Deep brain stimulation for Parkinson’s disease: Australian referral guidelines

Silberstein, Paul; Bittar, Richard G.; Boyle, Richard; Cook, Raymond; Coyne, Terry; O'sullivan, D. J.; Pell, Malcolm; Peppard, Richard; Rodrigues, Julian P.; Silburn, Peter A.; Stell, Rick; Watson, Peter J.

doi:10.1016/j.jocn.2008.11.026

Cited by 34 publications

(38 citation statements)

References 40 publications

(84 reference statements)

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“…All patients presented severe and disabling motor fluctuations and drug‐induced dyskinesias despite adjustments to their medical treatment, and a L ‐dopa responsiveness of ≥50%, as measured by their score on Part III of the Unified Parkinson's Disease Rating Scale (UPDRS). STN DBS was contraindicated for all patients, due to global cognitive impairment (Mattis Dementia Rating Scale ≤ 130),19 impaired executive functions (impaired scores at almost three tests among the battery of tests assessing executive functions, according to the normal values expected in regard of age and educational level), and/or dopa‐resistant axial motor signs at baseline, including dysarthria, freezing and falls (preoperative axial III score in the on‐dopa condition ≥3) 17, 20, 21. Demographic and clinical data are provided in Tables 1–3.…”

Section: Methodsmentioning

confidence: 99%

Pallidal stimulation in advanced Parkinson's patients with contraindications for subthalamic stimulation

Rouaud¹,

Dondaine²,

Drapier³

et al. 2010

Movement Disorders

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The aim of this study was to evaluate the efficacy and safety of bilateral pallidal (GPi) deep brain stimulation (DBS) 6 months after surgery in advanced parkinsonian patients whose dopa-resistant axial motor signs or cognitive decline constituted contraindications for subthalamic nucleus (STN) DBS. Seventeen patients with a mean age of 59.3 ± 7.1 years (range, 45-70), mean disease duration of 12.5 ± 4.3 years (range, 7-20), and contraindications for STN DBS, underwent bilateral GPi DBS. They were evaluated before surgery and 6 months afterward, in accordance with Core Assessment Program for Intracerebral Transplantation recommendations. There were mean improvements of 41.1% in the UPDRS III motor score in the off-dopa condition and 20.3% in the activities of daily living score. Motor fluctuations were reduced by 22.9% and dyskinesias by 68.6%. Axial motor signs improved in the off-dopa condition by 34.2%. Neuropsychological performances remained unchanged at the 6-month assessment. Bilateral GPi DBS is both safe and effective in advanced parkinsonian patients with untreatable motor fluctuations, for whom STN DBS is contraindicated due to dopa-resistant axial motor signs or cognitive decline. As such, it should be regarded as a viable option for these patients.

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Section: Methodsmentioning

confidence: 99%

Pallidal stimulation in advanced Parkinson's patients with contraindications for subthalamic stimulation

Rouaud¹,

Dondaine²,

Drapier³

et al. 2010

Movement Disorders

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“…However, other symptoms, including gait dysfunction and falls, do not necessarily improve after DBS and may even worsen 35 . Appropriate patient selection for DBS is critical, and Australian consensus guidelines have been recently published 36 …”

Section: Later Treatment Of Parkinson Diseasementioning

confidence: 99%

Current concepts in the management of Parkinson disease

Hayes

Fung

Kimber

et al. 2010

Medical Journal of Australia

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Parkinson disease (PD) is a multisystem neurodegenerative disorder that affects about 1% of the population over the age of 55 years and has mean age of onset of about 60 years. The Braak hypothesis proposes that the earliest pathological evidence of PD is found in the enteric nervous system, medulla and olfactory bulb, and only subsequently progresses (over years) to the substantia nigra and cortex. Non‐motor symptoms, such as constipation, hyposmia and sleep disorders, may precede typical motor features of PD by several years. No treatment has been convincingly shown to slow PD progression (ie, a neuroprotective drug remains elusive). Symptomatic benefit from dopaminergic therapy is usually maintained throughout the course of the disease. The decision as to whether to commence treatment with either levodopa or a dopamine agonist needs to be individually tailored, but long‐term outcomes appear to be equivalent. Advanced PD is complicated by the loss of non‐dopaminergic neurones, resulting in symptoms that are largely unresponsive to dopaminergic therapy. Treatment with apomorphine, Duodopa or deep‐brain stimulation surgery may be beneficial for selected patients with advanced PD. Non‐motor symptoms, such as mood disorders, cognitive impairment, autonomic dysfunction and sleep disorders, are responsible for significant morbidity. Management often requires a multidisciplinary approach.

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“…The mainstay of treatment is medical with pharmacological therapy aimed at increasing dopamine in the basal ganglia. The natural course of the disease results in a number of clinical challenges, including declining and fluctuating responses to medical therapy as well as medication-induced dyskinesia [2]. Deep brain stimulation (DBS) for PD is commonly considered in patients in whom there may exist one or more of the aforementioned challenges associated with progression of the disease [3].…”

Section: Introductionmentioning

confidence: 99%

Registration Accuracy of CT/MRI Fusion for Localisation of Deep Brain Stimulation Electrode Position: An Imaging Study and Systematic Review

Geevarghese

O’Gorman

Lumsden

et al. 2016

Stereotact Funct Neurosurg

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Background: Postoperative imaging is essential for verifying electrode location in patients undergoing deep brain stimulation (DBS). MRI offers better visualisation of brain targets, but concerns about adverse events have limited its use. Preoperative stereotactic MRI fused with a postoperative stereotactic CT, demonstrating the electrode position, is now widely used. Objectives: The aims of this study were to: (1) evaluate the accuracy of image registration using Neuroinspire, and (2) undertake a systematic review of the literature on CT/MRI fusion techniques to ascertain the accuracy of other software packages. Methods: Twenty patients who underwent bilateral subthalamic nucleus DBS for Parkinson's disease were selected. The postoperative CT was registered and fused with the preoperative MRI using Neuroinspire. The position of each electrode tip was determined in stereotactic coordinates both in the (unfused) postoperative CT and the fused CT/MRI. The difference in tip position was used to evaluate the registration accuracy. Results: The mean error ± SD of CT/MRI fusion using Neuroinspire was 0.25 ± 0.15, 0.33 ± 0.26 and 0.46 ± 0.55 mm in lateral, anteroposterior and vertical axes. A systematic review suggested that CT/MRI registration with Neuroinspire is more accurate than that achieved with other tested CT/MRI fusion algorithms. Conclusion: CT/MRI fusion for localisation of electrode placement offers an accurate, reliable and safe modality for assessing electrode location.

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Deep brain stimulation for Parkinson’s disease: Australian referral guidelines

Cited by 34 publications

References 40 publications

Pallidal stimulation in advanced Parkinson's patients with contraindications for subthalamic stimulation

Pallidal stimulation in advanced Parkinson's patients with contraindications for subthalamic stimulation

Current concepts in the management of Parkinson disease

Registration Accuracy of CT/MRI Fusion for Localisation of Deep Brain Stimulation Electrode Position: An Imaging Study and Systematic Review

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