Unilateral deep brain stimulation of the subthalamic nucleus for Parkinson disease

Abstract

Unilateral STN DBS is an effective and safe treatment for selected patients with advanced PD. Unilateral STN DBS provides improvement of contralateral motor symptoms of PD as well as quality of life, reduces requirements for medication, and possibly enhances mental flexibility. This method of surgical treatment may be associated with a reduced risk and may provide an alternative to bilateral STN DBS for PD, especially in older patients or patients with asymmetry of parkinsonism.

Changes in Regional Blood Flow Induced by Unilateral Subthalamic Nucleus Stimulation in Patients With Parkinson's Disease

“…2) Slowinski and colleagues reported a series of 24 parkinsonian patients similarly implanted, with 63% improvement in contralateral UPDRS Part III scores and approximately 15% improvement ipsilaterally. 3) Similar clinical responses contralaterally and ipsilaterally were found in this series reported by Tanei and colleagues.…”

“…1) The frontal cortex provides control of the motor, cognitive, and emotional aspects of information processing. 1,3,5,6,14) Motor functional areas are located in the supplementary motor area (SMA), pre-SMA, and premotor cortex. Associative functional areas are located in the dorsolateral prefrontal cortex (DLPFC) and prefrontal cortex.…”

“…15,17) Unilateral STN DBS improves motor symptoms both contralateral and ipsilateral to the operative side, as well as axial features. 8,20) Various studies have investigated the changes induced by bilateral STN DBS, 2,9,11,12,18,19) although none have reported regional cerebral blood flow (rCBF) changes induced by unilateral STN DBS. Single photon emission computed tomography (SPECT) or positron emission tomography (PET) imaging can measure DBS-induced changes in rCBF throughout the entire brain.…”

Influence of cell preparation and target location on the behavioral recovery after striatal transplantation of fetal dopaminergic neurons in a primate model of Parkinson’s disease

“…This highlights the fact that striatal cell transplantation can offer a substantial clinical benefit also in moderate to severe PD patients, as has been recently reported in an open label study (Mendez et al, 2005). It is also worth noting that these functional benefits were achieved with only unilateral striatal transplantation, in a bilateral PD primate model, similar to cases in clinical studies of fetal transplantation (Defer et al, 1996;Lindvall et al, 1994;Mendez et al, 2005;Piccini et al, 1999), unilateral striatal GDNF infusion (Slevin et al, 2007;Slevin et al, 2005), and DBS stimulation (Slowinski et al, 2007). In these previous reports, bilateral functional benefit included mild to moderate ipsilateral and axial improvements and a pronounced contralateral improvements (Bastian et al, 2003;Germano et al, 2004), although the magnitude of ipsilateral and axial changes was not studied in detail.…”

Postoperative management of deep brain stimulation in Parkinson’s disease

“…In this case, medication needs to be adapted to the unoperated side and stimulation should be reduced to avoid dyskinesia. Considering both that unilateral stimulation is performed in asymmetrical disease and that unilateral stimulation can have an ipsilateral effect (Bastian et al, 2003;Slowinski et al, 2007;Agostino et al, 2008;Alberts et al, 2008;Arai et al, 2008;Tabbal et al, 2008;Castrioto et al, 2011b), a good compromise is generally achieved.…”