Effects of bilateral subthalamic stimulation on sleep in Parkinson?s disease

Monaca, Christelle; Özsancak, Canan; Jacquesson, J.; Poirot, I.; Blond, S.; Destée, Alain; Guieu, J.D.; Derambure, Philippe

doi:10.1007/s00415-004-0305-7

Cited by 72 publications

(62 citation statements)

References 16 publications

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“…3,4,5 To date, most studies including objective polysomnographic measures have been small case series, with different patient populations, study protocols, various assessment time points, and electrode settings: Arnulf and colleagues evaluated 10 insomniac PD patients 3 to 6 months after STN-DBS, and found stimulation to increase total sleep time and sleep efficiency. 6 Similar findings have been made by Monaca et al in 10 patients before STN-DBS and again after 3 months, 7 by Cicolin and colleagues in 5 patients before and 3 months after bilateral STN-DBS electrode implantation, 8 and by Merlino et al in 15 patients one week before and after microsubthalamotomy. 9 On the other hand, Iranzo and colleagues evaluated 11 PD patients before and 6 months after bilateral STN-DBS implantation, but stimulation did not increase sleep efficiency.…”

Section: Introductionsupporting

confidence: 73%

The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients

Baumann‐Vogel

Imbach

Sürücü

et al. 2017

Sleep

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Study Objectives: This prospective observational study was designed to systematically examine the effect of subthalamic deep brain stimulation (DBS) on subjective and objective sleep-wake parameters in Parkinson patients. Methods: In 50 consecutive Parkinson patients undergoing subthalamic DBS, we assessed motor symptoms, medication, the position of DBS electrodes within the subthalamic nucleus (STN), subjective sleep-wake parameters, 2-week actigraphy, video-polysomnography studies, and sleep electroencepahalogram frequency and dynamics analyses before and 6 months after surgery. Results: Subthalamic DBS improved not only motor symptoms and reduced daily intake of dopaminergic agents but also enhanced subjective sleep quality and reduced sleepiness (Epworth Sleepiness Scale: −2.1 ± 3.8, p < .001). Actigraphy recordings revealed longer bedtimes (+1:06 ± 0:51 hours, p < .001) without shifting of circadian timing. Upon polysomnography, we observed an increase in sleep efficiency (+5.2 ± 17.6%, p = .005) and deep sleep (+11.2 ± 32.2 min, p = .017) and increased accumulation of slow-wave activity over the night (+41.0 ± 80.0%, p = .005). Rapid eye movement sleep features were refractory to subthalamic DBS, and the dynamics of sleep as assessed by state space analyses did not normalize. Increased sleep efficiency was associated with active electrode contact localization more distant from the ventral margin of the left subthalamic nucleus. Conclusion: Subthalamic DBS deepens and consolidates nocturnal sleep and improves daytime wakefulness in Parkinson patients, but several outcomes suggest that it does not normalize sleep. It remains elusive whether modulated activity in the STN directly contributes to changes in sleep-wake behavior, but dorsal positioning of electrodes within the STN is linked to improved sleep-wake outcomes.

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Section: Introductionsupporting

confidence: 73%

The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients

Baumann‐Vogel

Imbach

Sürücü

et al. 2017

Sleep

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“…They showed that stimulation significantly increased total sleep time and sleep efficiency and improved subjective sleep quality as well. In addition, the duration of slow wave sleep and REM sleep was increased, but the percentages of each sleep stage were not significantly different, and changes in sleep did not correlate significantly with motor improvement [Monaca et al 2004]. Cicolin and colleagues showed significantly reduced WASO, increased sleep efficiency, and decreased REM latency in five patients with PD 3 months after bilateral STN DBS.…”

Section: Subthalamic Nucleus Deep Brain Stimulationmentioning

confidence: 99%

The effects of deep brain stimulation on sleep in Parkinson’s disease

Amara

Watts

Walker

2010

Ther Adv Neurol Disord

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Sleep dysfunction is a common nonmotor symptom experienced by patients with Parkinson's disease (PD). Symptoms, including excessive daytime sleepiness, sleep fragmentation, rapid eye movement (REM) sleep behavior disorder and others, can significantly affect quality of life and daytime functioning in these patients. Recent studies have evaluated the effects of deep brain stimulation (DBS) at various targets on sleep in patients with advanced PD. Several of these studies have provided evidence that subthalamic nucleus DBS improves subjective and objective measures of sleep, including sleep efficiency, nocturnal mobility, and wake after sleep onset (minutes spent awake after initial sleep onset). Although fewer studies have investigated the effects of bilateral internal globus pallidus and thalamic ventral intermedius DBS on sleep, pallidal stimulation does appear to improve subjective sleep quality. Stimulation of the pedunculopontine nucleus has recently been proposed for selected patients with advanced PD to treat severe gait and postural dysfunction. Owing to the role of the pedunculopontine nucleus in modulating behavioral state, the impact of stimulation at this target on sleep has also been evaluated in a small number of patients, showing that pedunculopontine nucleus DBS increases REM sleep. In this review, we discuss the effects of stimulation at these various targets on sleep in patients with PD. Studying the effects of DBS on sleep can enhance our understanding of the pathophysiology of sleep disorders, provide strategies for optimizing clinical benefit from DBS, and may eventually guide novel therapies for sleep dysfunction.

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“…Previous electrophysiological and patient-reported outcome-based studies demonstrated the beneficial effect of STN DBS on sleep quality in PD [3][4][5][6].…”

Section: Introductionmentioning

confidence: 97%

Bilateral Subthalamic Stimulation can Improve Sleep Quality in Parkinson’s Disease

Deli

Aschermann

Ács

et al. 2015

JPD

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Abstract.Background: Sleep problems are among the most common non-motor symptoms of Parkinson's disease (PD). The PD Sleep Scale 2nd version (PDSS-2) improved the original PDSS by adding more items on different aspects of sleep problems, making it a more robust tool to evaluate the severity of sleep disturbances. However, previous studies on deep brain stimulation (DBS) have not used the PDSS-2. Objective: To determine if the PDSS-2 could detect improvement reliably in sleep problems after bilateral subthalamic nucleus DBS for PD. Methods: In this prospective study, 25 consecutive patients undergoing DBS implantation were enrolled. Patients were examined twice: 1 week prior to the DBS implantation (baseline) and 12 months postoperatively. Severity of PD symptoms were assessed by the Movement Disorders Society Unified PD Rating Scale (MDS-UPDRS) and the Non-Motor Symptoms Scale (NMSS). Presence and severity of sleep disturbances were specifically measured by PDSS-2. Results: Total score of MDS-UPDRS improved from 81 (median, interquartile-range: 63-103) to 55 points (median, IQR: 46-75, p < 0.001). Health-related quality of life, measured by PDQ-39, also improved from 29 (IQR: 18-40) to 15 (IQR: 9-28) points (p = 0.002). Most domains of NMSS also improved. At baseline 13 patients reported sleep problems, but 1 year after DBS implantation only 3 did (p = 0.012). Although only 6 out of 15 items showed a significant decrease after DBS implantation, the total score of PDSS-2 decreased from 24 (IQR: 17-32) to 10 (IQR: 7-18) points (P < 0.001). Conclusions: Based on our results, PDSS-2 can detect improvements in sleep quality reliably after DBS implantation.

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Effects of bilateral subthalamic stimulation on sleep in Parkinson?s disease

Cited by 72 publications

References 16 publications

The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients

The Impact of Subthalamic Deep Brain Stimulation on Sleep–Wake Behavior: A Prospective Electrophysiological Study in 50 Parkinson Patients

The effects of deep brain stimulation on sleep in Parkinson’s disease

Bilateral Subthalamic Stimulation can Improve Sleep Quality in Parkinson’s Disease

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