Subthalamic Stimulation in Parkinson Disease

Houeto, Jean‐Luc; Mallet, Luc; Mesnage, Valérie; Montcel, Sophie Tezenas du; Béhar, C.; Gargiulo, Marcela; Torny, F.; Pélissolo, Antoine; Welter, Marie‐Laure; Agid, Yves

doi:10.1001/archneur.63.8.1090

Cited by 136 publications

(131 citation statements)

References 34 publications

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“…88 A higher-than-expected frequency of suicide has also been reported among patients undergoing STN DBS for advanced PD. 89 In a prospective study of 20 patients during the 2 years after surgery, however, Houeto et al 90 showed that provided patients with PD are rigorously selected for neurosurgery, STN stimulation improves mood, anxiety, and quality of life. The procedure does not result in severe permanent psychiatric disorders or modify patients' personalities, and it does not improve social function.…”

Section: Cognitive Side Effects Of Dbsmentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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SUMMARY: Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD).Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. Chronic high-frequency stimulation of the ventral intermediate nucleus (VIM) of the thalamus was first described in the early 1990s by Benabid et al.1 These authors implanted chronic stimulating electrodes in the VIM connected to a subcutaneous pulse generator positioned in the thoracic region to treat disabling tremor in 26 patients with Parkinson disease (PD) and in 6 with essential tremor.1 They demonstrated the effectiveness of this technique and its ability to produce complete relief from tremor. Improvement was maintained for up to 29 months. This was the first clinical demonstration that chronic high-frequency stimulation of nuclei (deep brain stimulation [DBS]) could replace destructive lesion-producing functional neurosurgery such as thalamotomy. This new technique was reversible and led to a renaissance in functional neurosurgery.Next, the same team introduced bilateral DBS of the subthalamic nucleus (STN) in patients with disabling akineticrigid PD and severe motor fluctuations.2 This work extended data obtained in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine monkey model of PD showing that lesions and electric stimulation of the subthalamic nucleus reduced all of the major motor disturbances in this animal model. The results in patients with advanced PD were striking and were reproduced in many centers internationally. The US Food and Drug Administration approved the use of DBS for treatment of advanced PD with bilateral STN stimulation in 2002 and internal globus pallidus (GPi) stimulation in 2003. The main indication for DBS remains advanced PD, but numerous additional applications have been developed, ranging from dystonia to cluster headache, Tourette syndrome, and even psychiatric indications like obsessive-compulsive disorders (OCD) and major depression.DBS is a neurosurgical method, but the role of neuroimaging in successful DBS intervention is critical. Neuroimaging is used for the preoperative selection of patients who will have DBS and to localize the intended target nuclei. In the postoperative period, imaging detects complications that uncommonly accompany the procedure, confirms the pos...

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Section: Cognitive Side Effects Of Dbsmentioning

confidence: 99%

Neuroimaging and Deep Brain Stimulation

Dormont¹,

Seidenwurm²,

Galanaud³

et al. 2009

AJNR Am J Neuroradiol

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“…Nonetheless, changes attributed to DBS have included depression, 66 aggression, 11 hypomania, 42,73 mania, 122 apathy, 31,110 and inappropriate laughter. 65 In a prospective study of 20 patients with PD treated with subthalamic nucleus DBS, Houeto and colleagues 55 reported an improvement in depression severity of 21% at 6 months and 33% at 24 months. In contrast, a recent report by Berney and colleagues 12 found that acute DBS in a small series of 15 patients did not result in clinically significant mood alterations.…”

Section: Mood and Behavioral Effects Of Dbs For Movement Disordersmentioning

confidence: 99%

Biological basis for the surgical treatment of depression

Abosch¹,

Cosgrove

2008

FOC

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An estimated 20% of patients with major depression are refractory to existing therapies. The purpose of this review is to provide a theoretical and neuroscientific framework in which to interpret new work in the field of surgical treatment for depression. This review focuses on existing clinical and imaging data, current disease models, and results of recent case reports and patient series that together may inform the construction of appropriate clinical trials for the surgical treatment of refractory depression.

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“…In contrast, a recent controlled study of 78 patients using a six-month follow-up reported depression in 5%, suicide in 1% and psychosis in 5%. 29 Potential mechanisms underlying psychiatric phenomena after DBS include pre-operative vulnerability, 63 stimulation, effects of surgery, psychosocial stressors and adaptation and alterations in medication after surgery. 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.…”

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 136 publications

References 34 publications

Neuroimaging and Deep Brain Stimulation

Neuroimaging and Deep Brain Stimulation

Biological basis for the surgical treatment of depression

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

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