Long‐term effects of pallidal or subthalamic deep brain stimulation on quality of life in Parkinson's disease

Volkmann, Jens; Albanese, Alberto; Kulisevsky, Jaime; Tornqvist, Aana Lena; Houeto, Jean Luc; Pidoux, B.; Bonnet, Anne Marie; Mendes, Alexandre; Benabid, Alim Louis; Fraix, Valérie; Blercom, N. Van; Xie, Jing; Obeso, José A.; Rodriguez-Oroz, María C.; Guridi, Jorge; Schnitzler, Alfons; Timmermann, Lars; Gironell, Alexandre; Molet, Juan; Pascual-Sedano, Berta; Rehncrona, Stig; Moro, Elena; Ae, Lang; Lozano, Andrés M.; Bentivoglio, Anna Rita; Scerrati, Massimo; Contarino, Maria Fiorella; Romito, Luigi; Janssens, Marc; Agid, Yves

doi:10.1002/mds.22496

Cited by 141 publications

(91 citation statements)

References 30 publications

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“…DBS has been used successfully for many years in movement disorders such as Parkinson's disease (PD), [1][2][3] yet treatment may sometimes be suboptimal for several different reasons, such as inappropriate patient selection or programming or electrode placement; two referral centers for DBS troubleshooting have reported that therapy failure in half of the evaluated leads was caused by suboptimal positioning. 4 Stimulation of the dorsolateral subthalamic nucleus (STN) is associated with best motor symptom control, 5,6 but excessive stimulation of adjacent fiber tracts can cause adverse effects such as disturbances in speech and fine-motor control.…”

Section: Clinical Opportunitiesmentioning

confidence: 99%

Directional leads for deep brain stimulation: Opportunities and challenges

et al. 2017

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Section: Clinical Opportunitiesmentioning

confidence: 99%

Directional leads for deep brain stimulation: Opportunities and challenges

et al. 2017

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“…Thirteen observational studies fulfilled the selection criteria. Two of these studies were excluded 16,17 because the population samples were subsets of the populations in 2 other articles that were included because they had larger sample sizes. 18,19 Of the remaining 11 studies, 3 examined bilateral GPi, 9 examined bilateral STN stimulation, and 1 study included both STN and GPi target sites.…”

mentioning

confidence: 99%

A meta-regression of the long-term effects of deep brain stimulation on balance and gait in PD

George¹,

Nutt²,

Burchiel³

et al. 2010

Neurology

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Objective: Deep brain stimulation (DBS) alleviates the cardinal Parkinson disease (PD) symptoms of tremor, rigidity, and bradykinesia. However, its effects on postural instability and gait disability (PIGD) are uncertain. Contradictory findings may be due to differences the in stimulation site and the length of time since DBS surgery. This prompted us to conduct the first meta-regression of long-term studies of bilateral DBS in the subthalamic nucleus (STN) and globus pallidus interna (GPi).Results: Eleven articles reported a breakdown of the Unified Parkinson's Disease Rating Scale score before and beyond 3 years postsurgery (mean 4.5 years). Random effects meta-regression revealed that DBS initially improved PIGD compared to the OFF medicated state before surgery, but performance declined over time and extrapolation showed subjects would reach presurgery levels 9 years postsurgery. ON medication, DBS improved PIGD over and above the effect of medication before surgery. Nevertheless, for the STN group, PIGD progressively declined and was worse than presurgery function within 2 years. In contrast, GPi patients showed no significant long-term decline in PIGD in the medicated state. Improvements in cardinal signs with DBS at both sites were maintained across 5 years in the OFF and ON medication states.Conclusions: DBS alone does not offer the same improvement to PIGD as it does to the cardinal symptoms, suggesting axial and distal control are differentially affected by DBS. GPi DBS in combination with levodopa seemed to preserve PIGD better than did STN DBS, although more studies of GPi DBS and randomized controls are needed. Neurology Balance and gait are gradually, and inevitably, impaired as Parkinson disease (PD) progresses, resulting in significant impairment of mobility. Mobility disability is one of the most important causes of diminished quality of life, morbidity, and mortality in patients with PD.1,2 Deep brain stimulation (DBS) of either the subthalamic nucleus (STN) or globus pallidus interna (GPi) is an increasingly common therapy for mid-to late-stage PD. With optimized stimulation settings, DBS typically lessens the motor symptoms of tremor, limb rigidity, bradykinesia, and akinesia. However, the long-term effects on balance, locomotion, and speech, often referred to as axial motor signs, are debated.Despite improvements in clinical ratings of PIGD immediately after DBS surgery, patients tend to fall more.3 These seemingly contradictory findings are not altogether surprising given that balance and gait are complex behaviors consisting of many sensorimotor subsystems that may not be fully characterized by the PIGD items in the Unified Parkinson's Disease Rating Scale (UPDRS). So although posture and gait are affected by bradykinesia, rigidity, and to a lesser extent tremor, other sensorimotor systems underlying posture and gait, such as setdependent flexibility, 4 sensory integration, 5 and postural synergies, 6 do not show the same responsiveness to levodopa. Therefore, each subsystem underl...

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“…Ein Dopamindysregulationssyndrom wird in der Regel durch eine THS gebessert, selten aber auch negativ beeinflusst. Positive Lebensqualitätsef-fekte blieben über 2 Jahre nach THS erhalten, nahmen im Verlauf von über 3 Jahren aber deutlich ab [24,28].…”

Section: Parkinson-krankheitunclassified