Characterization and localization of upper and lower extremity motor improvements in STN DBS for Parkinson's disease

Askari, Asra; Zhu, Brandon; Lyu, Xiru; Chou, Kelvin L.; Patil, Parag G.

doi:10.1016/j.parkreldis.2021.11.036

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Recent reexamination of motor symptoms in PD has suggested that symptoms have distinct patterns based on body location, which may manifest as differences in response to treatment [30,31]. When MDS-UPDRS-III items were grouped into sub-scores, responders to tPBM (approximately 70% of those receiving active treatment) showed a significant improvement in all MDS-UPDRS-III sub-scores.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Placebo-Controlled Study of a Transcranial Photobiomodulation Helmet in Parkinson’s Disease: Post-Hoc Analysis of Motor Outcomes

McGee

Liebert

Bicknell

et al. 2023

JCM

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Emerging evidence is increasingly supporting the use of transcranial photobiomodulation (tPBM) to improve symptoms of neurodegenerative diseases, including Parkinson’s disease (PD). The objective of this study was to analyse the safety and efficacy of tPBM for PD motor symptoms. The study was a triple blind, randomized placebo-controlled trial with 40 idiopathic PD patients receiving either active tPBM (635 nm plus 810 nm LEDs) or sham tPBM for 24 min per day (56.88J), six days per week, for 12 weeks. The primary outcome measures were treatment safety and a 37-item MDS-UPDRS-III (motor domain) assessed at baseline and 12 weeks. Individual MDS-UPDRS-III items were clustered into sub-score domains (facial, upper-limb, lower-limb, gait, and tremor). The treatment produced no safety concerns or adverse events, apart from occasional temporary and minor dizziness. There was no significant difference in total MDS-UPDRS-III scores between groups, presumably due to the placebo effect. Additional analyses demonstrated that facial and lower-limb sub-scores significantly improved with active treatment, while gait and lower-limb sub-scores significantly improved with sham treatment. Approximately 70% of participants responded to active treatment (≥5 decrease in MDS-UPDRS-III score) and improved in all sub-scores, while sham responders improved in lower-limb sub-scores only. tPBM appears to be a safe treatment and improved several PD motor symptoms in patients that responded to treatment. tPBM is proving to be increasingly attractive as a possible non-pharmaceutical adjunct therapy.

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Section: Discussionmentioning

confidence: 99%

A Randomized Placebo-Controlled Study of a Transcranial Photobiomodulation Helmet in Parkinson’s Disease: Post-Hoc Analysis of Motor Outcomes

McGee

Liebert

Bicknell

et al. 2023

JCM

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“…Using our previously developed atlas-independent electric field computational model [16, 17], we determined the maximal-effect stimulation loci for constipation and urinary dysfunction and compared these to motor improvement loci. For each condition, patients experiencing an improvement or decline in MDS-UPDRS score were identified.…”

Section: Methodsmentioning

confidence: 99%

Impact of Subthalamic Nucleus Stimulation on Urinary Dysfunction and Constipation in Parkinson’s Disease

Askari

Zhu

Lam

et al. 2022

Preprint

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Introduction. The effect of subthalamic nucleus deep brain stimulation (STN DBS) on urinary dysfunction and constipation in Parkinsons disease (PD) is variable. This study aims to identify potential surgical and non-surgical variables predicting their outcome. Methods. We used the Movement Disorder Society-Unified PD Rating Scale (MDS-UPDRS) Part I to assess urinary dysfunction (item 10) and constipation (item 11) preoperatively and 6-12 months postoperatively. A multiple linear regression model was used to investigate the impact of Global Cerebral Atrophy (GCA) and active electrode contact location on the urinary dysfunction and constipation follow-up score, controlling for age, disease duration, baseline score, motor improvement, and levodopa-equivalent dose changes. An electric field model was applied to localize the maximal effect-site for constipation and urinary dysfunction compared to motor improvement. Result. Among 74 patients, 23 improved, 28 deteriorated, and 23 remained unchanged for urinary dysfunction; 25 improved, 15 deteriorated, and 34 remained unchanged for constipation. GCA score and age significantly predicted urinary dysfunction follow-up score (R2 = 0.36, P<0.001). Increasing GCA and age independently were associated with worsening urinary symptoms. Disease duration, baseline constipation score, and anterior active electrode contacts in both hemispheres were significant predictors for constipation follow-up score (R2 =0.31, P<0.001). Higher baseline constipation score and disease duration were associated with worsening constipation; anterior active contact location was associated with improvement in constipation. Conclusion. Anterior active contact locations are associated with improvement in constipation in PD patients after STN DBS. PD patients with greater GCA scores before surgery were more likely to experience urinary deterioration after DBS.

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“…Using our previously developed atlas-independent electric field computational model, 16,17 we determined the maximal-effect stimulation loci for constipation and urinary dysfunction and compared these to the motor improvement loci. For each condition, patients who experienced an improvement or decline in MDS-UPDRS score were identified.…”

Section: Localization Of Maximal-effect Stimulation Locimentioning

confidence: 99%

Impact of subthalamic nucleus stimulation on urinary dysfunction and constipation in Parkinson’s disease

Askari,

Zhu,

Lam

et al. 2024

Journal of Neurosurgery

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OBJECTIVE The effect of subthalamic nucleus (STN) deep brain stimulation (DBS) on urinary dysfunction and constipation in Parkinson’s disease (PD) is variable. This study aimed to identify potential surgical and nonsurgical variables predictive of these outcomes. METHODS The authors used the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part I to assess urinary dysfunction (item 10) and constipation (item 11) preoperatively and at 6–12 months postoperatively. A multiple linear regression model was used to investigate the impact of global cerebral atrophy (GCA) and active electrode contact location on the urinary dysfunction and constipation follow-up scores, controlling for age, disease duration, baseline score, motor improvement, and levodopa-equivalent dose changes. An electric field model was applied to localize the maximal-effect sites for constipation and urinary dysfunction compared with those for motor improvement. RESULTS Among 74 patients, 23 improved, 28 deteriorated, and 23 remained unchanged for urinary dysfunction; 25 improved, 15 deteriorated, and 34 remained unchanged for constipation. GCA score and age significantly predicted urinary dysfunction follow-up score (R2 = 0.36, p < 0.001). Increased GCA and age were independently associated with worsening urinary symptoms. Disease duration, baseline constipation score, and anterior active electrode contacts in both hemispheres were significant predictors of constipation follow-up score (R2 = 0.31, p < 0.001). Higher baseline constipation score and disease duration were associated with worsening constipation; anterior active contact location was associated with improvement in constipation. CONCLUSIONS Anterior active contact location was associated with improvement in constipation in PD patients after STN DBS. PD patients with greater GCA scores before surgery were more likely to experience urinary deterioration after DBS.

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Characterization and localization of upper and lower extremity motor improvements in STN DBS for Parkinson's disease

Cited by 3 publications

References 19 publications

A Randomized Placebo-Controlled Study of a Transcranial Photobiomodulation Helmet in Parkinson’s Disease: Post-Hoc Analysis of Motor Outcomes

A Randomized Placebo-Controlled Study of a Transcranial Photobiomodulation Helmet in Parkinson’s Disease: Post-Hoc Analysis of Motor Outcomes

Impact of Subthalamic Nucleus Stimulation on Urinary Dysfunction and Constipation in Parkinson’s Disease

Impact of subthalamic nucleus stimulation on urinary dysfunction and constipation in Parkinson’s disease

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