Subthalamic stimulation may inhibit the beneficial effects of levodopa on akinesia and gait

Fleury, Vanessa; Pollak, Pierre; Gere, Julien; Tommasi, Giorgio; Romito, Luigi; Combescure, Christophe; Bardinet, Éric; Chabardès, Stéphan; Momjian, Shahan; Krainik, Alexandre; Burkhard, Pierre; Yelnik, Jérôme; Krack, Paul

doi:10.1002/mds.26545

Cited by 53 publications

(38 citation statements)

References 45 publications

(52 reference statements)

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“…Moreover, disabling side effects may be associated with the stimulation of this area. Worsening bradykinesia and freezing have been reported and possibly correlate with the stimulation of the pallidothalamic fibers [31,32,33]. Similarly, dysarthria and postural instability have also been described and correlated to the possible diffusion of current to the cerebellothalamic tract and on the other hand by blocking levodopa effects [34].…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Fiechter¹,

Nowacki²,

Oertel³

et al. 2017

Stereotact Funct Neurosurg

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Background: Subthalamic nucleus (STN) stimulation has been recognized to control resting tremor in Parkinson disease. Similarly, thalamic stimulation (ventral intermediate nucleus; VIM) has shown tremor control in Parkinson disease, essential, and intention tremors. Recently, stimulation of the posterior subthalamic area (PSA) has been associated with excellent tremor control. Thus, the optimal site of stimulation may be located in the surrounding white matter. Aims: The objective of this work was to investigate the area of stimulation by determining the contact location correlated with the best tremor control in STN/VIM patients. Methods: The mean stimulation site and related volume of tissue activated (VTA) of 25 tremor patients (STN or VIM) were projected on the Morel atlas and compared to stimulation sites from other tremor studies. Results: All patients showed a VTA that covered ≥50% of the area superior and medial to the STN or inferior to the VIM. Our stimulation areas suggest involvement of the more lateral and superior part of the dentato-rubro-thalamic tract (DRTT), whereas targets described in other studies seem to involve the DRTT in its more medial and inferior part when it crosses the PSA. Conclusions: According to anatomical and diffusion tensor imaging data, the DRTT might be the common structure stimulated at different portions within the PSA/caudal zona incerta.

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Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Fiechter¹,

Nowacki²,

Oertel³

et al. 2017

Stereotact Funct Neurosurg

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“…Most studies were performed retrospectively and in a small number of patients. In addition, inconsistencies in the efficacy and adverse effects of ZI stimulation exist and likely reflect the inability to directly target the ZI resulting in variability of contact placement [20-23, 31, 32]. Methods for visualization of the rZI allowing direct stereotactic targeting have recently been reported [33, 34].…”

Section: Discussionmentioning

confidence: 99%

“…The antidyskinetic effects of rZI stimulation evident in our study and reported in the literature may involve stimulation of the rZI and/or the surrounding pallidothalamic fibers. Within the rZI, these clinical effects may resemble those of ventral GPi stimulation in PD patients, leading to a complete arrest of dyskinesias [29, 31]. Large myelinated pallidothalamic fibers are very sensitive to applied electrical fields.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, as one of the greatest limitations of increasing stimulation are unwanted adverse effects, studies aimed at assessing the response to titration of stimulation as well as immediate and potential delayed side effects need to be performed. Preliminary data indicate that dysarthria, speech articulation, postural instability, and ataxia as well as blocking beneficial effects of levodopa on bradykinesia and freezing, may be obtained with posterior subthalamic area/cZI stimulation while the adverse effects of rZI stimulation have not been fully determined [31, 35, 36]. …”

Section: Discussionmentioning

confidence: 99%

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Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Kern

Picillo

Thompson

et al. 2018

Stereotact Funct Neurosurg

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Background/Aims: Interleaving stimulation (ILS) in deep brain stimulation (DBS) provides individualized stimulation of 2 contacts delivered in alternating order. Currently, limited information on the utility of ILS exists. The aims of this study were to determine the practical applications and outcomes of ILS DBS in Parkinson’s disease (PD), tremor, and dystonia. Methods: We performed a single-center, unblinded, retrospective chart review of all patients with DBS attempted on ILS at our referral center assessing for rationale and outcomes. Results: Fifty patients (PD, n = 27; tremor, n = 7; dystonia, n = 16 patients) tried ILS for 2 rationales: management of adverse effects (n = 29) and to improve clinical efficacy (n = 21). A total of 19 patients demonstrated improvement with ILS for adverse effect management predominately for the treatment of dyskinesias (n = 12). In the vast majority of dyskinetic patients, a contact added into the rostral zona incerta with ILS was performed. Nine out of 21 patients demonstrated improved clinical efficacy with ILS with all 6 PD patients who tried ILS for this rationale demonstrating benefit. Conclusions: In PD, ILS provided benefits for dyskinesias and parkinsonism, with minimal improvement of other adverse effects. In tremor and dystonia, marginal effects in terms of mitigation of adverse effects and improvement of clinical outcomes were evident.

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“…DBS alleviates the motor symptoms of PD [1], but may lead to side effects, such as impaired cognition [2], speech [3,4], gait [5] and balance [6]. An adaptive DBS system with active modulation of stimulation by appropriate physiological control variables may reduce these side effects, while providing maximum therapeutic benefit of PD motor symptoms [7,8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Task- and Dopamine-Dependent Dynamics of Subthalamic Local Field Potentials in Parkinson’s Disease

et al. 2016

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Subthalamic nucleus (STN) local field potentials (LFP) are neural signals that have been shown to reveal motor and language behavior, as well as pathological parkinsonian states. We use a research-grade implantable neurostimulator (INS) with data collection capabilities to record STN-LFP outside the operating room to determine the reliability of the signals over time and assess their dynamics with respect to behavior and dopaminergic medication. Seven subjects were implanted with the recording augmented deep brain stimulation (DBS) system, and bilateral STN-LFP recordings were collected in the clinic over twelve months. Subjects were cued to perform voluntary motor and language behaviors in on and off medication states. The STN-LFP recorded with the INS demonstrated behavior-modulated desynchronization of beta frequency (13–30 Hz) and synchronization of low gamma frequency (35–70 Hz) oscillations. Dopaminergic medication did not diminish the relative beta frequency oscillatory desynchronization with movement. However, movement-related gamma frequency oscillatory synchronization was only observed in the medication on state. We observed significant inter-subject variability, but observed consistent STN-LFP activity across recording systems and over a one-year period for each subject. These findings demonstrate that an INS system can provide robust STN-LFP recordings in ambulatory patients, allowing for these signals to be recorded in settings that better represent natural environments in which patients are in a variety of medication states.

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Subthalamic stimulation may inhibit the beneficial effects of levodopa on akinesia and gait

Cited by 53 publications

References 45 publications

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Interleaving Stimulation in Parkinson’s Disease, Tremor, and Dystonia

Long-Term Task- and Dopamine-Dependent Dynamics of Subthalamic Local Field Potentials in Parkinson’s Disease

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