Deep brain stimulation for movement disorders

Fasano, Alfonso; Lozano, Andrés M.

doi:10.1097/wco.0000000000000226

Cited by 79 publications

(54 citation statements)

References 134 publications

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“…There is strong evidence supporting the use of GPi DBS for the treatment of isolated generalized or segmental dystonia, as well as for patients with cervical dystonia [242,243]. The stimulation parameters are typically the same as for PD, although some patients may also respond to lower frequencies.…”

Section: Use Of Dbs For Dystoniamentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

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Deep brain stimulation (DBS) is highly effective for both hypo-and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal gangliathalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.

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Section: Use Of Dbs For Dystoniamentioning

confidence: 99%

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

2016

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“…DBS is an effective and reversible surgical technique used for the symptomatic relief of refractory movement disorders [13]. However, its higher cost, its maintenance, and the possibility of hardware complications, compared to the ablative techniques, are the main problems with this procedure.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency Lesions through Deep Brain Stimulation Electrodes in Movement Disorders: Case Report and Review of the Literature

Pérez-Suárez

Torres²,

Manzanares³

et al. 2017

Stereotact Funct Neurosurg

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Background: Although there are few reports of radiofrequency lesions performed through deep brain stimulation (DBS) electrodes in patients with movement disorders, experience with this method is scarce. Methods: We present 2 patients who had been previously treated with DBS of subthalamic nuclei (STN) and the ventral intermediate (VIM) nucleus of the thalamus for Parkinson's disease and essential tremor, respectively, and underwent a radiofrequency lesion through their DBS electrodes after developing a hardware infection. The authors conduct a review of the literature regarding this method. Results: Both patients had a good clinical outcome after 20 and 8 months, respectively, as assessed by a reduction in Fahn-Tolosa-Marin Scale and Unified Parkinson's Disease Rating Scale scores. The second patient underwent a second DBS system implantation surgery after his radiofrequency treatment to optimize his management, achieving optimal clinical control with lower current and drug requirements than before the radiofrequency intervention. No adverse effects were observed. Conclusions: Radiofrequency lesions through DBS electrodes allow the creation of small and localized lesions. Its effectiveness and low-risk profile, in addition to its low cost, make this procedure suitable and a possible alternative in the therapeutic repertoire for the surgical treatment of movement disorders.

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“…The procedure, however, has caveats, limitations, and is well recognized as potentially harmful if indicated in the wrong timing and clinical scenario 9 . Therefore, despite the encouraging overall experience, only about 20-30% of patients with PD meet an adequate profile to be considered good candidates for DBS and an even smaller proportion will eventually undergo the surgical procedure 10 . In other words, appropriate patient selection is critical, and surgery must be performed during a relatively restricted window of time during the course of disease, that is, at a time in which it can provide gain (or "regain") of motor functionality while social adaptation is still possible 11 .…”

Section: Functional Neurosurgery In Parkinson's Diseasementioning

confidence: 99%

Decisions about deep brain stimulation therapy in Parkinson’s disease

Brandão

Grippe²,

Modesto³

et al. 2018

Arq. Neuro-Psiquiatr.

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Parkinson' s disease (PD), a hypokinetic movement disorder characterized by the classic tetrad of bradykinesia, rest tremor, plastic rigidity, and postural disturbances 1,2 , is a neurodegenerative disorder with an increasing impact on the Brazilian social and healthcare system, mirroring known demographic-epidemiological changes such as aging of the population and widening of the apex of the age pyramid 3,4 . Considering a prevalence of 3.3% in those aged 65 or older in the Brazilian population 5 , the country has at least 200,000 patients living with the disorder, a definitive challenge to the public health system. ABSTRACTParkinson's disease can be treated surgically in patients who present with motor complications such as fluctuations and dyskinesias, or medically-refractory disabling tremor. In this review, a group of specialists formulated suggestions for a preoperative evaluation protocol after reviewing the literature published up to October 2017. In this protocol, eligibility and ineligibility criteria for surgical treatment were suggested, as well as procedures that should be carried out before the multidisciplinary therapeutic decisions. The review emphasizes the need to establish "DBS teams", with professionals dedicated specifically to this area. Finally, surgical target selection (subthalamic nucleus or globus pallidus internus) is discussed briefly, weighing the pros and cons of each target.Keywords: Parkinson disease; deep brain stimulation; reference standards; basal ganglia; neurosurgical procedures. RESUMOA doença de Parkinson pode ser tratada cirurgicamente em pacientes que desenvolveram complicações motoras, como flutuações e discinesias, ou tremores refratários ao uso de medicação. Nesta revisão, um grupo de especialistas formulou sugestões para um protocolo de avaliação pré-operatória, depois de revisar a literatura publicada até outubro de 2017. Neste protocolo, são sugeridos critérios de elegibilidade e inadmissibilidade para tratamento cirúrgico, bem como procedimentos que devem ser realizados antes das decisões terapêuticas multidisciplinares. A revisão enfatiza a necessidade de estabelecer "equipes de DBS", com profissionais dedicados especialmente a esta área. Ao final, a seleção do alvo cirúrgico (núcleo subtalâmico ou globo pálido interno) é discutida brevemente, ponderando prós e contras de cada escolha.Palavras-chave: doença de Parkinson; estimulação cerebral profunda; padrões de referência; gânglios da base; procedimentos neurocirúrgicos.

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Deep brain stimulation for movement disorders

Abstract: The recent successes of DBS along the clinical and technological directions are changing the current practice of neuromodulation and, more importantly, will also drive future developments of this fascinating treatment.

Cited by 79 publications

References 134 publications

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

Radiofrequency Lesions through Deep Brain Stimulation Electrodes in Movement Disorders: Case Report and Review of the Literature

Decisions about deep brain stimulation therapy in Parkinson’s disease

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