Deep-Brain Stimulation of the Subthalamic Nucleus or the Pars Interna of the Globus Pallidus in Parkinson's Disease

Abstract

ConclusionsEVODOPA is the mainstay of treatment for Parkinson's disease. 1 However, long-term levodopa treatment is complicated by involuntary movements known as dyskinesia and motor fluctuations in which patients cycle between periods of good mobility ("on" periods) and impaired mobility ("off " periods). 2 These complications result in disability that cannot be satisfactorily controlled by medical therapy in the majority of patients. Advances in understanding of the pathophysiology of the basal ganglia have provided opportunities for new therapeutic strategies to manage these problems. [3][4][5] In animal models of Parkinson's disease, neuronal activity is increased in the subthalamic nucleus and pars interna of the globus pallidus, 6 and lesions of these structures result in marked improvement in motor function. [6][7][8] These findings have led to the development of surgical procedures for Parkinson's disease that target the subthalamic nucleus and pars interna of the globus pallidus. 9,10 In patients with Parkinson's disease, the creation of lesions in the pars interna of the globus pallidus (pallidotomy) improves contralateral dyskinesia and provides moderate antiparkinsonian benefits. 11,12 However, pallidotomy necessitates making a destructive brain lesion and entails the risk of inducing neurologic deficits, particularly with bilateral procedures. 13 The creation of lesions in the subthalamic nucleus also provides benefits to patients, 14 but is associated with the risk of hemiballismus. 15 Accordingly, physicians have been reluctant to perform bilateral pallidotomy or subthalamotomy. 10 High-frequency deep-brain stimulation of specific brain targets simulates the effect of a lesion without deliberately damaging the brain. 16 Deep-brain stimulation of the thalamus has been shown to control tremor 17 but not other, more disabling, features of Parkinson's disease. Studies in small numbers of patients with Parkinson's disease suggest that stimulation of the subthalamic nucleus and pars interna of the globus pallidus can improve the full constellation of parkinsonian motor features. [18][19][20][21][22] We evaluated the results LThe New England Journal of Medicine METHODSWe performed a six-month, prospective, multicenter trial of bilateral deep-brain stimulation of the subthalamic nucleus or pars interna of the globus pallidus in patients with advanced Parkinson's disease. The study included a double-blind, randomized, crossover evaluation of the immediate effects of stimulation three months after implantation of the electrodes; unblinded evaluations of motor function two weeks before and one, three, and six months after implantation; and assessments of motor status with the use of a home diary. PatientsThe ages of the patients ranged from 30 to 75 years. The criteria for inclusion were the presence of at least two cardinal features of parkinsonism (tremor, rigidity, and bradykinesia), a good response to levodopa, a minimal score of 30 points on the motor portion of the Unified Parkinson's Disease Rating S...

Transient Disabling Dyskinesias: A Predictor of Good Outcome in Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease

“…After STN-DBS, we observed an average of 70% motor benefit (UPDRS III), a 58% reduction of LEDD and a 70% reduction of dyskinesias (UPDRS IV). These results are consistent with those reported by other authors [2, 12, 25]. We registered disabling dyskinesias immediately after surgery in 5 patients (5/75; 6.6%; dyskinesia group).…”

Imaging for deep brain stimulation: The zona incerta at 7 Tesla

“…DBS is a reversible stereotactic long-term therapeutic option for patients with chronic movement disorders including PD and tremor [1,51] . The method plays, after the approval by the US Food and Drug Administration, an accepted role in the treatment of medically refractory movement disorders including ET [52] .…”

“…The subthalamKerl HU et al . Zona incerta at 7 Tesla ic nucleus (STN) represents the commonly chosen target site to suppress resting tremor in patients with PD [1,5,6] . Despite the improvements in motor function, several clinical trails have yielded information about negative limbic effects of STN DBS, including depression, apathy, and decreased cognitive function [7,8] .…”

“…is an accepted neurosurgical technique for the treatment of many neurological and psychiatric disorders, such as Parkinson's disease (PD), essential tremor (ET), dystonia [1][2][3][4] . The subthalamKerl HU et al .…”

Diazonium-Based Anchoring of PEDOT on Pt/Ir Electrodes via Diazonium Chemistry

“…5,6 DBS involves the stimulation of specific regions of the brain (e.g. sub-thalamus nucleus or Broadman Area 25 via electrical impulses 7,8 and requires permanent surgical implantation of microelectrodes. 9 Platinum/iridium (Pt/Ir) electrodes have become the gold standard for DBS, as they exhibit excellent electrical conductivity, mechanical strength, and long-term electrochemical stability, in addition to greater resistance to fouling compared to other materials.…”