Bilateral Effects of Unilateral Subthalamic Nucleus Deep Brain Stimulation in Advanced Parkinson’s Disease

Chung, Sun Ju; Jeon, Sang Ryong; Kim, Sung R.; Sung, Young Hee; Lee, Myoung C.

doi:10.1159/000095704

Cited by 74 publications

(79 citation statements)

References 27 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, improvement of brainstem structures such as pedunculopontine nuclei plays an indispensable role in improvement of axial and gait disturbances [1,3,28]. Our data support further speculation that mutual connections at both sides of basal ganglia and thalamic nuclei might explain improvement of both sides in unilateral DBS.…”

Section: Contralateral Gpi Deactivationsupporting

confidence: 83%

“…Therefore, our study was limited to patients with unilateral DTN-DBS. Previous reports have described that unilateral STN-DBS improved the UPDRS motor scale from 23 % to 43 % [3,6,12,16]. Our patients exhibited greater improvement (50 %) than those probably because our patients had marked asymmetric symptoms and rather milder impairments.…”

Section: Discussioncontrasting

confidence: 46%

“…Especially, the mechanisms underlying unilateral STN-DBS have only rarely been studied. On the other hand, improvement of bilateral and axial PD symptoms has been accomplished even by unilateral STN-DBS [1,3,6,12,16]. This communication describes our study of mechanisms underlying unilateral STN-DBS using 18 …”

Section: Introductionmentioning

confidence: 93%

“…It has been supposed that some bilateral descending pathways from motor cortical areas can explain the bilateral and axial improvement [3,12]. In addition, improvement of brainstem structures such as pedunculopontine nuclei plays an indispensable role in improvement of axial and gait disturbances [1,3,28].…”

Section: Contralateral Gpi Deactivationmentioning

confidence: 99%

See 3 more Smart Citations

Mechanisms of unilateral STN-DBS in patients with Parkinson’s disease

et al. 2008

View full text Add to dashboard Cite

Bilateral symptoms and signs of Parkinson's disease (PD) are often improved by unilateral subthalamic nucleus deep brain stimulation (STN-DBS). However, the mechanism for such bilateral effects is unknown. This study was intended to examine effects of unilateral STN-DBS using positron emission computed tomography (PET) and to elucidate mechanisms for bilateral improvement achieved by unilateral stimulation.We conducted (18)F-fluorodeoxyglucose ((18)FDG) and (18)F-fluorodopa ((18)F-DOPA ) PET scans in PD patients whose bilateral limb symptoms and axial symptoms were improved by unilateral DBS. Two scans were performed in each PET study: when DBS was on and off. We compared those images using statistic parametric mapping (SPM) 99.The significant clinical improvement obtained by unilateral DBS was shown as improvements in bilateral motor limb, axial, and gait subscores of the Unified PD Rating Scale (UPDRS). Moreover, (18)FDG PET revealed significant metabolic increases in the ipsilateral ventrolateral thalamic areas and metabolic decrease at the contralateral globus pallidus interna (GPi). In contrast, (18)F-DOPA PET showed no significant differences between DBS on and off.Ipsilateral thalamic activation might induce ipsilateral motor cortical activation, which explains the improvement of contralateral limb symptoms. Furthermore, deactivation of the contralateral GPi might disinhibit the thalamus and contralateral motor cortex, which explains reduction of ipsilateral limb symptoms. These results suggest the mechanisms for bilateral improvement achieved by unilateral DBS.

show abstract

Section: Contralateral Gpi Deactivationsupporting

confidence: 83%

Section: Discussioncontrasting

confidence: 46%

Section: Introductionmentioning

confidence: 93%

Section: Contralateral Gpi Deactivationmentioning

confidence: 99%

See 2 more Smart Citations

Mechanisms of unilateral STN-DBS in patients with Parkinson’s disease

et al. 2008

View full text Add to dashboard Cite

show abstract

“…However, unilateral STN DBS was found to yield similar effects to unilateral GPi DBS on tests of contralateral fine motor function. 63 Unilateral STN DBS improved 'off' motor UPDRS scores by 26%, 64 31%, 65 and 37%, 66 remarkably similar to the results with unilateral pallidotomy. Samii et al 67 found an improvement in 'off' motor UPDRS scores of 25% with unilateral STN DBS, increasing to 43% when the contralateral side was added, stressing that one of the advantages of DBS is that it can be performed bilaterally, but that the results are not simply twice as good as unilateral surgery because of axial as well as ipsilateral effects of unilateral STN DBS (as seen by others as well).…”

Section: Is Dbs a Safer And More Effective Therapy For Pd?supporting

confidence: 52%

What Happened to Posteroventral Pallidotomy for Parkinson’s Disease and Dystonia?

Gross

2008

Neurotherapeutics

View full text Add to dashboard Cite

Summary: Fifteen years after its resurrection, pallidotomy for Parkinson's disease (PD) and dystonia has once again been supplanted, this time by deep brain stimulation (DBS). Did this occur because pallidotomy was not effective or safe, or because DBS was found to be more effective and safer? This review focuses on the evidence-and its quality-supporting the effectiveness and safety of pallidotomy for PD and dystonia, and the comparative effectiveness and safety of DBS of the subthalamic nucleus (STN) and globus pallidus pars interna (GPi). Discussed first are the determinants of "level 1" recommendations, including the confounding effects on interpretation of randomized clinical trials (RCTs) that fail to control for patient bias (i.e., placebo effects). Although several RCTs have been performed comparing unilateral pallidotomy to medical therapy, GPi DBS, or STN DBS for PD, none controlled for patient bias. Comparison of these trials to estimate the placebo effect, and examination of retrospective case series, suggests that the true effectiveness of unilateral pallidotomy is 20% to 30% reduction of 'off' total motor UPDRS scores, which is similar to the effects of unilateral GPi DBS or STN DBS, but less than bilateral STN DBS. At experienced centers, safety of unilateral pallidotomy appears equivalent to unilateral DBS, but bilateral DBS is likely safer than bilateral pallidotomy. Whereas there have been no RCTs of pallidotomy for dystonia, two doubleblind, sham-controlled RCTs of bilateral GPi DBS were performed. Nevertheless, limited uncontrolled series suggest that bilateral pallidotomy is similar to GPi DBS in effectiveness and safety for dystonia. Thus, pallidotomy was not rejected because of lack of effectiveness or safety, and it remains a viable alternative in situations where DBS is not available or not feasible.

show abstract

Bradykinesia and Its Progression Are Related to Interhemispheric Beta Coherence

Wilkins

Kehnemouyi

Petrucci

et al. 2023

Annals of Neurology

View full text Add to dashboard Cite

Objective Bradykinesia is the major cardinal motor sign of Parkinson disease (PD), but its neural underpinnings are unclear. The goal of this study was to examine whether changes in bradykinesia following long‐term subthalamic nucleus (STN) deep brain stimulation (DBS) are linked to local STN beta (13–30 Hz) dynamics or a wider bilateral network dysfunction. Methods Twenty‐one individuals with PD implanted with sensing neurostimulators (Activa® PC + S, Medtronic, PLC) in the STN participated in a longitudinal ‘washout’ therapy study every three to 6 months for an average of 3 years. At each visit, participants were withdrawn from medication (12/24/48 hours) and had DBS turned off (>60 minutes) before completing a repetitive wrist‐flexion extension task, a validated quantitative assessment of bradykinesia, while local field potentials were recorded. Local STN beta dynamics were investigated via beta power and burst duration, while interhemispheric beta synchrony was assessed with STN‐STN beta coherence. Results Higher interhemispheric STN beta coherence, but not contralateral beta power or burst duration, was significantly associated with worse bradykinesia. Bradykinesia worsened off therapy over time. Interhemispheric STN‐STN beta coherence also increased over time, whereas beta power and burst duration remained stable. The observed change in bradykinesia was related to the change in interhemispheric beta coherence, with greater increases in synchrony associated with further worsening of bradykinesia. Interpretation Together, these findings implicate interhemispheric beta synchrony as a neural correlate of the progression of bradykinesia following chronic STN DBS. This could imply the existence of a pathological bilateral network contributing to bradykinesia in PD. ANN NEUROL 2023;93:1029–1039

show abstract

Bilateral Effects of Unilateral Subthalamic Nucleus Deep Brain Stimulation in Advanced Parkinson’s Disease

Cited by 74 publications

References 27 publications

Mechanisms of unilateral STN-DBS in patients with Parkinson’s disease

Mechanisms of unilateral STN-DBS in patients with Parkinson’s disease

What Happened to Posteroventral Pallidotomy for Parkinson’s Disease and Dystonia?

Bradykinesia and Its Progression Are Related to Interhemispheric Beta Coherence

Contact Info

Product

Resources

About