Neurostimulation for Parkinson's Disease with Early Motor Complications

Schuepbach, W.M. Michael; Rau, Joern; Knudsen, Karina; Volkmann, Jens; Krack, Paul; Timmermann, Lars; Hälbig, Thomas D.; Hesekamp, Helke; Navarro, Soledad; Meier, Niklaus; Falk, Daniela; Mehdorn, Maximilian; Paschen, Steffen; Maarouf, M.; Barbe, Michael T.; Fink, Gereon R.; Kupsch, Andreas; Gruber, Doreen; Schneider, Gerd‐Helge; Seigneuret, Éric; Kistner, Andrea; Chaynes, Patrick; Ory‐Magne, Fabienne; Courbon, Christine Brefel; Vesper, Jan; Schnitzler, Alfons; Wojtecki, Lars; Houeto, Jean‐Luc; Bataille, B.; Maltête, David; Damier, Philippe; Raoul, Sylvie; Sixel‐Doering, F.; Hellwig, Dieter; Gharabaghi, Alireza; Krüger, Rejko; Pinsker, M.; Amtage, Florian; Régis, J.; Witjas, Tatiana; Thobois, Stéphane; Mertens, Patrick; Kloß, Manja; Hartmann, Andréas; Oertel, Wolfgang H.; Post, Bart; Speelman, Hans; Agid, Yves; Schade‐Brittinger, Carmen; Deuschl, Günther

doi:10.1056/nejmoa1205158

Cited by 1,182 publications

(1,011 citation statements)

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“…92,102 Panel 2 describes the clinical features of early reversible postoperative apathy. In a 2013 randomised study 103 comparing STN-DBS to best medical treatment in Parkinson's disease, the frequency of apathy did not diff er during the 2 years of follow-up, showing absence of early postoperative apathy when STN-DBS is accompanied by optimised medical treatment. The highest reported frequency of new-onset apathy during the fi rst year after STN-DBS was 50% of the patients.…”

Section: Apathy After Deep Brain Stimulation In Parkinson's Diseasementioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

422

394

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Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of diff erent networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of aff ected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely aff ect the quality of life of both patients and caregivers. Diff erentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.

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Section: Apathy After Deep Brain Stimulation In Parkinson's Diseasementioning

confidence: 99%

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Pagonabarraga

Kulisevsky

Strafella

et al. 2015

The Lancet Neurology

422

394

View full text Add to dashboard Cite

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“…Some large randomized controlled clinical trials have shown that in the short-term follow-up STN-DBS is superior to best medical treatment alone in controlling motor symptoms and complications and thus improving self-reported quality of life [1], [2] and [3].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Rizzone

Fasano

Daniele

et al. 2014

Parkinsonism & Related Disorders

160

152

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Background: Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome.Objective: To report the results of a long-term follow-up (mean 11 years, range 10-13) on 26 patients bilaterally implanted in two centres. Methods:Patients were assessed preoperatively and 1, 5 and 11 years after the implant by the Unified Parkinson's Disease Rating Scale (UPDRS) and a battery of neuropsychological tests. Stimulation parameters, drugs dosages, non-motor symptoms and adverse events were also recorded.Results: At 11 years, stimulation significantly improved the motor symptoms by 35.8%, as compared to the preoperative off-state. Motor complications were well controlled, with a 84.6% improvement of dyskinesias and a 65.8% improvement of motor fluctuations. Despite this, the UPDRS-II-on score worsened by 88.5%, mainly for the worsening of poorly levodopa-responsive symptoms. More than 70% of the patients performed in the normal range in most of the neuropsychological tests, despite the development of dementia in 22.7%. Age at disease onset, axial subscore in off-condition and presence of REM behaviour disorder at baseline were found to be associated with a higher risk of developing disability over time. Conclusions:Our study confirms the long-term safety and efficacy of STN-DBS in PD. Nevertheless, the functionality of patients worsens over time, mainly for the onset and progression of levodopa-resistant and non-motor symptoms. The role of PD-subtype seems to be relevant in the long-term outcome.

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“…[2][3][4] Recently, the efficacy of DBS has been also demonstrated in PD with early motor complications, 5 suggesting that the universe of potential surgical candidates is wider than previously established. However, concerns have been raised about potential cognitive and psychiatric adverse effects in PD patients following DBS, and some data even suggested that consequences might vary according to the chosen target, namely the subthalamic nucleus (STN) or the globus pallidus internus (GPi).…”

Section: Introductionmentioning

confidence: 99%

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

et al. 2014

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RESUMOIntrodução: A estimulação cerebral profunda (ECP) é eficaz na doença de Parkinson (DP) avançada, melhorando sintomas motores, flutuações e a qualidade de vida. No entanto, têm sido reportados efeitos adversos psiquiátricos, mas de uma forma variável e não padronizada. O objectivo deste artigo é analisar e sumarizar a evidência publicada sobre sintomas depressivos e ansiedade em doentes com DP após ECP, através de revisão sistemática e meta-análise. Material e Métodos: A PubMed foi pesquisada até Maio 2012 para identificar os estudos que avaliaram sintomas depressivos e ansiedade em doentes com doença de Parkinson submetidos a estimulação cerebral profunda bilateral do núcleo subtalâmico (NST) ou globo pálido interno (GPi). Foram feitas meta-análises com modelo de efeitos aleatórios para grupos de pelo menos três estudos homogéneos em relação ao desenho e instrumentos utilizados. Resultados: Foram selecionadas 63 referências; 98,4% continham dados relativos a escalas de avaliação de depressão e 38,1% relativos a ansiedade. Dois estudos não discriminavam o alvo usado; nos restantes 61 foi feita avaliação de curto prazo em 37 (60,7%), de médio prazo em 36 (59,0%) e de longo prazo em 5 (8,2%). Foram encontrados dados sobre variação pré/pós operatória em 57 (93,4%) estudos e 16 (26,2%) continham dados comparando ECP-NST versus outros grupos: ECP-GPi (n = 4 estudos, 25,0%), elegíveis para cirurgia (n = 6, 37,5%), e tratamento médico (n = 7, 43,8%). Discussão: É aparente a melhoria de depressão e ansiedade após ECP, sobretudo a curto prazo, efeito que tende a esbater-se em avaliações posteriores. Em relação à depressão a ECP-NST mostrou-se superior ao tratamento médico, mas não em comparação com o grupo de controlo elegível para cirurgia. Verificou-se o resultado oposto para a ansiedade, uma vez que os resultados favorecem o tratamento médico sobre a ECP-NST, e esta sobre o grupo de elegíveis para cirurgia. Não é evidente a superioridade de um alvo sobre o outro, mas os dados favorecem ligeiramente o GPi para ambos os tipos de sintomas. Conclusões:O padrão e curso dos sintomas depressivos e ansiedade após ECP na DP não são claros, mas ambos parecem melhorar no curto prazo, especialmente a depressão após a ECP-NST. Os resultados são bastante heterogéneos. Devem ser promovidos esforços no sentido de haver padronização de procedimentos de avaliação nos vários centros. Palavras-chave: Doença de Parkinson; Estimulação Cerebral Profunda; Ansiedade; Depressão; Meta-Análise. ABSTRACT Introduction: Deep brain stimulation (DBS) is effective in advancedParkinson's disease (PD), improving motor symptoms, fluctuations and quality of life. However, adverse psychiatric outcomes have been reported, albeit variably and in an unstandardized fashion. We aimed to summarize the published evidence on the outcomes of anxiety and depressive symptoms in Parkinson's disease patients following DBS, through systematic review and meta-analysis. Material and Methods: PubMed was searched until May 2012 to identify studies assessing anxiety and...

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Neurostimulation for Parkinson's Disease with Early Motor Complications

Cited by 1,182 publications

References 35 publications

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: From the advanced phase towards the late stage of the disease?

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

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