Pallidal vs Subthalamic Nucleus Deep Brain Stimulation in Parkinson Disease

Anderson, Valerie C.; Burchiel, Kim J.; Hogarth, Penelope; Favre, Jacques; Hammerstad, John P.

doi:10.1001/archneur.62.4.554

Cited by 486 publications

(385 citation statements)

References 32 publications

(12 reference statements)

Supporting

Mentioning

361

Contrasting

Unclassified

Order By: Relevance

“…DBS of the STN is most often performed bilaterally, although unilateral DBS of STN or GPi can be highly effective in some cases of asymmetric parkinsonism. In most patients, DBS alleviates parkinsonian motor signs, shortens 'off' periods, and reduces druginduced dyskinesias, dystonia, and motor fluctuations (Rodriguez-Oroz et al, 2004;Anderson et al, 2005;Weaver et al, 2005;Portman et al, 2006;Bronstein et al, 2011). In general, both GPi-and STN-DBS are more effective than medical management alone to alleviate motor deficits in patients with advanced PD (Just and Ostergaard, 2002;Martinez-Martin et al, 2002;Troster et al, 2003;Lezcano et al, 2004;Diamond and Jankovic, 2005;Erola et al, 2005;Halbig et al, 2005;Lyons and Pahwa, 2005;Deuschl et al, 2006;Rodrigues et al, 2007a, b;Montel and Bungener, 2009;Weaver et al, 2009b;Zahodne et al, 2009).…”

Section: Current Surgical Targetsmentioning

confidence: 99%

See 1 more Smart Citation

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

View full text Add to dashboard Cite

The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

show abstract

Section: Current Surgical Targetsmentioning

confidence: 99%

“…Most neurosurgeons currently prefer the STN over the GPi as a target for DBS in PD, because of the perceived greater antiparkinsonian benefit of STN-DBS (Anderson et al, 2005;Moro et al, 2010). However, there is no clear evidence that the STN is, in fact, a better target than GPi.…”

Section: Stn Vs Gpi As Targets For Dbs In Pd?mentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

View full text Add to dashboard Cite

show abstract

“…However, other early studies comparing STN and GPi DBS targets reveal increased adverse cognitive and behavioral effects after STN DBS. 8,196 Speculation as to the potential cause of cognitive decline in early versus more recent studies may stem from the close anatomical apposition of motor, associative, and limbic pathways in the STN. As targeting techniques have improved, side effects of stimulation of these nonmotor pathways may have decreased.…”

Section: Cognitive Effects Of Dbs In the Pd Populationmentioning

confidence: 99%

Deep brain stimulation: a mechanistic and clinical update

Karas

Mikell

Christian

et al. 2013

FOC

View full text Add to dashboard Cite

Deep brain stimulation (DBS), the practice of placing electrodes deep into the brain to stimulate subcortical structures with electrical current, has been increasing as a neurosurgical procedure over the past 15 years. Originally a treatment for essential tremor, DBS is now used and under investigation across a wide spectrum of neurological and psychiatric disorders. In addition to applying electrical stimulation for clinical symptomatic relief, the electrodes implanted can also be used to record local electrical activity in the brain, making DBS a useful research tool. Human single-neuron recordings and local field potentials are now often recorded intraoperatively as electrodes are implanted. Thus, the increasing scope of DBS clinical applications is being matched by an increase in investigational use, leading to a rapidly evolving understanding of cortical and subcortical neurocircuitry. In this review, the authors discuss recent innovations in the clinical use of DBS, both in approved indications as well as in indications under investigation. Deep brain stimulation as an investigational tool is also reviewed, paying special attention to evolving models of basal ganglia and cortical function in health and disease. Finally, the authors look to the future across several indications, highlighting gaps in knowledge and possible future directions of DBS treatment.

show abstract

“…Studies by Merello et al 15 and Fields et al 81 found the cognitive safety of GPi DBS and pallidotomy to be comparable. Although some suggest that bilateral GPi DBS may entail less cognitive morbidity than bilateral STN DBS, 27,74,82 the only randomised comparison of the cognitive effects of GPi and STN DBS has failed to reveal substantial differences between the two treatments. 57 A larger randomised trial comparing the effects Parkinson's Disease More out of levodopa.…”

Section: Pallidal Versus Subthalamic Deep Brain Stimulationmentioning

confidence: 99%

Effects of Deep Brain Stimulation on Cognition, Mood and Behaviour in Parkinson’s Disease

Tröster¹

2008

European Neurological Review

View full text Add to dashboard Cite

32Disappointed by the limitations of pharmacotherapy, emboldened by technological advances in surgery and radiology and armed with a better understanding of pathophysiology, physicians and scientists in the 1980s charted a renaissance of surgery for movement disorders such as Parkinson's disease (PD). The desire for a safer alternative to lesional or ablative neurosurgery, coupled with observations that intraoperative electrical stimulation used for target identification could alleviate abnormal movements, 1,2 prompted the exploration of fully Neurobehavioural Effects of Deep Brain Stimulation in Parkinson's DiseaseBy far the most attention to neurobehavioural outcomes of DBS has been devoted to PD, and the majority of these studies have examined the outcome of subthalamic (STN) rather than thalamic or pallidal (GPi) DBS. Probably greater controversy attends the neurobehavioural outcomes after STN DBS than after GPi or thalamic DBS, and this probably reflects, at least in part, differences among studies in the sample characteristics, selection and exclusion criteria, length of follow-up, surgical technique, post-operative DBS programming and pharmacotherapy protocols, and the thoroughness and timing of the neuropsychological evaluation protocol. In general, studies employing cognitive screening instruments fail to detect neurobehavioural morbidity. While some may argue that the lack of change on screening instruments suggests that neuropsychological changes detected by more extensive evaluations are not of clinical significance, a recent meta-analysis of the empirical data suggests that screening instruments may be insensitive even to clinically meaningful changes after DBS. 8 Consequently, cognitive screening measures are probably useful in helping decide which surgical candidates can be excluded from further evaluation (including full neuropsychological evaluation), but insufficient to adequately document neurobehavioural outcomes of DBS. Thalamic Deep Brain StimulationFour studies 9-12 have observed no widespread or significant changes in cognition, mood or behaviour after unilateral thalamic DBS, although one study suggested that statistically (but not necessarily clinically) significant declines in verbal memory are associated with left thalamic DBS. Few studies have examined mood after thalamic DBS, but one study 9 found an improvement in depressive symptoms four to 10 days after surgery. Pallidal Deep Brain StimulationUnilateral GPi DBS appears cognitively safe, although this conclusion is tempered by the limited number of small-sample studies published. [13][14][15] Although patients in one study showed statistically significant declines in visuoconstructional ability and verbal fluency, the changes were rarely of clinical significance. Even when using a liberal criterion of impairment (a test score falling one standard deviation below the mean of normative samples), another study 13 observed that only six of the 20 patients showed any increase, no matter how small, in the percentage of tests in the imp...

show abstract

Pallidal vs Subthalamic Nucleus Deep Brain Stimulation in Parkinson Disease

Cited by 486 publications

References 32 publications

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Deep brain stimulation: a mechanistic and clinical update

Effects of Deep Brain Stimulation on Cognition, Mood and Behaviour in Parkinson’s Disease

Contact Info

Product

Resources

About