How Does Deep Brain Stimulation Change the Course of Parkinson's Disease?

Mahlknecht, Philipp; Foltynie, Tom; Limousin, Patricia; Poewe, Werner

doi:10.1002/mds.29052

Cited by 41 publications

(35 citation statements)

References 90 publications

(244 reference statements)

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“…Even if DBS, especially STN DBS, is the best that has happened for patients with PD since the introduction of levodopa [11], one has to remember that all that glitters is not gold [94]. To start with, similar to levodopa treatment, DBS is not a cure of the disease, and the progression of the illness will continue no matter, but at variable and individual speed [95]. DBS is, as previously explained, a symptomatic treatment of some of the main symptoms of the disease.…”

Section: Limits Of and Issues In Dbs For Pdmentioning

confidence: 99%

“…Regardless of all the features mentioned above, DBS for PD remains an efficient symptomatic treatment, although the magnitude of improvement tends to decline over time [124], and DBS may contribute to delay some of the late-stage disability milestones [95]. With the expanding technical innovations and increasing sophistication of DBS, this therapy will put even more constraints on clinicians to keep themselves à jour, requiring thus their enhanced specialization in the multifaceted modern treatments of PD and the increased potentials offered by DBS technology to further improve patients' outcome.…”

Section: Future Prospects Of Dbs In Pdmentioning

confidence: 99%

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Deep brain stimulation for Parkinson's disease

Hariz

Blomstedt

2022

J Intern Med

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Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia–thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long‐lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow‐up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.

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Section: Limits Of and Issues In Dbs For Pdmentioning

confidence: 99%

Section: Future Prospects Of Dbs In Pdmentioning

confidence: 99%

Deep brain stimulation for Parkinson's disease

Hariz

Blomstedt

2022

J Intern Med

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“…Of note, despite their great efficacy in improving motor symptoms, MF, and QoL, the effect of advanced therapies remains symptomatic, and no disease-modifying effect has been proved. However, some authors have recently suggested that long-term controlled studies seem to suggest that STN-DBS may delay some of the late-stage disability milestones and slightly prolong survival compared with matched medically-treated patients [ 88 ].…”

Section: Surgical and Device-aided Therapiesmentioning

confidence: 99%

Off-time Treatment Options for Parkinson’s Disease

2023

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Motor fluctuations (MF) are deemed by patients with Parkinson's disease (PD) as the most troublesome disease feature resulting from the increasing impairment in responsiveness to dopaminergic drug treatments. MF are characterized by the loss of a stable response to levodopa over the nychthemeron with the reappearance of motor (and non-motor) parkinsonian clinical signs at various moments during the day and night. They normally appear after a few years of levodopa treatment and with a variable, though overall increasing severity, over the disease course. The armamentarium of first-line treatment options has widened in the last decade with new once-a-daily compounds,

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“…With focused ultrasound thalamotomy now becoming an alternative to DBS and to traditional forms of lesional surgery, the number of patients eligible for tremor surgery is increasing and now also includes the very elderly and patients with substantial comorbidities. The beneficial effect of bilateral subthalamic nucleus (STN) stimulation in controlling motor symptoms and improving quality of life in PD has been well documented in randomized controlled studies [ 118 ]. A non-randomized study in fluctuating PD patients with substantial off-tremor found that STN stimulation led to an 82% improvement of resting and a 78% improvement of action tremor during the “medication off” condition [ 119 ].…”

Section: Surgical and Ablative Approaches To Pd Tremormentioning

confidence: 99%

Pharmacological Treatment of Tremor in Parkinson’s Disease Revisited

Pirker¹,

Katzenschlager

Hallett

et al. 2023

JPD

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The pathophysiology of Parkinson’s disease (PD) tremor remains incompletely understood and there is a lack of clinical trials specifically addressing its pharmacological treatment. Levodopa is the most efficacious drug for most patients and should be used as primary approach to control troublesome tremor. While the efficacy of oral dopamine agonists on PD tremor has been demonstrated in controlled trials, there is no evidence of greater antitremor efficacy compared to levodopa. The magnitude of the antitremor effect of anticholinergics is generally lower than that of levodopa. Due to their adverse effects, anticholinergics have a limited role in selected young and cognitively intact patients. Propranolol may improve resting and action tremor and may be considered as an adjunct in patients with insufficient tremor response to levodopa and this also applies to clozapine, despite its unfavorable adverse effect profile. Treating motor fluctuations with MAO-B and COMT inhibitors, dopamine agonists, amantadine, or on-demand treatments such as subcutaneous or sublingual apomorphine and inhaled levodopa as well as with continuous infusions of levodopa or apomorphine will improve off period tremor episodes. For patients with drug-refractory PD tremor despite levodopa optimization deep brain stimulation and focused ultrasound are first-line considerations. Surgery can also be highly effective for the treatment medication-refractory tremor in selected patients without motor fluctuations. The present review highlights the clinical essentials of parkinsonian tremor, critically examines available trial data on the effects of medication and surgical approaches and provides guidance for the choice of treatments to control PD tremor in clinical practice.

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How Does Deep Brain Stimulation Change the Course of Parkinson's Disease?

Cited by 41 publications

References 90 publications

Deep brain stimulation for Parkinson's disease

Deep brain stimulation for Parkinson's disease

Off-time Treatment Options for Parkinson’s Disease

Pharmacological Treatment of Tremor in Parkinson’s Disease Revisited

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