Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation

Kumar, Rajeev; Lozano, Andrés M.; Sime, Elspeth; Halket, E.; Lang, Anthony E.

doi:10.1212/wnl.53.3.561

Cited by 243 publications

(167 citation statements)

References 24 publications

(5 reference statements)

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“…Similar results were observed by Samii et al, who scheduled patients with advanced PD for staged bilateral STN DBS (19). Unilateral STN DBS resulted in a 25% improvement of the motor UPDRS score with a further 53% improvement when an additional DBS lead was implanted (19 (5,22). The effects of unilateral STN DBS are not primarily restricted to the contralateral side, however most authors also report benefits in the ipsilateral and axial features (although the improvements tend to be only temporary (22,23,26).…”

Section: █ Discussionsupporting

confidence: 73%

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Unilateral subthalamic nucleus stimulation in the treatment of asymmetric parkinson's disease with early motor complications.

Sobstyl¹,

Ząbek²,

Zaczyński³

et al. 2015

Turkish Neurosurgery

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Patients with advanced PD and older age at surgery may not easily tolerate bilateral STN DBS, unlike younger patients with moderate PD. Moreover, approximately 30% of patients with long-standing PD develop depression, which is partially attributable to the disease itself. Dementia in PD patients is related to the age of PD onset, rather than to the duration of the disease (6,9,14,16). Psychiatric symptoms -such as compulsive behavior, gambling etc. -may be triggered or aggravated by long-term medication, especially in dopamine agonist therapy (14,27). Moreover, in the course of the disease a number of █ InTRODuCTIOn P arkinson's disease (PD) is diagnosed clinically based on the cardinal motor symptoms including resting tremor, rigidity and bradykinesia. A characteristic feature of early idiopathic PD is asymmetric motor symptom onset. In advanced PD, it is sometimes difficult to recognize which side of the body was first affected by disease. Generally, patients with advanced PD, with severe bilateral levodopa-induced dyskinesia (LID) and motor fluctuations require bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) (17,21). AIM:The aim of this study was to assess the results of unilateral subthalamic nucleus (STN) stimulation for the treatment of Parkinson's disease (PD) with marked asymmetry of parkinsonian motor symptoms and early motor complications. MATERIAL and METhODS:The clinical series consisted of 32 consecutive PD patients, in whom unilateral STN stimulation was performed. All patients were assessed according to the Unified Parkinson's Disease Rating Scale (UPDRS), and Hoehn and Yahr staging. The patients were assessed preoperatively, and at 12, and 24 months after unilateral STN stimulation. 22 patients were followed for 2 years. RESuLTS:Medication off/stimulation on total UPDRS motor scores were improved by 29% when compared to the baseline medication off motor scores. The contralateral motor scores improved by 49%, whereas the axial motor scores by 18% in medication off/stimulation on condition. The duration and severity of levodopa induced dyskinesia were reduced respectively by 73% and by 77%. The daily levodopa dose was decreased by only 10%.COnCLuSIOn: Unilateral STN stimulation is a safe and effective procedure for selected patients with marked asymmetry Parkinson's disease motor symptoms and early motor complications.

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Section: █ Discussionsupporting

confidence: 73%

“…Moreover, unilateral STN stimulation procedures are less invasive than bilateral simultaneous STN procedures (2,4,5,8,17,19,22,23). Bearing in mind all of the above facts, we aimed to operate on PD patients with the asymmetry of PD symptoms.…”

mentioning

confidence: 99%

Unilateral subthalamic nucleus stimulation in the treatment of asymmetric parkinson's disease with early motor complications.

Sobstyl¹,

Ząbek²,

Zaczyński³

et al. 2015

Turkish Neurosurgery

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“…One study measured the effects of ipsilateral, contralateral or bilateral STN DBS and found that contralateral and bilateral stimulation provided significant benefit in UPDRS ratings and timed hand movement tasks (Purdue pegboard and timed hand tapping). Ipsilateral stimulation did not significantly improve bradykinesia, tremor or rigidity as measured with the UPDRS or by Purdue pegboard test (Kumar et al, 1999). In that study, ipsilateral stimulation did improve timed hand tapping by 19% compared to 29% with contralateral stimulation and 54% with bilateral stimulation.…”

mentioning

confidence: 69%

Unilateral subthalamic nucleus stimulation has a measurable ipsilateral effect on rigidity and bradykinesia in parkinson disease

Tabbal

Ushe

Mink

et al. 2008

Experimental Neurology

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“…The mechanism of this bilateral effect is unknown, although transhemisphere interactions at thalamic or cortical levels may be involved (Parent and Hazrati, 1995;Eidelberg et al, 1996). Augmentation of network modulation by contralateral stimulation supports the utility of bilateral DBS interventions, even in asymmetrical parkinsonism (Kumar et al, 1999).…”

Section: Metabolic Changes With Stn Stimulationmentioning

confidence: 81%

Network modulation by the subthalamic nucleus in the treatment of Parkinson's disease

et al. 2006

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Deep brain stimulation of the subthalamic nucleus (STN DBS) has become an accepted tool for the treatment of Parkinson's disease (PD). Although the precise mechanism of action of this intervention is unknown, its effectiveness has been attributed to the modulation of pathological network activity. We examined this notion using positron emission tomography (PET) to quantify stimulation-induced changes in the expression of a PD-related covariance pattern (PDRP) of regional metabolism. These metabolic changes were also compared with those observed in a similar cohort of patients undergoing STN lesioning.We found that PDRP activity declined significantly (P < 0.02) with STN stimulation. The degree of network modulation with DBS did not differ from that measured following lesioning (P = 0.58). Statistical parametric mapping (SPM) revealed that metabolic reductions in the internal globus pallidus (GPi) and caudal midbrain were common to both STN interventions (P < 0.01), although declines in GPi were more pronounced with lesion. By contrast, elevations in posterior parietal metabolism were common to the two procedures, albeit more pronounced with stimulation.These findings indicate that suppression of abnormal network activity is a feature of both STN stimulation and lesioning. Nonetheless, these two interventions may differ metabolically at a regional level.

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Comparative effects of unilateral and bilateral subthalamic nucleus deep brain stimulation

Cited by 243 publications

References 24 publications

Unilateral subthalamic nucleus stimulation in the treatment of asymmetric parkinson's disease with early motor complications.

Unilateral subthalamic nucleus stimulation in the treatment of asymmetric parkinson's disease with early motor complications.

Unilateral subthalamic nucleus stimulation has a measurable ipsilateral effect on rigidity and bradykinesia in parkinson disease

Network modulation by the subthalamic nucleus in the treatment of Parkinson's disease

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