Background: Impulse control disorders (ICDs) and related disorders are common side effects of dopaminergic treatment in Parkinson’s disease (PD) and are associated with negative effects on mental and physical health, quality of life and interpersonal relationships. Current management options are limited, as a reduction of dopaminergic medication often leads to worsening of motor symptoms or dopamine agonist withdrawal syndrome. Objective: To investigate if ICDs improve, worsen, or remain stable after subthalamic deep brain stimulation (STN-DBS). Methods: We reviewed retrospective, prospective and randomized-controlled studies published between 2000 and 2019 examining the effect of STN-DBS on one or more ICDs. Number of participants, time of follow-up, methods used to measure ICDs, type of ICDs, the incidence of ICDs before STN-DBS, the incidence of improvement (remission or reduction) of ICDs after STN-DBS, the incidence of de novo ICDs or worsening of ICDs after STN-DBS, stimulation parameters, lead position, change in motor score and change in medication are reported for each study. Results and Conclusion: Available studies suggest that ICDs improve after STN- DBS in most patients and that persisting new-onset ICDs induced by DBS are rare. However, more randomized-controlled studies are needed to confirm the findings and to further investigate the underlying mechanisms.
Background Directional deep brain stimulation (DBS) allows for steering of the stimulation field, but extensive and time‐consuming testing of all segmented contacts is necessary to identify the possible benefit of steering. It is therefore important to determine under which circumstances directional current steering is advantageous. Methods Fifty two Parkinson's disease patients implanted in the STN with a directional DBS system underwent a standardized monopolar programming session 5 to 9 months after implantation. Individual contacts were tested for a potential advantage of directional stimulation. Results were used to build a prediction model for the selection of ring levels that would benefit from directional stimulation. Results On average, there was no significant difference in therapeutic window between ring‐level contact and best directional contact. However, according to our standardized protocol, 35% of the contacts and 66% of patients had a larger therapeutic window under directional stimulation compared to ring‐mode. The segmented contacts warranting directional current steering could be predicted with a sensitivity of 79% and a specificity of 57%. Conclusion To reduce time required for DBS programming, we recommend additional directional contact testing initially only on ring‐level contacts with a therapeutic window of less than 2.0 mA.
Background: Assessment of affective-behavioral states in patients with Parkinson’s disease (PD) undergoing deep brain stimulation (DBS) is essential. Objective: To analyze well-established questionnaires as a pilot-study with the long term aim to develop a screening tool evaluating affective-behavioral dysfunction, including depression, anxiety, apathy, mania, and impulse control disorders, in PD patients screened for DBS. Methods: Two hundred ninety-seven inpatients with PD underwent standardized neuropsychiatric testing including German versions of Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Apathy Evaluation Scale, Self-Report Manic Inventory, and Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, to assess appropriateness for DBS. Statistical item reduction was based on exploratory factor analysis, Cronbach’s alpha, item-total correlations, item difficulty, and inter-item correlations. Confirmatory factor analysis was conducted to assess factorial validity. An expert rating was performed to identify clinically relevant items in the context of PD and DBS, to maintain content validity. We compared the shortened subscales with the original questionnaires using correlations. To determine cutoff points, receiver operating characteristics analysis was performed. Results: The items of the initial questionnaires were reduced from 129 to 38 items. Results of confirmatory factor analyses supported the validity of the shortened pool. It demonstrated high internal consistency (Cronbach’s alpha = 0.72–0.83 across subscales), and the individual subscales were correlated with the corresponding original scales (rs = 0.84–0.95). Sensitivities and specificities exceeded 0.7. Conclusion: The shortened item pool, including 38 items, provides a good basis for the development of a screening tool, capturing affective-behavioral symptoms in PD patients before DBS implantation. Confirmation of the validity of such a screening tool in an independent sample of PD patients is warranted.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.