Exhaustive, ONE-YEAR FOLLOW-UP OF SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION IN A LARGE, SINGLE-CENTER COHORT OF PARKINSONIAN PATIENTS

Tir, Mélissa; Devos, David; Blond, S.; Touzet, Gustavo; Reyns, Nicolas; Duhamel, Alain; Cottencin, Olivier; Dujardin, Kathy; Cassim, F.; Destée, Alain; Defebvre, Luc; Krystkowiak, Pierre

doi:10.1227/01.neu.0000285347.50028.b9

Cited by 92 publications

(46 citation statements)

References 46 publications

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“…In a recent study, compared with baseline, the patients' scores at five years for motor function while off medication improved by 54% (p < 0.001) [30]. Tir et al reported a decrease by 43% in UPDRS-III scores 12 months after surgery [31]. Our results are in line with the literature.…”

Section: Discussionsupporting

confidence: 90%

The effects of brain stimulation of subthalamic nucleus surgery on gait and balance performance in Parkinson disease. A pilot study

Altuğ¹,

Acar²,

Acar³

et al. 2014

aoms

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A b s t r a c t I In nt tr ro od du uc ct ti io on n: : Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by tremor, rigidity and bradykinesia. Gait and postural difficulties supersede tremor, rigidity and bradykinesia as drivers of disease burden in patients with advanced PD. The aim of this study was to describe the effects of deep brain stimulation of the subthalamic nucleus on gait ability and balance performance in patients with PD. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : We studied 19 consecutive patients who underwent bilateral stimulation of the subthalamic nucleus. Patients were evaluated preoperatively and at the 5 th day and 6 th month after surgery. Timed Up and Go Test, 12 m Walking Test, Chair Stand Test and Berg Balance Scale (BBS) were used to assess mobility and balance performance. Unified Parkinson's Disease Rating Scale (UPDRS III) and Hoehn and Yahr Scale were also used. R Re es su ul lt ts s: : All the patients' mobility ability and balance performance improved after surgery (p < 0.05). At the 6 th month after surgery, the Timed Up and Go Test scores were decreased from 56.05 ±42.52 to 21.47 ±20.36, the 12 m Walking Test scores were decreased from 100.44 ±66.44 to 28.84 ±19.79, the Chair Stand Test scores were increased from 4.00 ±4.66 to 11.68 ±4.43 and the BBS score was increased from 12.84 ±6.89 to 38.89 ±8.79. UPDRS total scores were significantly improved 6 months after surgery (p < 0.001). UPDRS total scores were decreased from 98.26 ±37.69 to 39.36 ±18.85. The Hoehn and Yahr Scale score was significantly decreased after surgery (p < 0.05). C Co on nc cl lu us si io on ns s: : Surgical therapy is an effective treatment to improve gait ability and balance performance in Parkinson's patients. K Ke ey y w wo or rd ds s: : Parkinson's disease, balance performance, gait ability, subthalamic nucleus.

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Section: Discussionsupporting

confidence: 90%

The effects of brain stimulation of subthalamic nucleus surgery on gait and balance performance in Parkinson disease. A pilot study

Altuğ¹,

Acar²,

Acar³

et al. 2014

aoms

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“…A similar lack of satisfaction has also been reported after DBS in patients with Parkinson's disease despite clinical improvement [Tir et al, 2007]. Not only patients' expectations are at the base of their satisfaction, but the caregivers' opinion may influence the judgment of the stimulation effect in the patients as well.…”

Section: Patients' Expectations Versus Realistic Outcomessupporting

confidence: 52%

Issues Related to Deep Brain Stimulation for Treatment-Refractory Tourette’s Syndrome

et al. 2009

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Deep brain stimulation (DBS) has been used in a small number of patients with Tourette’s syndrome and results on tics and comorbidities have been promising. The choice of the DBS target appears to influence the effectiveness; preliminary studies and case reports suggest that certain target areas may be more effective than others in patients with specific symptoms and comorbidities. Clinical data on the effect of DBS on tics and behavioral symptoms support its use in patients with severe, refractory Tourette’s syndrome, particularly in younger adults who have a greater severity and prevalence of tics and comorbidities, and are more likely to experience social impairment. Although DBS has shown potential as an ‘add-on’ therapy for Tourette’s syndrome patients failing to show adequate improvement with conventional conservative treatments, several issues remain to be resolved, including patient selection, choice of target, and adverse effects. Successful DBS requires an experienced multidisciplinary team for the management of these complex pre-, peri- and postoperative issues. Future studies should include establishment of consistent inclusion criteria and specific practical requirements for clinical trials, evaluation of the impact of DBS on non-tic symptoms and their influence on outcome, social impairment and quality of life, and the identification of optimum neurophysiologically based DBS targets for improved efficacy in specific patient subtypes.

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“…Even when present, the impact of changes in verbal fluency on the quality of life appears to be relatively small (Alegret et al, 2004;Morrison et al, 2004;Montel and Bungener, 2009;Zahodne et al, 2009). Although almost half patients with DBS experience variable degrees of cognitive changes (Higginson et al, 2009), these deficits become 'relevant' in less than 10% treated patients (Castelli et al, 2006;Tir et al, 2007). However, because DBS is now widely used, even for patients with early PD in some centers, these adverse effects remain a major concern.…”

Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

“…Although the underlying substrate of these side effects remains to be characterized, it has been suggested that they may be induced by stimulation in non-motor areas of STN or GPi, inadvertent involvement of limbic structures outside of the target regions (Bejjani et al, 1999;Krack and Vercueil, 2001;Kulisevsky et al, 2002;Romito et al, 2002;Herzog et al, 2003a;Okun et al, 2003;Stefurak et al, 2003), and preexisting psychiatric conditions (Lilleeng and Dietrichs, 2008). Although significant unpleasant mood side effects following STN or GPi DBS are relatively rare (Funkiewiez et al, 2004;Castelli et al, 2006;Tir et al, 2007), their occurrence significantly disrupts patients' quality of life.…”

Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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Exhaustive, ONE-YEAR FOLLOW-UP OF SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION IN A LARGE, SINGLE-CENTER COHORT OF PARKINSONIAN PATIENTS

Cited by 92 publications

References 46 publications

The effects of brain stimulation of subthalamic nucleus surgery on gait and balance performance in Parkinson disease. A pilot study

The effects of brain stimulation of subthalamic nucleus surgery on gait and balance performance in Parkinson disease. A pilot study

Issues Related to Deep Brain Stimulation for Treatment-Refractory Tourette’s Syndrome

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

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