basis of apathy, the potential role of the anatomical structures involved and the pathways in motivational and cognitive apathy.
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Affiliation(s)
- Matthieu Béreau
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Vincent Van Waes
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Mathieu Servant
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Eloi Magnin
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
| | - Laurent Tatu
- Département de Neurologie, CHU de Besançon, 25000 Besançon, France
- Université de Franche-Comté, LINC Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive, 25000 Besançon, France
- Laboratoire d'Anatomie, Université de Franche-Comté, 25000 Besançon, France
| | - Mathieu Anheim
- Département de Neurologie, CHU de Strasbourg, 67200 Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, 67000 Strasbourg, France
- Institut de génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), INSERM-U964, CNRS-UMR7104, Université de Strasbourg, 67400 Illkirch-Graffenstaden, France
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20
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Vanes L, Fenn-Moltu S, Hadaya L, Fitzgibbon S, Cordero-Grande L, Price A, Chew A, Falconer S, Arichi T, Counsell SJ, Hajnal JV, Batalle D, Edwards AD, Nosarti C. Longitudinal neonatal brain development and socio-demographic correlates of infant outcomes following preterm birth. Dev Cogn Neurosci 2023; 61:101250. [PMID: 37150083 PMCID: PMC10195853 DOI: 10.1016/j.dcn.2023.101250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023] Open
Abstract
Preterm birth results in premature exposure of the brain to the extrauterine environment during a critical period of neurodevelopment. Consequently, infants born preterm are at a heightened risk of adverse behavioural outcomes in later life. We characterise longitudinal development of neonatal regional brain volume and functional connectivity in the first weeks following preterm birth, sociodemographic factors, and their respective relationships to psychomotor outcomes and psychopathology in toddlerhood. We study 121 infants born preterm who underwent magnetic resonance imaging shortly after birth, at term-equivalent age, or both. Longitudinal regional brain volume and functional connectivity were modelled as a function of psychopathology and psychomotor outcomes at 18 months. Better psychomotor functioning in toddlerhood was associated with greater relative right cerebellar volume and a more rapid decrease over time of sensorimotor degree centrality in the neonatal period. In contrast, increased 18-month psychopathology was associated with a more rapid decrease in relative regional subcortical volume. Furthermore, while socio-economic deprivation was related to both psychopathology and psychomotor outcomes, cognitively stimulating parenting predicted psychopathology only. Our study highlights the importance of longitudinal imaging to better predict toddler outcomes following preterm birth, as well as disparate environmental influences on separable facets of behavioural development in this population.
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Affiliation(s)
- Lucy Vanes
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom.
| | - Sunniva Fenn-Moltu
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Laila Hadaya
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Sean Fitzgibbon
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lucilio Cordero-Grande
- Biomedical Image Technologies, TelecomunicacionETSI Telecomunicación, Universidad Politécnica de Madrid & CIBER-BBN, ISCIII, Spain
| | - Anthony Price
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Andrew Chew
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Shona Falconer
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom; Paediatric Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Serena J Counsell
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Joseph V Hajnal
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom
| | - Dafnis Batalle
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - A David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom
| | - Chiara Nosarti
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King's College London, United Kingdom; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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21
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Pasquereau B, Turner RS. Neural dynamics underlying self-control in the primate subthalamic nucleus. eLife 2023; 12:e83971. [PMID: 37204300 PMCID: PMC10259453 DOI: 10.7554/elife.83971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/18/2023] [Indexed: 05/20/2023] Open
Abstract
The subthalamic nucleus (STN) is hypothesized to play a central role in neural processes that regulate self-control. Still uncertain, however, is how that brain structure participates in the dynamically evolving estimation of value that underlies the ability to delay gratification and wait patiently for a gain. To address that gap in knowledge, we studied the spiking activity of neurons in the STN of monkeys during a task in which animals were required to remain motionless for varying periods of time in order to obtain food reward. At the single-neuron and population levels, we found a cost-benefit integration between the desirability of the expected reward and the imposed delay to reward delivery, with STN signals that dynamically combined both attributes of the reward to form a single integrated estimate of value. This neural encoding of subjective value evolved dynamically across the waiting period that intervened after instruction cue. Moreover, this encoding was distributed inhomogeneously along the antero-posterior axis of the STN such that the most dorso-posterior-placed neurons represented the temporal discounted value most strongly. These findings highlight the selective involvement of the dorso-posterior STN in the representation of temporally discounted rewards. The combination of rewards and time delays into an integrated representation is essential for self-control, the promotion of goal pursuit, and the willingness to bear the costs of time delays.
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Affiliation(s)
- Benjamin Pasquereau
- Institut des Sciences Cognitives Marc Jeannerod, UMR 5229, Centre National de la Recherche Scientifique, 69675 Bron CedexBronFrance
- Université Claude Bernard Lyon 1, 69100 VilleurbanneVilleurbanneFrance
| | - Robert S Turner
- Department of Neurobiology, Center for Neuroscience and The Center for the Neural Basis of Cognition, University of PittsburghPittsburghUnited States
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22
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Ma R, Yin Z, Chen Y, Yuan T, An Q, Gan Y, Xu Y, Jiang Y, Du T, Yang A, Meng F, Zhu G, Zhang J. Sleep outcomes and related factors in Parkinson's disease after subthalamic deep brain electrode implantation: a retrospective cohort study. Ther Adv Neurol Disord 2023; 16:17562864231161163. [PMID: 37200769 PMCID: PMC10185976 DOI: 10.1177/17562864231161163] [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: 10/18/2022] [Accepted: 02/15/2023] [Indexed: 05/20/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) improves sleep qualities in Parkinson's disease (PD) patients; however, it remains elusive whether STN-DBS improves sleep by directly influencing the sleep circuit or alleviates other cardinal symptoms such as motor functions, other confounding factors including stimulation intensity may also involve. Studying the effect of microlesion effect (MLE) on sleep after STN-DBS electrode implantation may address this issue. Objective To examine the influence of MLE on sleep quality and related factors in PD, as well as the effects of regional and lateral specific correlations with sleep outcomes after STN-DBS electrode implantation. Study Design Case-control study; Level of evidence, 3. Data Sources and Methods In 78 PD patients who underwent bilateral STN-DBS surgery in our center, we compared the sleep qualities, motor performances, anti-Parkinsonian drug dosage, and emotional conditions at preoperative baseline and postoperative 1-month follow-up. We determined the related factors of sleep outcomes and visualized the electrodes position, simulated the MLE-engendered volume of tissue lesioned (VTL), and investigated sleep-related sweet/sour spots and laterality in STN. Results MLE improves sleep quality with Pittsburgh Sleep Quality Index (PSQI) by 13.36% and Parkinson's Disease Sleep Scale-2 (PDSS-2) by 17.95%. Motor (P = 0.014) and emotional (P = 0.001) improvements were both positively correlated with sleep improvements. However, MLE in STN associative subregions, as an independent factor, may cause sleep deterioration (r = 0.348, P = 0.002), and only the left STN showed significance (r = 0.327, P = 0.004). Sweet spot analysis also indicated part of the left STN associative subregion is the sour spot indicative of sleep deterioration. Conclusion The MLE of STN-DBS can overall improve sleep quality in PD patients, with a positive correlation between motor and emotional improvements. However, independent of all other factors, the MLE in the STN associative subregion, particularly the left side, may cause sleep deterioration.
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Affiliation(s)
- Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yingchuan Chen
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tingting Du
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
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23
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Boon LI, Potters WV, Hillebrand A, de Bie RMA, Bot M, Richard Schuurman P, van den Munckhof P, Twisk JW, Stam CJ, Berendse HW, van Rootselaar AF. Magnetoencephalography to measure the effect of contact point-specific deep brain stimulation in Parkinson's disease: A proof of concept study. Neuroimage Clin 2023; 38:103431. [PMID: 37187041 PMCID: PMC10197095 DOI: 10.1016/j.nicl.2023.103431] [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: 12/21/2022] [Revised: 03/26/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for disabling fluctuations in motor symptoms in Parkinson's disease (PD) patients. However, iterative exploration of all individual contact points (four in each STN) by the clinician for optimal clinical effects may take months. OBJECTIVE In this proof of concept study we explored whether magnetoencephalography (MEG) has the potential to noninvasively measure the effects of changing the active contact point of STN-DBS on spectral power and functional connectivity in PD patients, with the ultimate aim to aid in the process of selecting the optimal contact point, and perhaps reduce the time to achieve optimal stimulation settings. METHODS The study included 30 PD patients who had undergone bilateral DBS of the STN. MEG was recorded during stimulation of each of the eight contact points separately (four on each side). Each stimulation position was projected on a vector running through the longitudinal axis of the STN, leading to one scalar value indicating a more dorsolateral or ventromedial contact point position. Using linear mixed models, the stimulation positions were correlated with band-specific absolute spectral power and functional connectivity of i) the motor cortex ipsilateral tot the stimulated side, ii) the whole brain. RESULTS At group level, more dorsolateral stimulation was associated with lower low-beta absolute band power in the ipsilateral motor cortex (p = .019). More ventromedial stimulation was associated with higher whole-brain absolute delta (p = .001) and theta (p = .005) power, as well as higher whole-brain theta band functional connectivity (p = .040). At the level of the individual patient, switching the active contact point caused significant changes in spectral power, but the results were highly variable. CONCLUSIONS We demonstrate for the first time that stimulation of the dorsolateral (motor) STN in PD patients is associated with lower low-beta power values in the motor cortex. Furthermore, our group-level data show that the location of the active contact point correlates with whole-brain brain activity and connectivity. As results in individual patients were quite variable, it remains unclear if MEG is useful in the selection of the optimal DBS contact point.
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Affiliation(s)
- Lennard I Boon
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam, The Netherlands.
| | - Wouter V Potters
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands; Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maarten Bot
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jos W Twisk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam, The Netherlands
| | - Henk W Berendse
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
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UMEMURA ATSUSHI. Deep Brain Stimulation for Parkinson's Disease. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:21-29. [PMID: 38854848 PMCID: PMC11153071 DOI: 10.14789/jmj.jmj22-0041-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/20/2022] [Indexed: 06/11/2024]
Abstract
There is a long history of surgical treatment for Parkinson's disease (PD). Currently, deep brain stimulation (DBS) has been performed as promising treatment option for medically refractory PD. DBS is an adjustable and reversible treatment using implanted medical devices to deliver electrical stimulation to precisely targeted areas of the brain. DBS modulates neurological function of the target region. The most common target for PD is the subthalamic nucleus (STN). DBS is particularly indicated for patients suffering from motor complications of dopaminergic medication such as fluctuations and dyskinesia. Although there is currently no curative treatment for PD, a combination of medical treatment and DBS provide long-term relief of motor symptoms. In this review, I introduce history, mechanism, indication, clinical outcome, complication, long term outcome, timing of surgery, surgical procedure, and current new technology concerning DBS for PD.
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Affiliation(s)
- ATSUSHI UMEMURA
- Corresponding author: Atsushi Umemura, Department of Research and Therapeutics for Movement Disorders, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan, TEL: +81-3-3813-3111 FAX: +81-3-5689-8343 E-mail: , 357th Triannual Meeting of the Juntendo Medical Society “Current Surgical Diagnosis and Treatment” 〔Held on Sep. 15, 2022〕
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Mameli F, Ruggiero F, Dini M, Marceglia S, Prenassi M, Borellini L, Cogiamanian F, Pirola E, Remore LG, Fiore G, Reitano MR, Maiorana N, Poletti B, Locatelli M, Barbieri S, Priori A, Ferrucci R. Energy Delivered by Subthalamic Deep Brain Stimulation for Parkinson Disease Correlates With Depressive Personality Trait Shift. Neuromodulation 2023; 26:394-402. [PMID: 35221204 DOI: 10.1016/j.neurom.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Despite the large amount of literature examining the potential influence of subthalamic nucleus deep brain stimulation (STN-DBS) on psychiatric symptoms and cognitive disorders, only a few studies have focused on its effect on personality. We investigated the correlation between total electrical energy delivered (TEED) and the occurrence of depressive traits in patients with Parkinson disease (PD) after one year of DBS. MATERIALS AND METHODS Our study involved 20 patients with PD (12 women, mean [±SD] age 57.60 ± 7.63 years) who underwent bilateral STN-DBS, whose personality characteristics were assessed using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), according to the core assessment program for surgical interventional therapies in Parkinson's disease (CAPSIT-PD) procedure. RESULTS We found that despite a marked improvement in motor functions and quality of life after 12 months, patients showed a significant increase in MMPI-2 subscales for depression (D scale and Depression scale) and in other content component scales (low self-esteem, work interference, and negative treatment indicators). Interestingly, only the TEED on the right side was inversely correlated with the changes in scale D (rs = -0.681, p = 0.007), whereas depressive traits did not correlate with disease duration, levodopa equivalent daily dose (LEDD) reduction, patient's age, or severity of motor symptoms. CONCLUSIONS Our preliminary observations indicate that despite the excellent motor outcome and general improvement in quality of life, DBS treatment can result in patients poorly adjusting to their personal, familiar, and socio-professional life. Different influences and multiple factors (such as TEED, intra/postsurgical procedure, coping mechanisms, and outcome expectations) may affect depressive traits. Further advances are expected to improve stimulation methods.
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Affiliation(s)
- Francesca Mameli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Fabiana Ruggiero
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Michelangelo Dini
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Marco Prenassi
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Linda Borellini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Filippo Cogiamanian
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Elena Pirola
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Luigi Gianmaria Remore
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Giorgio Fiore
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Maria Rita Reitano
- Neurology Unit I, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Natale Maiorana
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Marco Locatelli
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Sergio Barbieri
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neuroscience and Mental Health, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy; Neurology Unit I, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Roberta Ferrucci
- "Aldo Ravelli" Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy; Neurology Unit I, San Paolo University Hospital, ASST Santi Paolo e Carlo, Milan, Italy.
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Wang X, Mao Z, Yu X. Volume of tissue activated within subthalamic nucleus and clinical efficacy of deep brain stimulation in Meige syndrome. Neurol Sci 2023; 44:1643-1651. [PMID: 36622476 DOI: 10.1007/s10072-022-06594-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The clinical efficacy of deep brain stimulation (DBS) relies on the optimal electrode placement in a large extent. Subthalamic nucleus (STN) DBS was recognized as clinically effective for Meige syndrome. This study identified the correlations of volume of tissue activated (VTA) within the motor STN and the final efficacy of the surgical procedure. METHODS Clinical outcomes of the patients (n=25) were evaluated with the percentage improvement in Burke-Fahn-Marsden Dystonia Rating Scale movement (BFMDRS-M) scores at the last follow-up (LFU) visit. Pearson's correlation coefficients were calculated to identify the relationship of the final clinical outcomes with the VTA within the STN, VTA within the different STN territories, and other clinical variables. RESULTS On the whole, the patients showed an average of 59.21% improvement at the LFU visit relative to the baseline (5.72 ± 7.31 vs. 13.70 ± 7.36, P ˂ 0.001). Active electrode contacts mainly clustered in the STN motor territories. There were significant positive correlations between the BFMDRS-M percentage improvement and VTA within the STN (Pearson r = 0.434, P = 0.039) and the STN motor territories (r = 0.430, P = 0.041), but not associative or limbic STN. Other basic clinical characteristics including age, disease duration, and preoperative scores were not significantly correlated with the final outcomes. CONCLUSIONS Our study further validated the efficacy of STN-DBS in even the cases with intractable Meige syndrome. Furthermore, VTA within the motor STN could serve as a potential prognostic factor for the final clinical outcomes.
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Affiliation(s)
- Xin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, Shandong, China.
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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27
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Qian K, Wang J, Rao J, Zhang P, Sun Y, Hu W, Hao J, Jiang X, Fu P. Intraoperative microelectrode recording under general anesthesia guided subthalamic nucleus deep brain stimulation for Parkinson's disease: One institution's experience. Front Neurol 2023; 14:1117681. [PMID: 36908617 PMCID: PMC9997081 DOI: 10.3389/fneur.2023.1117681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Microelectrode recording (MER) guided subthalamic nucleus deep brain stimulation (STN-DBS) under local anesthesia (LA) is widely applied in the management of advanced Parkinson's disease (PD). Whereas, awake DBS under LA is painful and burdensome for PD patients. We analyzed the influence of general anesthesia (GA) on intraoperative MER, to assess the feasibility and effectiveness of GA in MER guided STN-DBS. Methods Retrospective analysis was performed on the PD patients, who underwent bilateral MER guided STN-DBS in Wuhan Union Hospital from July 2019 to December 2021. The patients were assigned to LA or GA group according to the anesthetic methods implemented. Multidimensional parameters, including MER signals, electrode implantation accuracy, clinical outcome and adverse events, were analyzed. Results A total of 40 PD patients were enrolled in this study, including 18 in LA group and 22 in GA group. There were no statistically significant differences in patient demographics and baseline characteristics between two groups. Although, the parameters of MER signal, including frequency, inter-spike interval (ISI) and amplitude, were obviously interfered under GA, the waveforms of MER signals were recognizable and shared similar characteristics with LA group. Both LA and GA could achieve effective electrode implantation accuracy and clinical outcome. They also shared similar adverse events postoperatively. Conclusion GA is viable and comparable to LA in MER guided STN-DBS for PD, regarding electrode implantation accuracy, clinical outcome and adverse events. Notably, GA is more friendly and acceptable to the patients who are incapable of enduring intraoperative MER under LA.
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Affiliation(s)
- Kang Qian
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiajing Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Rao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhang
- Wuhan National Laboratory for Optoelectronics, Britton Chance Center for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqiang Sun
- Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Guangdong Institute of Artificial Intelligence and Advanced Computing, Guangzhou, China
| | - Wenqing Hu
- Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Guangdong Institute of Artificial Intelligence and Advanced Computing, Guangzhou, China
| | - Jie Hao
- Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Guangdong Institute of Artificial Intelligence and Advanced Computing, Guangzhou, China
| | - Xiaobing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Fu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ling Y, Liu L, Wang S, Guo Q, Xiao Q, Liu Y, Qu B, Wen Z, Li Y, Zhang C, Wu B, Huang Z, Chu J, Chen L, Liu J, Jiang N. Characteristics of Electroencephalogram in the Prefrontal Cortex during Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease under Propofol General Anesthesia. Brain Sci 2022; 13:brainsci13010062. [PMID: 36672044 PMCID: PMC9856588 DOI: 10.3390/brainsci13010062] [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: 11/24/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Monitoring the depth of anesthesia by electroencephalogram (EEG) based on the prefrontal cortex is an important means to achieve accurate regulation of anesthesia for subthalamic nucleus (STN) deep brain stimulation (DBS) under general anesthesia in patients with Parkinson's disease (PD). However, no previous study has conducted an in-depth investigation into this monitoring data. Here, we aimed to analyze the characteristics of prefrontal cortex EEG during DBS with propofol general anesthesia in patients with PD and determine the reference range of parameters derived from the depth of anesthesia monitoring. Additionally, we attempted to explore whether the use of benzodiazepines in the 3 days during hospitalization before surgery impacted the interpretation of the EEG parameters. MATERIALS AND METHODS We included the data of 43 patients with PD who received STN DBS treatment and SedLine monitoring during the entire course of general anesthesia with propofol in a single center. Eighteen patients (41.86%) took benzodiazepines during hospitalization. We divided the anesthesia process into three stages: awake state before anesthesia, propofol anesthesia state, and shallow anesthesia state during microelectrode recording (MER). We analyzed the power spectral density (PSD) and derived parameters of the patients' prefrontal EEG, including the patient state index (PSI), spectral edge frequency (SEF) of the left and right sides, and the suppression ratio. The baseline characteristics, preoperative medication, preoperative frontal lobe image characteristics, preoperative motor and non-motor evaluation, intraoperative vital signs, internal environment and anesthetic information, and postoperative complications are listed. We also compared the groups according to whether they took benzodiazepines before surgery during hospitalization. RESULTS The average PSI of the awake state, propofol anesthesia state, and MER state were 89.86 ± 6.89, 48.68 ± 12.65, and 62.46 ± 13.08, respectively. The preoperative administration of benzodiazepines did not significantly affect the PSI or SEF, but did reduce the total time of suppression, maximum suppression ratio, and the PSD of beta and gamma during MER. Regarding the occurrence of postoperative delirium and mini-mental state examination (MMSE) scores, there was no significant difference between the two groups (chi-square test, p = 0.48; Mann-Whitney U test, p = 0.30). CONCLUSION For the first time, we demonstrate the reference range of the derived parameters of the depth of anesthesia monitoring and the characteristics of the prefrontal EEG of patients with PD in the awake state, propofol anesthesia state, and shallow anesthesia during MER. Taking benzodiazepines in the 3 days during hospitalization before surgery reduces suppression and the PSD of beta and gamma during MER, but does not significantly affect the observation of anesthesiologists on the depth of anesthesia, nor affect the postoperative delirium and MMSE scores.
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Affiliation(s)
- Yuting Ling
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Lige Liu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Simin Wang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Qianqian Guo
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Qingyuan Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yi Liu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Bo Qu
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Zhishuang Wen
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yongfu Li
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Changming Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Bin Wu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Zihuan Huang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jianping Chu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ling Chen
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jinlong Liu
- Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Nan Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
- Correspondence: ; Tel.: +86-137-2540-7606
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29
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Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson’s Disease under General Anesthesia. PARKINSON'S DISEASE 2022; 2022:6915627. [DOI: 10.1155/2022/6915627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 12/05/2022]
Abstract
Introduction. Postoperative delirium can increase cognitive impairment and mortality in patients with Parkinson’s disease. The purpose of this study was to develop and internally validate a clinical prediction model of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease under general anesthesia. Methods. We conducted a retrospective observational cohort study on the data of 240 patients with Parkinson’s disease who underwent deep brain stimulation of the subthalamic nucleus under general anesthesia. Demographic characteristics, clinical evaluation, imaging data, laboratory data, and surgical anesthesia information were collected. Multivariate logistic regression was used to develop the prediction model for postoperative delirium. Results. A total of 159 patients were included in the cohort, of which 38 (23.90%) had postoperative delirium. Smoking (OR 4.51, 95% CI 1.56–13.02,
) was the most important risk factor; other independent predictors were orthostatic hypotension (OR 3.42, 95% CI 0.90–13.06,
), inhibitors of type-B monoamine oxidase (OR 3.07, 95% CI 1.17–8.04,
), preoperative MRI with silent brain ischemia or infarction (OR 2.36, 95% CI 0.90–6.14,
), Hamilton anxiety scale score (OR 2.12, 95% CI 1.28–3.50,
), and apolipoprotein E level in plasma (OR 1.48, 95% CI 0.95–2.29,
). The area under the receiver operating characteristic curve (AUC) was 0.76 (95% CI 0.66–0.86). A nomogram was established and showed good calibration and clinical predictive capacity. After bootstrap for internal verification, the AUC was 0.74 (95% CI 0.66–0.83). Conclusion. This study provides evidence for the independent inducing factors of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson’s disease under general anesthesia. By predicting the development of delirium, our model may identify high-risk groups that can benefit from early or preventive intervention.
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Bove F, Genovese D, Moro E. Developments in the mechanistic understanding and clinical application of deep brain stimulation for Parkinson's disease. Expert Rev Neurother 2022; 22:789-803. [PMID: 36228575 DOI: 10.1080/14737175.2022.2136030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION. Deep brain stimulation (DBS) is a life-changing treatment for patients with Parkinson's disease (PD) and gives the unique opportunity to directly explore how basal ganglia work. Despite the rapid technological innovation of the last years, the untapped potential of DBS is still high. AREAS COVERED. This review summarizes the developments in the mechanistic understanding of DBS and the potential clinical applications of cutting-edge technological advances. Rather than a univocal local mechanism, DBS exerts its therapeutic effects through several multimodal mechanisms and involving both local and network-wide structures, although crucial questions remain unexplained. Nonetheless, new insights in mechanistic understanding of DBS in PD have provided solid bases for advances in preoperative selection phase, prediction of motor and non-motor outcomes, leads placement and postoperative stimulation programming. EXPERT OPINION. DBS has not only strong evidence of clinical effectiveness in PD treatment, but technological advancements are revamping its role of neuromodulation of brain circuits and key to better understanding PD pathophysiology. In the next few years, the worldwide use of new technologies in clinical practice will provide large data to elucidate their role and to expand their applications for PD patients, providing useful insights to personalize DBS treatment and follow-up.
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Affiliation(s)
- Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Genovese
- Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM, U1216, Grenoble, France
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31
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Canonica T, Zalachoras I. Motivational disturbances in rodent models of neuropsychiatric disorders. Front Behav Neurosci 2022; 16:940672. [PMID: 36051635 PMCID: PMC9426724 DOI: 10.3389/fnbeh.2022.940672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Motivated behavior is integral to the survival of individuals, continuously directing actions toward rewards or away from punishments. The orchestration of motivated behavior depends on interactions among different brain circuits, primarily within the dopaminergic system, that subserve the analysis of factors such as the effort necessary for obtaining the reward and the desirability of the reward. Impairments in motivated behavior accompany a wide range of neuropsychiatric disorders, decreasing the patients’ quality of life. Despite its importance, motivation is often overlooked as a parameter in neuropsychiatric disorders. Here, we review motivational impairments in rodent models of schizophrenia, depression, and Parkinson’s disease, focusing on studies investigating effort-related behavior in operant conditioning tasks and on pharmacological interventions targeting the dopaminergic system. Similar motivational disturbances accompany these conditions, suggesting that treatments aimed at ameliorating motivation levels may be beneficial for various neuropsychiatric disorders.
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Chu C, He N, Zeljic K, Zhang Z, Wang J, Li J, Liu Y, Zhang Y, Sun B, Li D, Yan F, Zhang C, Liu C. Subthalamic and pallidal stimulation in Parkinson's disease induce distinct brain topological reconstruction. Neuroimage 2022; 255:119196. [PMID: 35413446 DOI: 10.1016/j.neuroimage.2022.119196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022] Open
Abstract
The subthalamic nucleus (STN) and globus pallidus internus (GPi) are the two most common and effective target brain areas for deep brain stimulation (DBS) treatment of advanced Parkinson's disease. Although DBS has been shown to restore functional neural circuits of this disorder, the changes in topological organization associated with active DBS of each target remain unknown. To investigate this, we acquired resting-state functional magnetic resonance imaging (fMRI) data from 34 medication-free patients with Parkinson's disease that had DBS electrodes implanted in either the subthalamic nucleus or internal globus pallidus (n = 17 each), in both ON and OFF DBS states. Sixteen age-matched healthy individuals were used as a control group. We evaluated the regional information processing capacity and transmission efficiency of brain networks with and without stimulation, and recorded how stimulation restructured the brain network topology of patients with Parkinson's disease. For both targets, the variation of local efficiency in motor brain regions was significantly correlated (p < 0.05) with improvement rate of the Uniform Parkinson's Disease Rating Scale-III scores, with comparable improvements in motor function for the two targets. However, non-motor brain regions showed changes in topological organization during active stimulation that were target-specific. Namely, targeting the STN decreased the information transmission of association, limbic and paralimbic regions, including the inferior frontal gyrus angle, insula, temporal pole, superior occipital gyri, and posterior cingulate, as evidenced by the simultaneous decrease of clustering coefficient and local efficiency. GPi-DBS had a similar effect on the caudate and lenticular nuclei, but enhanced information transmission in the cingulate gyrus. These effects were not present in the DBS-OFF state for GPi-DBS, but persisted for STN-DBS. Our results demonstrate that DBS to the STN and GPi induce distinct brain network topology reconstruction patterns, providing innovative theoretical evidence for deciphering the mechanism through which DBS affects disparate targets in the human brain.
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Affiliation(s)
- Chunguang Chu
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kristina Zeljic
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Zhen Zhang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Jiang Wang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Jun Li
- School of Information Science and Technology, Shanghai Tech University, Shanghai, China
| | - Yu Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Youmin Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Neuroscience Center, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Neuroscience Center, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Neuroscience Center, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center for Brain Science and Brain-Inspired Technology, Shanghai, China.
| | - Chen Liu
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China.
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Prange S, Lin Z, Nourredine M, Danaila T, Laurencin C, Lagha-Boukbiza O, Anheim M, Klinger H, Longato N, Phillipps C, Voirin J, Polo G, Simon E, Mertens P, Rolland AS, Devos D, Metereau E, Tranchant C, Thobois S. Limbic stimulation drives mania in STN-DBS in Parkinson disease: a prospective study. Ann Neurol 2022; 92:411-417. [PMID: 35703252 DOI: 10.1002/ana.26434] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022]
Abstract
In this one-year prospective study, Parkinson's disease (PD) patients with or without mania following STN-DBS were compared to investigate risk and etiological factors, clinical management and consequences. Eighteen (16.2%) out of 111 consecutive PD patients developed mania, of whom 17 were males. No preoperative risk factor was identified. Postoperative mania was related to ventral limbic subthalamic stimulation in 15 (83%) patients, and resolved as stimulation was relocated to the sensorimotor STN, besides discontinuation or reduction of dopamine agonists and use of low-dose clozapine in 12 patients, while motor and nonmotor outcomes were similar. These findings underpin the prominent role of limbic subthalamic stimulation in postoperative mania. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stéphane Prange
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - Zhengyu Lin
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France.,Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Teodor Danaila
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Chloé Laurencin
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Nadine Longato
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clelie Phillipps
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN, Strasbourg University Hospital, Strasbourg, France
| | - Gustavo Polo
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Emile Simon
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Patrick Mertens
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Anne-Sophie Rolland
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - David Devos
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - Elise Metereau
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Stéphane Thobois
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Oullins, France
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Zhang X, Zhang H, Lin Z, Barbosa DAN, Lai Y, Halpern CH, Voon V, Li D, Zhang C, Sun B. Effects of Bilateral Subthalamic Nucleus Stimulation on Depressive Symptoms and Cerebral Glucose Metabolism in Parkinson's Disease: A 18F-Fluorodeoxyglucose Positron Emission Tomography/Computerized Tomography Study. Front Neurosci 2022; 16:843667. [PMID: 35720690 PMCID: PMC9200334 DOI: 10.3389/fnins.2022.843667] [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: 12/26/2021] [Accepted: 03/10/2022] [Indexed: 02/02/2023] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) can improve motor symptoms in Parkinson's disease (PD), as well as potentially improving otherwise intractable comorbid depressive symptoms. To address the latter issue, we evaluated the severity of depressive symptoms along with the severity of motor symptoms in 18 PD patients (mean age, 58.4 ± 5.4 years; 9 males, 9 females; mean PD duration, 9.4 ± 4.4 years) with treatment-resistant depression (TRD) before and after approximately 1 year of STN-DBS treatment. Moreover, to gain more insight into the brain mechanism mediating the therapeutic action of STN-DBS, we utilized 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) to assess cerebral regional glucose metabolism in the patients at baseline and 1-year follow-up. Additionally, the baseline PET data from patients were compared with PET data from an age- and sex-matched control group of 16 healthy volunteers. Among them, 12 PD patients underwent post-operative follow-up PET scans. Results showed that the severity of both motor and depressive symptoms in patients with PD-TRD was reduced significantly at 1-year follow-up. Also, patients used significantly less antiparkinsonian medications and antidepressants at 1-year follow-up, as well as experiencing improved daily functioning and a better quality of life. Moreover, relative to the PET data from healthy controls, PD-TRD patients displayed widespread abnormalities in cerebral regional glucose metabolism before STN-DBS treatment, which were partially recovered at 1-year follow-up. Additionally, significant correlations were observed between the patients' improvements in depressive symptoms following STN-DBS and post-operative changes in glucose metabolism in brain regions implicated in emotion regulation. These results support the view that STN-DBS provides a promising treatment option for managing both motor and depressive symptoms in patients who suffer from PD with TRD. However, the results should be interpreted with caution due to the observational nature of the study, small sample size, and relatively short follow-up.
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Affiliation(s)
- Xiaoxiao Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huiwei Zhang
- PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Daniel A. N. Barbosa
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, CA, United States
| | - Yijie Lai
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Casey H. Halpern
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, CA, United States
| | - Valerie Voon
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,*Correspondence: Chencheng Zhang,
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China,Bomin Sun,
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Jørgensen LM, Henriksen T, Mardosiene S, Wyon O, Keller SH, Jespersen B, Knudsen GM, Stenbæk DS. Hot and Cold Cognitive Disturbances in Parkinson Patients Treated with DBS-STN: A Combined PET and Neuropsychological Study. Brain Sci 2022; 12:brainsci12050654. [PMID: 35625040 PMCID: PMC9139237 DOI: 10.3390/brainsci12050654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with Parkinson’s disease (PD) often suffer from non-motor symptoms, which may be caused by serotonergic dysfunction. Deep Brain Stimulation (DBS) in the subthalamic nucleus (STN) may also influence non-motor symptoms. The aim of this study is to investigate how the cerebral 5-HT system associates to disturbances in cognition and mood in PD patients with DBS-STN turned on and off. We used psychological tests and questionnaires to evaluate cognitive function and the effects on mood from turning DBS-STN off. We applied a novel PET neuroimaging methodology to evaluate the integrity of the cerebral serotonin system. We measured 5-HT1BR binding in 13 DBS-STN-treated PD patients, at baseline and after turning DBS off. Thirteen age-matched volunteers served as controls. The measures for cognition and mood were correlated to the 5-HT1BR availability in temporal limbic cortex. 5-HT1BR binding was proportional to working memory performance and inverse proportional to affective bias for face recognition. When DBS is turned off, patients feel less vigorous; the higher the limbic and temporal 5-HT1BR binding, the more they are affected by DBS being turned off. Our study suggests that cerebral 5-HTR binding is associated with non-motor symptoms, and that preservation of serotonergic functions may be predictive of DBS-STN effects.
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Affiliation(s)
- Louise M. Jørgensen
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Copenhagen Spine Research Unit, Center for Rheumatology and Spine Disease, Copenhagen University Hospital-Rigshospitalet, 2600 Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence:
| | - Tove Henriksen
- Department of Neurology, Copenhagen University Hospital-Bispebjerg, 2400 Copenhagen, Denmark; (T.H.); (S.M.)
| | - Skirmante Mardosiene
- Department of Neurology, Copenhagen University Hospital-Bispebjerg, 2400 Copenhagen, Denmark; (T.H.); (S.M.)
| | - Ottilia Wyon
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Copenhagen Spine Research Unit, Center for Rheumatology and Spine Disease, Copenhagen University Hospital-Rigshospitalet, 2600 Glostrup, Denmark
| | - Sune H. Keller
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Bo Jespersen
- Department of Neurosurgery, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Gitte M. Knudsen
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Dea S. Stenbæk
- Neurobiology Research Unit, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark; (O.W.); (G.M.K.); (D.S.S.)
- Department of Psychology, University of Copenhagen, 1353 Copenhagen, Denmark
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36
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Pozzi NG, Palmisano C, Reich MM, Capetian P, Pacchetti C, Volkmann J, Isaias IU. Troubleshooting Gait Disturbances in Parkinson's Disease With Deep Brain Stimulation. Front Hum Neurosci 2022; 16:806513. [PMID: 35652005 PMCID: PMC9148971 DOI: 10.3389/fnhum.2022.806513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus or the globus pallidus is an established treatment for Parkinson's disease (PD) that yields a marked and lasting improvement of motor symptoms. Yet, DBS benefit on gait disturbances in PD is still debated and can be a source of dissatisfaction and poor quality of life. Gait disturbances in PD encompass a variety of clinical manifestations and rely on different pathophysiological bases. While gait disturbances arising years after DBS surgery can be related to disease progression, early impairment of gait may be secondary to treatable causes and benefits from DBS reprogramming. In this review, we tackle the issue of gait disturbances in PD patients with DBS by discussing their neurophysiological basis, providing a detailed clinical characterization, and proposing a pragmatic programming approach to support their management.
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Affiliation(s)
- Nicoló G. Pozzi
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Martin M. Reich
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Philip Capetian
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Claudio Pacchetti
- Parkinson’s Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Ioannis U. Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
- Parkinson Institute Milan, ASST Gaetano Pini-CTO, Milan, Italy
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37
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Bucur M, Papagno C. Deep Brain Stimulation in Parkinson Disease: A Meta-analysis of the Long-term Neuropsychological Outcomes. Neuropsychol Rev 2022; 33:307-346. [PMID: 35318587 PMCID: PMC10148791 DOI: 10.1007/s11065-022-09540-9] [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: 08/23/2021] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidum internus (GPi) improves motor functions in patients with Parkinson's disease (PD) but may cause a decline in specific cognitive domains. The aim of this systematic review and meta-analysis was to assess the long-term (1-3 years) effects of STN or GPi DBS on four cognitive functions: (i) memory (delayed recall, working memory, immediate recall), (ii) executive functions including inhibition control (Color-Word Stroop test) and flexibility (phonemic verbal fluency), (iii) language (semantic verbal fluency), and (iv) mood (anxiety and depression). Medline and Web of Science were searched, and studies published before July 2021 investigating long-term changes in PD patients following DBS were included. Random-effects model meta-analyses were performed using the R software to estimate the standardized mean difference (SMD) computed as Hedges' g with 95% CI. 2522 publications were identified, 48 of which satisfied the inclusion criteria. Fourteen meta-analyses were performed including 2039 adults with a clinical diagnosis of PD undergoing DBS surgery and 271 PD controls. Our findings add new information to the existing literature by demonstrating that, at a long follow-up interval (1-3 years), both positive effects, such as a mild improvement in anxiety and depression (STN, Hedges' g = 0,34, p = 0,02), and negative effects, such as a decrease of long-term memory (Hedges' g = -0,40, p = 0,02), verbal fluency such as phonemic fluency (Hedges' g = -0,56, p < 0,0001), and specific subdomains of executive functions such as Color-Word Stroop test (Hedges' g = -0,45, p = 0,003) were observed. The level of evidence as qualified with GRADE varied from low for the pre- verses post-analysis to medium when compared to a control group.
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Affiliation(s)
- Madalina Bucur
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy
| | - Costanza Papagno
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy.
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38
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Neural circuit control of innate behaviors. SCIENCE CHINA. LIFE SCIENCES 2022; 65:466-499. [PMID: 34985643 DOI: 10.1007/s11427-021-2043-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/10/2021] [Indexed: 12/17/2022]
Abstract
All animals possess a plethora of innate behaviors that do not require extensive learning and are fundamental for their survival and propagation. With the advent of newly-developed techniques such as viral tracing and optogenetic and chemogenetic tools, recent studies are gradually unraveling neural circuits underlying different innate behaviors. Here, we summarize current development in our understanding of the neural circuits controlling predation, feeding, male-typical mating, and urination, highlighting the role of genetically defined neurons and their connections in sensory triggering, sensory to motor/motivation transformation, motor/motivation encoding during these different behaviors. Along the way, we discuss possible mechanisms underlying binge-eating disorder and the pro-social effects of the neuropeptide oxytocin, elucidating the clinical relevance of studying neural circuits underlying essential innate functions. Finally, we discuss some exciting brain structures recurrently appearing in the regulation of different behaviors, which suggests both divergence and convergence in the neural encoding of specific innate behaviors. Going forward, we emphasize the importance of multi-angle and cross-species dissections in delineating neural circuits that control innate behaviors.
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Pozzi NG, Isaias IU. Adaptive deep brain stimulation: Retuning Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:273-284. [PMID: 35034741 DOI: 10.1016/b978-0-12-819410-2.00015-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A brain-machine interface represents a promising therapeutic avenue for the treatment of many neurologic conditions. Deep brain stimulation (DBS) is an invasive, neuro-modulatory tool that can improve different neurologic disorders by delivering electric stimulation to selected brain areas. DBS is particularly successful in advanced Parkinson's disease (PD), where it allows sustained improvement of motor symptoms. However, this approach is still poorly standardized, with variable clinical outcomes. To achieve an optimal therapeutic effect, novel adaptive DBS (aDBS) systems are being developed. These devices operate by adapting stimulation parameters in response to an input signal that can represent symptoms, motor activity, or other behavioral features. Emerging evidence suggests greater efficacy with fewer adverse effects during aDBS compared with conventional DBS. We address this topic by discussing the basics principles of aDBS, reviewing current evidence, and tackling the many challenges posed by aDBS for PD.
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Affiliation(s)
- Nicoló G Pozzi
- Department of Neurology, University Hospital Würzburg and Julius Maximilian University Würzburg, Würzburg, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital Würzburg and Julius Maximilian University Würzburg, Würzburg, Germany.
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40
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Chen YC, Wu HT, Tu PH, Yeh CH, Liu TC, Yeap MC, Chao YP, Chen PL, Lu CS, Chen CC. Theta Oscillations at Subthalamic Region Predicts Hypomania State After Deep Brain Stimulation in Parkinson's Disease. Front Hum Neurosci 2022; 15:797314. [PMID: 34987369 PMCID: PMC8721814 DOI: 10.3389/fnhum.2021.797314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/26/2021] [Indexed: 12/11/2022] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment for the motor impairments of patients with advanced Parkinson's disease. However, mood or behavioral changes, such as mania, hypomania, and impulsive disorders, can occur postoperatively. It has been suggested that these symptoms are associated with the stimulation of the limbic subregion of the STN. Electrophysiological studies demonstrate that the low-frequency activities in ventral STN are modulated during emotional processing. In this study, we report 22 patients with Parkinson's disease who underwent STN DBS for treatment of motor impairment and presented stimulation-induced mood elevation during initial postoperative programming. The contact at which a euphoric state was elicited by stimulation was termed as the hypomania-inducing contact (HIC) and was further correlated with intraoperative local field potential recorded during the descending of DBS electrodes. The power of four frequency bands, namely, θ (4–7 Hz), α (7–10 Hz), β (13–35 Hz), and γ (40–60 Hz), were determined by a non-linear variation of the spectrogram using the concentration of frequency of time (conceFT). The depth of maximum θ power is located approximately 2 mm below HIC on average and has significant correlation with the location of contacts (r = 0.676, p < 0.001), even after partializing the effect of α and β, respectively (r = 0.474, p = 0.022; r = 0.461, p = 0.027). The occurrence of HIC was not associated with patient-specific characteristics such as age, gender, disease duration, motor or non-motor symptoms before the operation, or improvement after stimulation. Taken together, these data suggest that the location of maximum θ power is associated with the stimulation-induced hypomania and the prediction of θ power is frequency specific. Our results provide further information to refine targeting intraoperatively and select stimulation contacts in programming.
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Affiliation(s)
- Yi-Chieh Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, United States.,Department of Statistical Science, Duke University, Durham, NC, United States
| | - Po-Hsun Tu
- College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Neuroradiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chi Liu
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Po-Lin Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chin-Song Lu
- Professor Lu Neurological Clinic, Taoyuan, Taiwan
| | - Chiung-Chu Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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41
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Parolari L, Schneeberger M, Heintz N, Friedman JM. Functional analysis of distinct populations of subthalamic nucleus neurons on Parkinson's disease and OCD-like behaviors in mice. Mol Psychiatry 2021; 26:7029-7046. [PMID: 34099874 DOI: 10.1038/s41380-021-01162-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Abstract
The subthalamic nucleus (STN) is a component of the basal ganglia and plays a key role to control movement and limbic-associative functions. STN modulation with deep brain stimulation (DBS) improves the symptoms of Parkinson's disease (PD) and obsessive-compulsive disorder (OCD) patients. However, DBS does not allow for cell-type-specific modulation of the STN. While extensive work has focused on elucidating STN functionality, the understanding of the role of specific cell types is limited. Here, we first performed an anatomical characterization of molecular markers for specific STN neurons. These studies revealed that most STN neurons express Pitx2, and that different overlapping subsets express Gabrr3, Ndnf, or Nos1. Next, we used optogenetics to define their roles in regulating locomotor and limbic functions in mice. Specifically, we showed that optogenetic photoactivation of STN neurons in Pitx2-Cre mice or of the Gabrr3-expressing subpopulation induces locomotor changes, and improves locomotion in a PD mouse model. In addition, photoactivation of Pitx2 and Gabrr3 cells induced repetitive grooming, a phenotype associated with OCD. Repeated stimulation prompted a persistent increase in grooming that could be reversed by fluoxetine treatment, a first-line drug therapy for OCD. Conversely, repeated inhibition of STNGabrr3 neurons suppressed grooming in Sapap3 KO mice, a model for OCD. Finally, circuit and functional mapping of STNGabrr3 neurons showed that these effects are mediated via projections to the globus pallidus/entopeduncular nucleus and substantia nigra reticulata. Altogether, these data identify Gabrr3 neurons as a key population in mediating the beneficial effects of STN modulation thus providing potential cellular targets for PD and OCD drug discovery.
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Affiliation(s)
- Luca Parolari
- Laboratory of Molecular Genetics, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.
| | - Marc Schneeberger
- Laboratory of Molecular Genetics, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA
| | - Nathaniel Heintz
- Laboratory of Molecular Biology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.
| | - Jeffrey M Friedman
- Laboratory of Molecular Genetics, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.
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42
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Eguchi K, Shirai S, Matsushima M, Kano T, Yamazaki K, Hamauchi S, Sasamori T, Seki T, Hirata K, Kitagawa M, Otsuki M, Shiga T, Houkin K, Sasaki H, Yabe I. Correlation of active contact location with weight gain after subthalamic nucleus deep brain stimulation: a case series. BMC Neurol 2021; 21:351. [PMID: 34517835 PMCID: PMC8436541 DOI: 10.1186/s12883-021-02383-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/01/2021] [Indexed: 12/16/2022] Open
Abstract
Background Weight gain (WG) is a frequently reported side effect of subthalamic deep brain stimulation; however, the underlying mechanisms remain unclear. The active contact locations influence the clinical outcomes of subthalamic deep brain stimulation, but it is unclear whether WG is directly associated with the active contact locations. We aimed to determine whether WG is associated with the subthalamic deep brain stimulation active contact locations. Methods We enrolled 14 patients with Parkinson’s disease who underwent bilateral subthalamic deep brain stimulation between 2013 and 2019. Bodyweight and body mass index were measured before and one year following the surgery. The Lead-DBS Matlab toolbox was used to determine the active contact locations based on magnetic resonance imaging and computed tomography. We also created sweet spot maps for WG using voxel-wise statistics, based on volume of tissue activation and the WG of each patient. Fluorodeoxyglucose-positron emission tomography data were also acquired before and one year following surgery, and statistical parametric mapping was used to evaluate changes in brain metabolism. We examined which brain regions’ metabolism fluctuation significantly correlated with increased body mass index scores and positron emission tomography data. Results One year after surgery, the body mass index increase was 2.03 kg/m2. The sweet spots for WG were bilateral, mainly located dorsally outside of the subthalamic nucleus (STN). Furthermore, WG was correlated with increased metabolism in the left limbic and associative regions, including the middle temporal gyrus, inferior frontal gyrus, and orbital gyrus. Conclusions Although the mechanisms underlying WG following subthalamic deep brain stimulation are possibly multifactorial, our findings suggest that dorsal stimulation outside of STN may lead to WG. The metabolic changes in limbic and associative cortical regions after STN-DBS may also be one of the mechanisms underlying WG. Further studies are warranted to confirm whether dorsal stimulation outside of STN changes the activities of these cortical regions.
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Affiliation(s)
- Katsuki Eguchi
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan.
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Takahiro Kano
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Kazuyoshi Yamazaki
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Shuji Hamauchi
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Toru Sasamori
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Kita 22, Higashi 1, Higashi-ku, 065-0022, Sapporo, Japan
| | - Toshitaka Seki
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Mayumi Kitagawa
- Sapporo Teishinkai Hospital, Kita 33, Higashi 1, Higashi-ku, 065-0033, Sapporo, Japan
| | - Mika Otsuki
- Faculty of Health Sciences, Graduate School of Health Sciences, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Hidenao Sasaki
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, 060-8638, Sapporo, Japan
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43
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Wilt JA, Merner AR, Zeigler J, Montpetite M, Kubu CS. Does Personality Change Follow Deep Brain Stimulation in Parkinson's Disease Patients? Front Psychol 2021; 12:643277. [PMID: 34393883 PMCID: PMC8361492 DOI: 10.3389/fpsyg.2021.643277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Deep Brain Stimulation (DBS) has emerged as a safe, effective, and appealing treatment for Parkinson's Disease (PD), particularly for improving motor symptoms (e. g., tremor, bradykinesia, and rigidity). However, concerns have been raised about whether DBS causes psychological changes, including changes to personality: characteristic and relatively stable patterns of affect, behavior, cognition, and desire. In this article, after first presenting some background information about PD and DBS, we examined evidence obtained from various empirical research methods (quantitative, qualitative, and mixed methods for evaluating patient valued characteristics) pertaining to whether DBS causes personality change. General limitations across research methods include a lack of randomized clinical trials and small sample sizes. We organized our review of findings according to different layers of personality variables: dispositional traits (including personality pathology), characteristic adaptations, and narrative identity. Though most work has been done on dispositional traits, there is not much evidence that dispositional traits change following DBS. Little work has been done on characteristic adaptations, but there is somewhat consistent evidence for positive perceived progress toward goals across a number of domains: routine activities, work, social/relational, and leisure. Nascent work on narrative identity holds promise for revealing issues around self-image that may be common following DBS. We listed a number of strategies for advancing research, highlighting opportunities related to personality conceptualization, personality assessment, and interdisciplinary scholarship. Finally, we offer practical applications of our findings for the informed consent process and for ongoing treatment.
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Affiliation(s)
- Joshua A Wilt
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States.,Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Jaclyn Zeigler
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | | | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
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44
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Bove F, Mulas D, Cavallieri F, Castrioto A, Chabardès S, Meoni S, Schmitt E, Bichon A, Di Stasio E, Kistner A, Pélissier P, Chevrier E, Seigneuret E, Krack P, Fraix V, Moro E. Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease. Neurology 2021; 97:e254-e262. [PMID: 34078713 DOI: 10.1212/wnl.0000000000012246] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) on motor complications in patients with Parkinson disease (PD) beyond 15 years after surgery. METHODS Data on motor complications, quality of life (QoL), activities of daily living, Unified Parkinson's Disease Rating Scale motor scores, dopaminergic treatment, stimulation measures, and side effects of STN-DBS were retrospectively retrieved and compared before surgery, at 1 year, and beyond 15 years after bilateral STN-DBS. RESULTS Fifty-one patients with 17.06 ± 2.18 years STN-DBS follow-up were recruited. Compared to baseline, the time spent with dyskinesia and the time spent in the "off" state were reduced by 75% (p < 0.001) and by 58.7% (p < 0.001), respectively. Moreover, dopaminergic drugs were reduced by 50.6% (p < 0.001). Parkinson's Disease Quality of Life Questionnaire total score and the emotional function and social function domains improved 13.8% (p = 0.005), 13.6% (p = 0.01), and 29.9% (p < 0.001), respectively. Few and mostly manageable device-related adverse events were observed during the follow-up. CONCLUSIONS STN-DBS is effective beyond 15 years from the intervention, notably with significant improvement in motor complications and stable reduction of dopaminergic drugs. Furthermore, despite the natural continuous progression of PD with worsening of levodopa-resistant motor and nonmotor symptoms over the years, patients undergoing STN-DBS could maintain an improvement in QoL. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that, for patients with PD, STN-DBS remains effective at treating motor complications 15 years after surgery.
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Affiliation(s)
- Francesco Bove
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Delia Mulas
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Francesco Cavallieri
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Anna Castrioto
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Stephan Chabardès
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Sara Meoni
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Emmanuelle Schmitt
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Amélie Bichon
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Enrico Di Stasio
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Andrea Kistner
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Pierre Pélissier
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Eric Chevrier
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Eric Seigneuret
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Paul Krack
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Valerie Fraix
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland
| | - Elena Moro
- From the Movement Disorders Unit, Division of Neurology (F.B., D.M., F.C., A.C., S.M., E.S., A.B., A.K., P.P., E.C., V.F., E.M.), CHU Grenoble Alpes, Grenoble, France; Neurology Unit (F.B.) and Chemistry, Biochemistry and Clinical Molecular Biology (E.D.S.), Fondazione Policlinico Universitario A. Gemelli IRCCS; Department of Neurosciences (F.B.) and Institute of Biochemistry and Clinical Biochemistry (E.D.S.), Università Cattolica del Sacro Cuore, Rome; Institute of Neurology (D.M.), Mater Olbia Hospital, Olbia; Neurology Unit, Neuromotor and Rehabilitation Department (F.C.), Azienda USL-IRCCS di Reggio Emilia; Clinical and Experimental Medicine PhD Program (F.C.), University of Modena and Reggio Emilia, Modena, Italy; Grenoble Institute of Neurosciences (A.C., S.C., S.M., E.S., A.B., A.K., P.P., E.C., E.S., V.F., E.M.), University Grenoble Alpes, Inserm, U1216, Grenoble; Division of Neurosurgery (S.C., E.S.), Centre Hospitalier Universitaire (CHU), Grenoble Alpes University, France; Department of Health Sciences (S.M.), University of Milan, Italy; and Department of Neurology (P.K.), Bern University Hospital, Switzerland.
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Vos SH, Kessels RPC, Vinke RS, Esselink RAJ, Piai V. The Effect of Deep Brain Stimulation of the Subthalamic Nucleus on Language Function in Parkinson's Disease: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2794-2810. [PMID: 34157249 DOI: 10.1044/2021_jslhr-20-00515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose This systematic review focuses on the effect of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on language function in Parkinson's disease (PD). It fills an important gap in recent reviews by considering other language tasks in addition to verbal fluency. Method We critically and systematically reviewed the literature on studies that investigated the effect of bilateral STN-DBS on language function in PD. All studies included a matched PD control group who were on best medical treatment, with language testing at similar baseline and follow-up intervals as the DBS PD group. Results Thirteen identified studies included a form of a verbal fluency task, seven studies included picture naming, and only two studies included more language-oriented tasks. We found that verbal fluency was negatively affected after DBS, whereas picture naming was unaffected. Studies investigating individual change patterns using reliable change indices showed that individual variability is larger for picture naming than for verbal fluency. Conclusions Verbal fluency is the most frequently investigated aspect of language function. Our analysis showed a pattern of decline in verbal fluency across multiple studies after STN-DBS, whereas picture naming was unaffected. Data on more language-oriented tests in a large DBS sample and best medical treatment control group are sparse. The investigation of language function in PD after DBS requires sensitive language tests (with and without time pressure) and experimental designs as used in the studies reviewed here. Reliable change index statistics are a promising tool for investigating individual differences in performance after DBS. Supplemental Material https://doi.org/10.23641/asha.14794458.
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Affiliation(s)
- Sandra H Vos
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - R Saman Vinke
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rianne A J Esselink
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vitória Piai
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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Weiss D, Volkmann J, Fasano A, Kühn A, Krack P, Deuschl G. Changing Gears - DBS For Dopaminergic Desensitization in Parkinson's Disease? Ann Neurol 2021; 90:699-710. [PMID: 34235776 DOI: 10.1002/ana.26164] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
In Parkinson's disease, both motor and neuropsychiatric complications unfold as a consequence of both incremental striatal dopaminergic denervation and intensifying long-term dopaminergic treatment. Together, this leads to 'dopaminergic sensitization' steadily increasing motor and behavioral responses to dopaminergic medication that result in the detrimental sequalae of long-term dopaminergic treatment. We review the clinical presentations of 'dopaminergic sensitization', including rebound off and dyskinesia in the motor domain, and neuropsychiatric fluctuations and behavioral addictions with impulse control disorders and dopamine dysregulation syndrome in the neuropsychiatric domain. We summarize state-of-the-art deep brain stimulation, and show that STN-DBS allows dopaminergic medication to be tapered, thus supporting dopaminergic desensitization. In this framework, we develop our integrated debatable viewpoint of "changing gears", that is we suggest rethinking earlier use of subthalamic nucleus deep brain stimulation, when the first clinical signs of dopaminergic motor or neuropsychiatric complications emerge over the steadily progressive disease course. In this sense, subthalamic deep brain stimulation may help reduce longitudinal motor and neuropsychiatric symptom expression - importantly, not by neuroprotection but by supporting dopaminergic desensitization through postoperative medication reduction. Therefore, we suggest considering STN-DBS early enough before patients encounter potentially irreversible psychosocial consequences of dopaminergic complications, but importantly not before a patient shows first clinical signs of dopaminergic complications. We propose to consider neuropsychiatric dopaminergic complications as a new inclusion criterion in addition to established motor criteria, but this concept will require validation in future clinical trials. ANN NEUROL 2021.
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Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, Würzburg, Germany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Andrea Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig Holstein (UKSH), Christian-Albrechts-University Kiel, Kiel, Germany
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Jiang N, Ling YT, Yang C, Liu Y, Xian WB, Zhang LN, Guo QQ, Jin XY, Wu B, Zhang CM, Chen L, Zhang ZG, Liu JL. Optimized Propofol Anesthesia Increases Power of Subthalamic Neuronal Activity in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation. Neurol Ther 2021; 10:785-802. [PMID: 34095990 PMCID: PMC8571439 DOI: 10.1007/s40120-021-00259-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Propofol is a general anesthetic option for deep brain stimulation (DBS) of the subthalamic nucleus (STN) of patients with Parkinson's disease (PD). However, its effects on STN activity and neuropsychological outcomes are controversial. The optimal propofol anesthesia for asleep DBS is unknown. This study investigated the safety and effectiveness of an optimized propofol anesthesia regimen in asleep DBS. Methods This retrospective study enrolled 68 PD patients undergoing bilateral STN-DBS surgery. All patients received local scalp anesthesia, with (asleep group, n = 35) or without (awake group, n = 33) propofol-remifentanil general anesthesia by target-controlled infusion under electroencephalogram monitoring. The primary outcome was subthalamic neuronal spiking characterization during microelectrode recording. The secondary outcomes were clinical outcomes including motor, cognition, mind, sleep, and quality of life at 6 months. Results Significantly increased delta and theta power were obtained under propofol anesthesia (awake vs. asleep group, mean ± standard deviation; delta: 31.97 ± 9.87 vs. 39.77 ± 10.56, p < 0.01; theta: 21.09 ± 5.55 vs. 24.82 ± 6.63, p = 0.01). After excluding the influence of confounding factors of age and preoperative motor scores, there was a statistically significant influence on the delta, theta, and alpha power of STN neuronal activity under different anesthesia regimens (delta: β = 2.64, p < 0.01; theta: β = 2.11, p < 0.01; alpha: β = 1.42, p = 0.01). There were no differences in modified burst index, firing rate, tract numbers of microelectrode recording, and other clinical outcomes between the two groups. Conclusion Optimized propofol anesthesia enhanced the delta, theta, and alpha power in STN compared with the awake technique and likely contributed to target recognition under propofol anesthesia. These results demonstrate that propofol is suitable, but needs to be optimized, for asleep STN-DBS. Trial Registration Chinese Clinical Trial Registry Identification number: ChiCTR2100045942. Registered 29 April 2021–Retrospectively registered Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00259-y.
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Affiliation(s)
- Nan Jiang
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yu-Ting Ling
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chao Yang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yi Liu
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Wen-Biao Xian
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Li-Nan Zhang
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Qian-Qian Guo
- Department of Anesthesiology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Xing-Yi Jin
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518060, Guangdong Province, People's Republic of China
| | - Bin Wu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chang-Ming Zhang
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Ling Chen
- Department of Neurology, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Zhi-Guo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, 518060, Guangdong Province, People's Republic of China
| | - Jin-Long Liu
- Department of Neurosurgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Grembecka B, Glac W, Listowska M, Jerzemowska G, Plucińska K, Majkutewicz I, Badtke P, Wrona D. Subthalamic Deep Brain Stimulation Affects Plasma Corticosterone Concentration and Peripheral Immunity Changes in Rat Model of Parkinson's Disease. J Neuroimmune Pharmacol 2021; 16:454-469. [PMID: 32648088 PMCID: PMC8087570 DOI: 10.1007/s11481-020-09934-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (DBS-STN) is an effective treatment for advanced motor symptoms of Parkinson's disease (PD). Recently, a connection between the limbic part of the STN and side effects of DBS-STN has been increasingly recognized. Animal studies have shown that DBS-STN influences behavior and provokes neurochemical changes in regions of the limbic system. Some of these regions, which are activated during DBS-STN, are involved in neuroimmunomodulation. The therapeutic effects of DBS-STN in PD treatment are clear, but the influence of DBS-STN on peripheral immunity has not been reported so far. In this study, we examined the effects of unilateral DBS-STN applied in male Wistar rats with 6-hydroxydopamine PD model (DBS-6OHDA) and rats without nigral dopamine depletion (DBS) on corticosterone (CORT) plasma concentration, blood natural killer cell cytotoxicity (NKCC), leukocyte numbers, lymphocyte population and apoptosis numbers, plasma interferon gamma (IFN-γ), interleukin 6 (IL-6), and tumor necrosis factor (TNF-α) concentration. The same peripheral immune parameters we measured also in non-stimulated rats with PD model (6OHDA). We observed peripheral immunity changes related to PD model. The NKCC and percentage of T cytotoxic lymphocytes were enhanced, while the level of lymphocyte apoptosis was down regulated in 6OHDA and DBS-6OHDA groups. After DBS-STN (DBS-6OHDA and DBS groups), the plasma CORT and TNF-α were elevated, the number of NK cells and percentage of apoptosis were increased, while the number of B lymphocytes was decreased. We also found, changes in plasma IFN-γ and IL-6 levels in all the groups. These results suggest potential peripheral immunomodulative effects of DBS-STN in the rat model of PD. However, further studies are necessary to explain these findings and their clinical implication. Graphical Abstract Influence of deep brain stimulation of the subthalamic nucleus on peripheral immunity in rat model of Parkinson's disease.
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Affiliation(s)
- Beata Grembecka
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland.
| | - Wojciech Glac
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Magdalena Listowska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Grażyna Jerzemowska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Karolina Plucińska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Irena Majkutewicz
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
| | - Piotr Badtke
- Department of Physiology, Medical University of Gdańsk, 1 Dębinki Str, 80-211, Gdańsk, Poland
| | - Danuta Wrona
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, 59 Wita Stwosza Str, 80-308, Gdańsk, Poland
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A case-control study investigating food addiction in Parkinson patients. Sci Rep 2021; 11:10934. [PMID: 34035366 PMCID: PMC8149641 DOI: 10.1038/s41598-021-90266-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/18/2021] [Indexed: 02/07/2023] Open
Abstract
Eating disorders (EDs) in patients with Parkinson’s disease (PD) are mainly described through impulse control disorders but represent one end of the spectrum of food addiction (FA). Although not formally recognized by DSM-5, FA is well described in the literature on animal models and humans, but data on prevalence and risk factors compared with healthy controls (HCs) are lacking. We conducted a cross-sectional study including 200 patients with PD and 200 age- and gender-matched HCs. Characteristics including clinical data (features of PD/current medication) were collected. FA was rated using DSM-5 criteria and the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). Patients with PD had more EDs compared to HCs (27.0% vs. 13.0%, respectively, p < 0.001). They mainly had FA (24.5% vs. 12.0%, p = 0.001) and night eating syndrome (7.0% vs. 2.5% p = 0.03). In PD patients, FA was associated with female gender (p = 0.04) and impulsivity (higher attentional non-planning factor) but not with the dose or class of dopaminergic therapy. Vigilance is necessary, especially for PD women and in patients with specific impulsive personality traits. Counterintuitively, agonist dopaminergic treatment should not be used as an indication for screening FA in patients with PD.
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50
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Liu C, Lee CY, Asher G, Cao L, Terakoshi Y, Cao P, Kobayakawa R, Kobayakawa K, Sakurai K, Liu Q. Posterior subthalamic nucleus (PSTh) mediates innate fear-associated hypothermia in mice. Nat Commun 2021; 12:2648. [PMID: 33976193 PMCID: PMC8113537 DOI: 10.1038/s41467-021-22914-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
The neural mechanisms of fear-associated thermoregulation remain unclear. Innate fear odor 2-methyl-2-thiazoline (2MT) elicits rapid hypothermia and elevated tail temperature, indicative of vasodilation-induced heat dissipation, in wild-type mice, but not in mice lacking Trpa1-the chemosensor for 2MT. Here we report that Trpa1-/- mice show diminished 2MT-evoked c-fos expression in the posterior subthalamic nucleus (PSTh), external lateral parabrachial subnucleus (PBel) and nucleus of the solitary tract (NTS). Whereas tetanus toxin light chain-mediated inactivation of NTS-projecting PSTh neurons suppress, optogenetic activation of direct PSTh-rostral NTS pathway induces hypothermia and tail vasodilation. Furthermore, selective opto-stimulation of 2MT-activated, PSTh-projecting PBel neurons by capturing activated neuronal ensembles (CANE) causes hypothermia. Conversely, chemogenetic suppression of vGlut2+ neurons in PBel or PSTh, or PSTh-projecting PBel neurons attenuates 2MT-evoked hypothermia and tail vasodilation. These studies identify PSTh as a major thermoregulatory hub that connects PBel to NTS to mediate 2MT-evoked innate fear-associated hypothermia and tail vasodilation.
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Affiliation(s)
- Can Liu
- Peking University-Tsinghua University-NIBS Joint Graduate Program, School of Life Sciences, Tsinghua University, Beijing, China
- National Institute of Biological Sciences (NIBS), Beijing, China
| | - Chia-Ying Lee
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Greg Asher
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Liqin Cao
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuka Terakoshi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Peng Cao
- National Institute of Biological Sciences (NIBS), Beijing, China
- Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China
| | - Reiko Kobayakawa
- Department of Functional Neuroscience, Institute of Biomedical Science, Kansai Medical University, Osaka, Japan
| | - Ko Kobayakawa
- Department of Functional Neuroscience, Institute of Biomedical Science, Kansai Medical University, Osaka, Japan
| | - Katsuyasu Sakurai
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Qinghua Liu
- National Institute of Biological Sciences (NIBS), Beijing, China.
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan.
- Tsinghua Institute of Multidisciplinary Biomedical Research (TIMBR), Tsinghua University, Beijing, China.
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