Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Bjerknes, Silje; Skogseid, Inger Marie; Hauge, Tobias; Dietrichs, Espen; Toft, Mathias

doi:10.1038/s41531-020-00131-0

Cited by 11 publications

(13 citation statements)

References 66 publications

(100 reference statements)

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“…Both mean MDS‐UPDRS I and Scopa‐Aut total score had at 5 years returned to about the same level as preoperatively (Table 2). The Scopa‐Aut sub‐score of thermoregulatory function was significantly improved at 1 year as published previously 27 . At 5 years it was still better than preoperatively, but no longer statistically significant ( P = 0.043, Bonferroni adjusted α‐value <0.017).…”

Section: Resultssupporting

confidence: 81%

“…The Scopa-Aut sub-score of thermoregulatory function was significantly improved at 1 year as published previously. 27 At 5 years it was still better than preoperatively, but no longer statistically significant (P = 0.043, Bonferroni adjusted α-value <0.017). Pupillomotor score was worse than preoperatively (P = 0.006).…”

Section: Resultsmentioning

confidence: 82%

“…We have previously reported results from a randomized controlled trial with one‐year follow‐up of 60 PD patients undergoing STN‐DBS surgery, with targeting guidance either from single microelectrode (one central trajectory, or as few as needed to confirm STN signals; sMER) for target verification, or multiple simultaneously inserted MER for target mapping (mMER) 26,27 . The mMER group had a significantly greater improvement after 1 year both in MDS‐UPDRS III medication‐off score and in two PDQ‐39 domains (activities of daily living and bodily discomfort).…”

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confidence: 99%

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Subthalamic Nucleus Stimulation in Parkinson's Disease: 5‐Year Extension Study of a Randomized Trial

Bjerknes

Toft

Brandt

et al. 2021

Movement Disord Clin Pract

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BackgroundBackground: In Parkinson's disease (PD) long-term motor outcomes of subthalamic nucleus deep brain stimulation (STN-DBS) are well documented, while comprehensive reports on non-motor outcomes are fewer and less consistent. Objective Objective: To report motor and non-motor symptoms after 5-years of STN-DBS. Methods Methods:We performed an open 5-year extension study of a randomized trial that compared intraoperative verification versus mapping of STN using microelectrode recordings. Changes from preoperative to 5-years of STN-DBS were evaluated for motor and non-motor symptoms (MDS-UPDRS I-IV), sleep disturbances (PDSS), autonomic symptoms (Scopa-Aut), quality of life (PDQ-39) and cognition through a neuropsychological test battery. We evaluated whether any differences between the two randomization groups were still present, and assessed preoperative predictors of physical dependence after 5 years of treatment using logistic regression. ResultsResults: We found lasting improvement of off-medication motor symptoms (total MDS-UPDRS III, bradykinetic-rigid symptoms and tremor), on-medication tremor, motor fluctuations, and sleep disturbances, but reduced performance across all cognitive domains, except verbal memory. Reduction of verbal fluency and executive function was most pronounced the first year and may thus be more directly related to the surgery than worsening in other domains. The group mapped with multiple microelectrode recordings had more improvement of bradykinetic-rigid symptoms and of PDQ-39 bodily discomfort sub-score, but also more reduction in word fluency. Older age was the most important factor associated with physical dependence after 5 years. Conclusion Conclusion:STN-DBS offers good long-term effects, including improved sleep, despite disease progression. STN-DBS surgery may negatively impact verbal fluency and executive function. Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for Parkinson's disease (PD) with motor fluctuations or tremor not responsive to levodopa. While shortterm effects have been well documented both on motor symptoms, 1-7 and non-motor symptoms (NMS), [8][9][10][11][12] studies on long-term effects of STN-DBS (≥5 years) have mainly reported effects on motor symptoms. A sustained effect has been shown on bradykinesia, rigidity and tremor, but less so on axial symptoms like gait freezing, postural instability and dysarthria that worsen gradually in parallel with advancing disease. [13][14][15][16][17][18] Studies reporting long-term effects on sleep and dysautonomia are lacking, and reports on the long-term impact on cognitive functions are few and show conflicting results. 19 Many long-term studies are small and some have relatively high drop-out rates (in the range 37-82%), causing methodological challenges. [20][21][22] Drop-outs from such studies occur more frequently

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Section: Resultssupporting

confidence: 81%

Section: Resultsmentioning

confidence: 82%

mentioning

confidence: 99%

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Subthalamic Nucleus Stimulation in Parkinson's Disease: 5‐Year Extension Study of a Randomized Trial

Bjerknes

Toft

Brandt

et al. 2021

Movement Disord Clin Pract

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“…Analyses of each SCOPA-Aut domain showed signi cant improvement at 6 months only for the Urinary and thermoregulatory dysfunction showed a remarkable decrease after the chronic stimulation. However, one study of 24 patients reported similar results as presented here, where Scopa-Aut improved after 3 months of follow-up but with subsequent deterioration [29][30][31]. So We need further follow-up studies to con rm this, a prospective study with pre-operative and post-operative urodynamics would yield more detailed information about the effect of STN-DBS on bladder function.…”

Section: Discussionsupporting

confidence: 73%

Subthalamic Nucleus-Deep Brain Stimulation Improves Autonomic Dysfunction in Parkinson’s Disease

Zhang

Wang

et al. 2021

Preprint

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Background To study the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on autonomic dysfunction in Parkinson's disease (PD) patients. Methods 57 PD patients, who underwent bilateral STN-DBS from March to December 2018, were retrospectively analyzed, preplanned assessments at baseline and postoperatively at 1, 3 and 6 months also included the Scales for Outcomes in Parkinson's Disease-Autonomic questionnaire (SCOPA-Aut), the Unified Parkinson's Disease Rating Scale (UPDRS) III score, levodopa equivalent day dose (LEDD), Parkinson's Disease Quality of Life Scale (PDQ-39), the Hamilton Anxiety Rating Scale (HAMA), the Hamilton Depression Rating Scale (HAMD). Results The SCOPA-Aut scores improved significantly [14.59% (18.32%), 24.00% (27.05%), 22.16% (27.07%), respectively, all P <0.001] at 1 months, 3 months, 6months of STN-DBS respectively. Analysis of the SCOPA-Aut subitems showed significant improvement only in urine and thermoregulation subitems at 6 months after operation (P <0.001). There was no significant correlation between the improvement rate of SCOPA-Aut scores and the improvement rate of PDQ-39 scores (P>0.05) at 6 months after operation. SCOPA-Aut scores was positively correlated with age (r=0.428, P=0.001); The improvement rate of SCCOPA-Aut scores was positively correlated with the improvement rate of HAMA and HAMD scores (HAMA: r=0.325, P=0.015; HAMD: r=0.265, P=0.049) at 6 months after operation. Conclusion STN-DBS can improve autonomic dysfunction symptoms of PD patients, urinary and thermoregulatory subitems of autonomic dysfunction were improved in the short term after operation. There was a close relationship between improved autonomic symptoms and improved anxiety and depression 6 months after operation. We should pay more attention to the autonomic dysfunction in Parkinson's disease, detailed preoperative evaluation and postoperative follow-up, so as to better improve the QOL of patients.

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“…Dies deshalb, weil postoperativ die Dosis der Medikation erheblich reduziert werden kann und weil schwere Symptome von Off-Phasen aufgehoben oder erheblich gelindert werden [23]. Nicht gebessert wird durch die THS eine orthostatische Dysregulation [24], während andere vegetative Symptome wie Blasenentleerungsstörungen [25] oder übermäßiges Schwitzen und Schlafstörungen [26] sich häufig postoperativ bessern.…”

Section: Präoperative Patientenberatungunclassified

Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom

Pfister¹,

Demmel²

2021

Nervenheilkunde

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ZUSAMMENFASSUNGIndikationen für die tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom sind medikamentös therapieresistenter Tremor oder medikamentös nicht ausreichend beherrschbare Wirkfluktuationen, Dyskinesien und schwere Nebenwirkungen der Medikation. Die sorgfältige präoperative Beratung der Patienten bezüglich der realistischen Therapieziele ist wesentlich für die postoperative Therapiezufriedenheit. Tremor sowie alle Off-Phasen-gebundenen motorischen und nicht motorischen Symptome sind der Therapie der tiefen Hirnstimulation gut zugänglich, dagegen sind Symptome, die präoperativ auch im medikamentösen On persistieren (On-Phasen-Freezing, Gleichgewichtsstörungen), durch die tiefe Hirnstimulation nicht zu bessern. Einige vegetative Symptome (Blasenstörungen, Schlafstörungen) können sich bessern, andere (orthostatische Dysregulation) nicht. In der postoperativen Phase können – meist transiente – psychische Störungen wie Depressivität, erhöhte Impulsivität oder Hypomanie auftreten. Die Wirkung der tiefen Hirnstimulation auf die Zielsymptome Rigor, Tremor und Hypokinese hält an, die Progredienz der neurodegenerativen Erkrankung wird aber nicht aufgehalten.

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Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

Cited by 11 publications

References 66 publications

Subthalamic Nucleus Stimulation in Parkinson's Disease: 5‐Year Extension Study of a Randomized Trial

Subthalamic Nucleus Stimulation in Parkinson's Disease: 5‐Year Extension Study of a Randomized Trial

Subthalamic Nucleus-Deep Brain Stimulation Improves Autonomic Dysfunction in Parkinson’s Disease

Tiefe Hirnstimulation beim idiopathischen Parkinson-Syndrom

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