Subthalamic Stimulation in Parkinson Disease

Houeto, Jean‐Luc; Damier, Philippe; Bejjani, Paul-Boulos; Staedler, Claudio; Bonnet, Anne‐Marie; Arnulf, Isabelle; Pidoux, B.; Dormont, Didier; Cornu, Philippe; Agid, Yves

doi:10.1001/archneur.57.4.461

Cited by 195 publications

(108 citation statements)

References 15 publications

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“…However, after the administration of levodopa, cadence was increased in some reports [19] and not changed in the others [7,34] as in our study. Chronic bilateral STN stimulation improves akinesia, rigidity and tremor in patients with severe PD [21,[24][25][26][27][29][30]. The exact mechanism of STN stimulation is still unknown.…”

Section: Discussionmentioning

confidence: 99%

Effect of bilateral subthalamic nucleus stimulation on parkinsonian gait

Xie¹,

Krack²,

Benabid

et al. 2001

Journal of Neurology

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Section: Discussionmentioning

confidence: 99%

Effect of bilateral subthalamic nucleus stimulation on parkinsonian gait

Xie¹,

Krack²,

Benabid

et al. 2001

Journal of Neurology

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“…This possibility after STN stimulation to withdraw all the antiparkinsonian treatment or at least levodopa underlines the great efficacy of this therapy and is largely responsible for the reduction of levodopa-induced dyskinesias [11, 12]. In previous reports, the reduction of the levodopa equivalent daily dose is between 40–50% [2, 3]and 80.4% [7]and is usually about 60–70% [4, 6, 8, 9, 10]. However, in most of these previous works, pharmacological therapy reduction was assessed globally using the dopa equivalent daily dose which is calculated by multiplying the total daily dose of each antiparkinsonian drug by its potency relative to a standard levodopa dose (100 mg levodopa = 10 mg bromocriptine = 5 mg ropinirole = 1 mg pergolide = 1 mg lisuride) [10].…”

Section: Discussionmentioning

confidence: 99%

“…Since the pioneering works of Benabid and Pollak in the mid nineties, several reports have demonstrated the high potency of chronic subthalamic nucleus (STN) stimulation in alleviating severe disabling motor symptoms in Parkinson’s disease (PD) [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. However, this surgical therapy needs, to achieve a successful result, a precise and complex postoperative management, especially concerning the antiparkinsonian medical treatment which is greatly reduced [2, 3, 4, 5, 6, 7, 8, 9, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

“…However, this surgical therapy needs, to achieve a successful result, a precise and complex postoperative management, especially concerning the antiparkinsonian medical treatment which is greatly reduced [2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. This drug reduction, however, is usually calculated using the dopa equivalent dose which includes dopaminergic agonists and levodopa doses, whereas the modification of the other antiparkinsonian treatments is rarely specified.…”

Section: Introductionmentioning

confidence: 99%

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The Timing of Antiparkinsonian Treatment Reduction after Subthalamic Nucleus Stimulation

Thobois

Corvaisier²,

Mertens

et al. 2002

Eur Neurol

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The objective of this work was to precisely analyse the reduction of the antiparkinsonian treatment in 18 consecutive patients with Parkinson’s disease (PD) operated on for bilateral subthalamic nucleus (STN) stimulation, first after 1 month of follow-up, then at 1 year postoperatively. Trihexyphenidyle, selegiline, entacapone, apomorphine and lisuride could be withdrawn shortly after starting STN electrical stimulation. The levodopa mean daily dose was reduced by 57% at 1 month after surgery and remained stable at 1 year. The mean ropinirole and bromocriptine daily dose decrements after surgery corresponded to 54 and 63%, respectively, at 1 month and to 77 and 40% at 1 year. At 12 months postoperatively, one third of the patients no longer received any antiparkinsonian drugs and the others were on monotherapy of either levodopa or dopamine agonists or received a combined treatment of a dopaminergic agonist and levodopa. In conclusion, STN stimulation allows a major reduction and simplification of antiparkinsonian treatment which can usually be achieved during the early postoperative period.

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“…Stimulation in or around the STN has been observed to acutely lead to visual hallucinations, 64 pseudobulbar crying, 65 laughter and euphoria 4,66 and depression. 67,68 Acute mood changes are typically provoked by stimulation, dorsal or ventral, to the target for motor symptom control, 69 whereas apathy is associated with ventral and medial STN DBS, 55 hypomania with anteromedial STN DBS 70 and delusions with medial stimulation. 71 Aggression occurs with stimulation in the region of the triangle of Sano, 72 although aggression has also been observed after stimulation via accurately placed STN electrodes.…”

Section: Controversymentioning

confidence: 99%

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

Tröster¹

2008

European Neurological Review

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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...

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Subthalamic Stimulation in Parkinson Disease

Cited by 195 publications

References 15 publications

Effect of bilateral subthalamic nucleus stimulation on parkinsonian gait

Effect of bilateral subthalamic nucleus stimulation on parkinsonian gait

The Timing of Antiparkinsonian Treatment Reduction after Subthalamic Nucleus Stimulation

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

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