Microsubthalamotomy: An immediate predictor of long‐term subthalamic stimulation efficacy in Parkinson disease

Maltête, David; Derrey, Stéphane; Chastan, Nathalie; Debono, Bertrand; Gérardin, Emmanuel; Fréger, P.; Mihout, B; Ménard, Jean François; Hannequin, Didier

doi:10.1002/mds.22054

Cited by 54 publications

(58 citation statements)

References 20 publications

(26 reference statements)

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“…100,101,135,152,189 This observation provided evidence to the knowledge that small and confined STN inactivation can be sufficient to produce an improvement of PD, as replicated in animal models. 21 These so-called microlesions appear to have similar effects on the metabolic activity of the globus pallidus, the striatum, the thalamus, and the cortex as those measured after subthalamotomy, but to a lesser extent.…”

Section: Effects On Levodopa Needs and Lidmentioning

confidence: 59%

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Jourdain

Schechtmann

Paolo

2014

JNS

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Parkinson's disease (PD) is a neurodegenerative condition that can be pharmacologically treated with levodopa. However, important motor and nonmotor symptoms appear with its long-term use. The subthalamic nucleus (STN) is known to be involved in the pathophysiology of PD and to contribute to levodopa-induced complications. Surgery is considered in patients who have advanced PD that is refractory to pharmacotherapy and who display disabling dyskinesia. Deep brain stimulation of the STN is currently the main surgical procedure for PD, but lesioning is still performed. This review covers the clinical aspects and complications of subthalamotomy as one of the lesion-based options for PD patients with levodopa-induced dyskinesias. Moreover, the authors discuss the possible effects of subthalamic lesioning.

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Section: Effects On Levodopa Needs and Lidmentioning

confidence: 59%

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Jourdain

Schechtmann

Paolo

2014

JNS

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“…Our findings are consistent with evidence suggesting the potential predictive value of microsubthalamotoy in these patients. 1 In contrast, whereas most of our patients with generalized dystonia that had MLE also benefited from DBS at 6 months, one patient who failed to show MLE also had significant motor improvement with DBS. This indicates that MLE may be less predictive of the beneficial effect of DBS in generalized dystonia than in PD.…”

Section: Discussionmentioning

confidence: 72%

“…1 This finding led some to conclude that microsubthalamotomy may be a predictor of long-term efficacy of STN stimulation in PD, 1 although there are also claims to the contrary. 2 The mechanisms of this micro lesion effect (MLE) are unknown.…”

mentioning

confidence: 95%

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

et al. 2009

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To determine whether the immediate response to electrode implantation (micro lesion effect, MLE) in the internal segment of the globus pallidus (GPi) predicts symptom improvement with deep brain stimulation (DBS) at 6 months in patients with Parkinson's disease (PD) or generalized dystonia. Electrode implantation in the subthalamic nucleus (STN) prior to electrical stimulation has been reported to predict a beneficial effect of DBS in patients with PD, but whether this is also the case for the GPi in either PD or dystonia patients has not been established. We studied 20 patients (11 with PD and 9 with dystonia) who underwent electrode implantation in the GPi. Effects were assessed using standardized scales after 24 hours, weekly for 3 weeks prior to starting DBS, and after 6 months of DBS. 10 of 11 PD and 8 of 9 dystonia cases who benefited from electrode implantation also showed improvement in all motor and disability scores after 6 months of DBS of the GPi. One dystonia patient who did not show MLE benefited from DBS. The presence of MLE after electrode implantation in the GPi may help predict motor benefit from DBS in PD and generalized dystonia patients.

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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%

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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Microsubthalamotomy: An immediate predictor of long‐term subthalamic stimulation efficacy in Parkinson disease

Cited by 54 publications

References 20 publications

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

Subthalamotomy in the treatment of Parkinson's disease: clinical aspects and mechanisms of action

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

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

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