Micro lesion effect of the globus pallidus internus and outcome with deep brain stimulation in patients with Parkinson disease and dystonia

Cersósimo, María G.; Raina, Gabriela; Benarroch, Eduardo E.; Piedimonte, Fabián; Alemán, Gabriela González; Micheli, Federico

doi:10.1002/mds.22641

Cited by 56 publications

(44 citation statements)

References 18 publications

(19 reference statements)

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“…So far, MLE has only been reported to present as motor symptoms. The fact that psychotic symptoms were not elicited by a later activation of the stimulator is consistent with the observation that MLE extends beyond the target site [5]. In this case, we would expect MLE to extend into the vicinity of the target site, i.e.…”

Section: Discussionsupporting

confidence: 67%

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Evidence of a non-motor microlesion effect following deep brain surgery: a case report

Rozanski¹,

Lieb²,

Vollmar³

et al. 2012

Acta Neurochir

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We report the case of a patient who developed acute transient psychosis after implantation, but not activation of pallidal deep brain electrodes for generalised dystonia. Psychotic symptoms coincided temporally with postoperative motor improvement induced by the microlesion effect after electode implantation. This finding suggests that the microlesion effect may not be confined to motor improvement, but also comprises non-motor symptoms. In our case, affection of adjacent dopaminergic fibres of passages has to be assumed.

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Section: Discussionsupporting

confidence: 67%

“…On the basis of these observations, we raise the hypothesis that the patient's psychiatric symptoms were due to affection of dopaminergic fibres adjacent to GPi and presented as a non-motor microlesion effect after deep brain surgery [4,5,8]. So far, MLE has only been reported to present as motor symptoms.…”

Section: Discussionmentioning

confidence: 92%

Evidence of a non-motor microlesion effect following deep brain surgery: a case report

Rozanski¹,

Lieb²,

Vollmar³

et al. 2012

Acta Neurochir

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“…Interestingly, the microlesion effect (MLE), although commonly known, was only casually and briefly accented in the midst of a multitude of publications. Only a few studies were adequately designed and included analysis of the MLE as the primary endpoint [7,8,9,10,11]. Their results unambiguously confirmed the presence of the MLE and provided qualitative and quantitative analysis of this phenomenon.…”

Section: Introductionmentioning

confidence: 79%

“…Cerosimo et al [10] reported the presence of the MLE after electrode implantation to the GPi for PD and generalized dystonia. This study provided two interesting conclusions.…”

Section: Discussionmentioning

confidence: 99%

Microlesion Effect as a Predictor of the Effectiveness of Subthalamic Deep Brain Stimulation for Parkinson’s Disease

Tykocki

Nauman

Koziara³

et al. 2012

Stereotact Funct Neurosurg

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Background: Microlesion effect (MLE) is a commonly observed phenomenon after electrode insertion into the subthalamic nucleus (STN) for deep brain stimulation (DBS). Objectives: The aim of this study was to determine the presence of the MLE in the early postoperative period and the relationship between MLE and STN DBS. Methods: 74 patients with Parkinson’s disease were included in this study. Motor symptoms were evaluated preoperatively, within 48 h after electrode implantation and at 6 months with United Parkinson’s Disease Rating Scale part III (UPDRS-III). According to the improvement level with MLE, all participants were stratified into three groups: (1) less than 20%; (2) 20–40%, and (3) more than 40% in OFF medication states. The degree of improvement in UPDRS-III with DBS ON for each MLE group was assessed at the 6-month follow-up. Regression analysis was applied for the evaluation of the relationship between MLE and improvement with DBS ON. Results: Mean results in UPDRS-III with the MLE in ON and OFF medication states were 22.1 ± 10.5 and 42.1 ± 14 points, respectively. At the 6-month follow-up, with active stimulation, results tended to further ameliorate to 14.6 (59.4%) points in ON and 20.8 (55.3%) in OFF. Mean improvement in MLE groups were: 33.6% group 1, 47.5% group 2 and 61.4% group 3. Regression analysis revealed a positive correlation between the MLE and results at 6 months with DBS ON. Conclusion: Results proved the presence of MLE in the early postoperative period. Furthermore, a positive correlation between MLE and improvement degree with active stimulation was observed.

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“…After an intra-operative trial, stimulation was switched off for 1 week to allow consolidation of the tissue surrounding the electrode tips (eg, changes in resistance) and to control for microlesional effects (Cersosimo et al, 2009;Granziera et al, 2008). One week post-operatively, this DBS setting was resumed and the voltage was successively increased from 2 to 4 V.…”

Section: Stimulation Parameters and Additional Treatmentsmentioning

confidence: 99%

Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

Bewernick

Kayser

Sturm

et al. 2012

Neuropsychopharmacol

317

198

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Deep brain stimulation (DBS) to the nucleus accumbens (NAcc-DBS) was associated with antidepressant, anxiolytic, and procognitive effects in a small sample of patients suffering from treatment-resistant depression (TRD), followed over 1 year. Results of long-term follow-up of up to 4 years of NAcc-DBS are described in a group of 11 patients. Clinical effects, quality of life (QoL), cognition, and safety are reported. Eleven patients were stimulated with DBS bilateral to the NAcc. Main outcome measures were clinical effect (Hamilton Depression Rating Scale, Montgomery-Asperg Rating Scale of Depression, and Hamilton Anxiety Scale) QoL (SF-36), cognition and safety at baseline, 12 months (n ¼ 11), 24 months (n ¼ 10), and last follow-up (maximum 4 years, n ¼ 5). Analyses were performed in an intent-to-treat method with last observation carried forward, thus 11 patients contributed to each point in time. In all, 5 of 11 patients (45%) were classified as responders after 12 months and remained sustained responders without worsening of symptoms until last follow-up after 4 years. Both ratings of depression and anxiety were significantly reduced in the sample as a whole from first month of NAcc-DBS on. All patients improved in QoL measures. One non-responder committed suicide. No severe adverse events related to parameter change were reported. First-time, preliminary long-term data on NAcc-DBS have demonstrated a stable antidepressant and anxiolytic effect and an amelioration of QoL in this small sample of patients suffering from TRD. None of the responders of first year relapsed during the observational period (up to 4 years).

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Micro lesion effect of the globus pallidus internus and outcome with deep brain stimulation in patients with Parkinson disease and dystonia

Cited by 56 publications

References 18 publications

Evidence of a non-motor microlesion effect following deep brain surgery: a case report

Evidence of a non-motor microlesion effect following deep brain surgery: a case report

Microlesion Effect as a Predictor of the Effectiveness of Subthalamic Deep Brain Stimulation for Parkinson’s Disease

Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

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