Cognitive sequelae of subthalamic nucleus deep brain stimulation in Parkinson's disease: a meta-analysis

Parsons, Thomas D.; Rogers, Steven A.; Braaten, Alyssa; Woods, Steven Paul; Tröster, Alexander I.

doi:10.1016/s1474-4422(06)70475-6

Cited by 449 publications

(398 citation statements)

References 83 publications

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“…According to a meta-analysis, STN-DBS causes moderate declines in verbal fluency and small declines in executive function, and verbal learning and memory. 19) A randomized, multicenter study concluded that STN-DBS does not reduce overall cognition or affectivity, although there is a selective decrease in frontal cognitive functions. 31) In conclusion, STN-DBS seems to be a relatively safe treatment option for medically refractory PD.…”

Section: Discussionmentioning

confidence: 99%

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Umemura

Oka

Yamamoto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. Device-related complications involved device infection in 5, skin erosion in 5, and implantable pulse generator malfunction in 2 patients. All of these patients required surgical repair. Surgery and device-related complications could be reduced with increased surgical experience and the introduction of new surgical equipment and technology. Treatment or stimulation-related complications were intractable dyskinesia/dystonia in 11, problematic dysarthria in 7, apraxia of eyelid opening (ALO) in 11, back pain in 10, and restless leg syndrome in 6 patients. Neuropsychiatric complications were transient mood changes in some, impulse control disorder in 2, severe depression related to excessive reduction of dopaminergic medications in 2, rapid progression of dementia in 1, and suicide attempts in 2 patients. Most complications were mild and transient. Dysarthria and ALO were the most frequent permanent sequelae after STN-DBS. Treatment-related adverse events may be caused not only by the effect of stimulation effect but also excessive reduction of dopaminergic medication, or progression of the disease. In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.

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Section: Discussionmentioning

confidence: 99%

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Umemura

Oka

Yamamoto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…110 Long-term, treatment-resistant postoperative apathy tends to develop in association with levodopa-resistant frontal dysexecutive syndrome, and can be explained by diff use cortical synucleinopathy 2,10,50,56,111,112 rather than by STN-DBS on its own. Although dementia might be a part of Parkinson's disease progression, 113,114 in the young and largely cognitively preserved populations of patients with Parkinson's disease who are generally selected for deep brain stimulation, overall cognition, including frontal dysexecutive syndrome, is relatively stable 115,116 in the fi rst years after STN-DBS, although in a small proportion of patients, surgery itself can induce cognitive deterioration. 117 Surgical treatment of Parkinson's disease has given rise to a new phenotype of patients with advanced Parkinson's disease who have little akinesia, no tremor or rigidity, and little dyskinesia, and are mainly disabled by frontal dementia, apathy, and levodoparesistant axial motor features.…”

Section: Apathy After Deep Brain Stimulation In Parkinson's Diseasementioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

405

394

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Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of diff erent networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of aff ected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely aff ect the quality of life of both patients and caregivers. Diff erentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.

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“…Among these three deep brain structures, the STN became the mean target of high-frequency DBS in patients with PD and severe disabled symptoms [2]. Even if STN DBS has proved its efficiency for motor symptoms improvement, several studies have reported adverse-events after DBS surgery affecting cognitive functions, emotion or behavior [3,4,5]. It remains interrogations about contacts location that provide the largest motor improvement while producing the least clinical side effects.…”

Section: Introductionmentioning

confidence: 99%

Correlating Clinical Scores with Anatomical Electrodes Locations for Assessing Deep Brain Stimulation

Lalys

Haegelen

Abadie

et al. 2011

Information Processing in Computer-Assisted Interventions

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Abstract. Movement disorders in patients withParkinson's disease may require functional surgery, when medical therapy isn't effective. In Deep Brain Stimulation (DBS), electrodes are implanted within the brain to stimulate deep structures such as SubThalamic Nucleus (STN). This paper describes successive steps for constructing digital atlases gathering patient's location of electrode contacts and clinical scores. Three motor and three neuropsychological scores were integrated in the study. Correlations between active contacts localization and clinical data were carried out using an adapted Hierarchical Ascendant Classification and have enabled the extraction of clusters aiming to suggest optimum sites for therapeutic STN DBS. The postero-superior region has been found to be effective for motor score improvement whereas the antero-inferior region revealed noticeable neuropsychological scores deterioration. Comparison with existing results has shown that such atlases are very promising for understanding phenomena better.

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Cognitive sequelae of subthalamic nucleus deep brain stimulation in Parkinson's disease: a meta-analysis

Cited by 449 publications

References 83 publications

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Correlating Clinical Scores with Anatomical Electrodes Locations for Assessing Deep Brain Stimulation

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