The Study of Subthalamic Deep Brain Stimulation for Parkinson Disease-Associated Camptocormia

Liang, Shu; Yu, Yang; Li, Haitao; Wang, Yue; Cheng, Yuanyuan; Yang, Hechao

doi:10.12659/msm.919682

Cited by 11 publications

(20 citation statements)

References 62 publications

(78 reference statements)

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“…Whole body kinematic analysis of body movement may also unravel alterations between the coupling of proximal and distal body segments in PD 18 , 19 . The coupling of segments identifies the phase between two regions, which can be in-phase, in counter-phase or independent.…”

Section: Introductionmentioning

confidence: 99%

Strategic alterations of posture are delayed in Parkinson’s disease patients during deep brain stimulation

Patel

Nilsson

Rehncrona

et al. 2021

Sci Rep

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Parkinson’s disease (PD) is characterized by rigidity, akinesia, postural instability and tremor. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor but the effects on postural instability are inconsistent. Another component of postural control is the postural strategy, traditionally referred to as the ankle or hip strategy, which is determined by the coupling between the joint motions of the body. We aimed to determine whether DBS STN and vision (eyes open vs. eyes closed) affect the postural strategy in PD in quiet stance or during balance perturbations. Linear motion was recorded from the knee, hip, shoulder and head in 10 patients with idiopathic PD with DBS STN (after withdrawal of other anti-PD medication), 25 younger adult controls and 17 older adult controls. Correlation analyses were performed on anterior–posterior linear motion data to determine the coupling between the four positions measured. All participants were asked to stand for a 30 s period of quiet stance and a 200 s period of calf vibration. The 200 s vibration period was subdivided into four 50 s periods to study adaptation between the first vibration period (30–80 s) and the last vibration period (180–230 s). Movement was recorded in patients with PD with DBS ON and DBS OFF, and all participants were investigated with eyes closed and eyes open. DBS settings were randomized and double-blindly programmed. Patients with PD had greater coupling of the body compared to old and young controls during balance perturbations (p ≤ 0.046). Controls adopted a strategy with greater flexibility, particularly using the knee as a point of pivot, whereas patients with PD adopted an ankle strategy, i.e., they used the ankle as the point of pivot. There was higher flexibility in patients with PD with DBS ON and eyes open compared to DBS OFF and eyes closed (p ≤ 0.011). During balance perturbations, controls quickly adopted a new strategy that they retained throughout the test, but patients with PD were slower to adapt. Patients with PD further increased the coupling between segmental movement during balance perturbations with DBS ON but retained a high level of coupling with DBS OFF throughout balance perturbations. The ankle strategy during balance perturbations in patients with PD was most evident with DBS OFF and eyes closed. The increased coupling with balance perturbations implies a mechanism to reduce complexity at a cost of exerting more energy. Strategic alterations of posture were altered by DBS in patients with PD and were delayed. Our findings therefore show that DBS does not fully compensate for disease-related effects on posture.

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Section: Introductionmentioning

confidence: 99%

Strategic alterations of posture are delayed in Parkinson’s disease patients during deep brain stimulation

Patel

Nilsson

Rehncrona

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Trunk position in PD has been measured or assumed from muscle echo intensity of the abdominal wall [ 18 ], from review of video recordings [ 4 , 19 ], subjectively using the 0–4 MDS Unified Parkinson’s Disease Rating Scale [ 20 – 22 ], or through observation [ 23 ]. Here, we use objective ultrasound motion detection to study and quantify alterations of body position in patients with PD and consider the longer-term effectiveness of DBS in the STN.…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

et al. 2021

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Parkinson’s disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.

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“…Deep brain stimulation (DBS) is indicated for such patients, as an effective measure to improve quality of life. 5 …”

Section: Introductionmentioning

confidence: 99%

“…Deep brain stimulation (DBS) is indicated for such patients, as an effective measure to improve quality of life. 5 DBS is actually an invasive procedure, involving placement of electrode and stimulation of thalamic nuclei surgically. Target nuclei (Subthalamic nuclei, Globus pallidus, Pars internal, Ventralis and intermedius) lie deep.…”

Section: Introductionmentioning

confidence: 99%

Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

et al. 2020

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Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS). Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data. Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth of sedation, and kept between 70-85 during sedative phase. All patients had successful intraoperative neurological monitoring, stimulation, and placement of electrodes. Total duration of anesthesia varied significantly in between the patients. Maximum duration was 600 minutes. None of our patient had any intraoperative event related to anaesthetic management. Overall five patients had some adverse events during ward stay. Mean LOS in hospital was four days. Conclusion: Anaesthetic management of DBS is well-tolerated. It requires dedicated team. The SAS technique is excellent for intraoperative neurophysiological monitoring. Careful selection of sedative agents and monitoring depth of anaesthesia using BIS would be beneficial in terms of improving related outcomes. doi: https://doi.org/10.12669/pjms.36.7.2870 How to cite this:Ahmed U, Shafiq F, Kumar D, Ahsan K, Ghaffar W, Bari E. Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2870 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The Study of Subthalamic Deep Brain Stimulation for Parkinson Disease-Associated Camptocormia

Cited by 11 publications

References 62 publications

Strategic alterations of posture are delayed in Parkinson’s disease patients during deep brain stimulation

Strategic alterations of posture are delayed in Parkinson’s disease patients during deep brain stimulation

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

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