Varying time-course of effects of high frequency stimulation of sub-regions of the globus pallidus in patients with parkinson's disease

Angeli, A.; Akram, Harith; Zacharia, André; Limousin, Patricia; Hariz, Marwan; Zrinzo, Ludvic; Foltynie, Thomas

doi:10.1016/j.parkreldis.2015.03.019

Cited by 12 publications

(16 citation statements)

References 31 publications

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“…Pallidal DBS directly suppresses dyskinesia, and clinical studies have shown more significant improvement in dyskinesia after pallidal DBS as compared with subthalamic nucleus (STN) DBS 1,2 . However, contrary to the general belief in the dyskinesia‐suppressing effect of pallidal DBS, some studies have reported that pallidal DBS can worsen or even induce dyskinesia presumably depending on the location of the stimulated area 3‐6 …”

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confidence: 99%

Pallidal Connectivity Profiling of Stimulation‐Induced Dyskinesia in Parkinson's Disease

et al. 2020

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Objectives The aim of this study is to identify anatomical regions related to stimulation‐induced dyskinesia (SID) after pallidal deep brain stimulation (DBS) in Parkinson's disease (PD) patients and to analyze connectivity associated with SID. Methods This retrospective study analyzed the clinical and imaging data of PD patients who experienced SID during the monopolar review after pallidal DBS. We analyzed structural and functional connectivity using normative connectivity data with the volume of tissue activated (VTA) modeling. Each contact was assigned to either that producing SID (SID VTA) or that without SID (non‐SID VTA). Structural and functional connectivity was compared between SID and non‐SID VTAs. “Optimized VTAs” were also estimated using the DBS settings at 6 months after implantation. Results Of the 68 consecutive PD patients who underwent pallidal implantation, 20 patients (29%) experienced SID. SID VTAs were located more dorsally and anteriorly compared with non‐SID and optimized VTAs and were primarily in the dorsal globus pallidus internus (GPi) and dorsal globus pallidus externus (GPe). SID VTAs showed significantly higher structural connectivity than non‐SID VTAs to the associative cortex and supplementary motor area/premotor cortex (P < 0.0001). Simultaneously, non‐SID VTAs showed greater connectivity to the primary sensory cortex, cerebellum, subthalamic nucleus, and motor thalamus (all P < 0.0004). Functional connectivity analysis showed significant differences between SID and non‐SID VTAs in multiple regions, including the primary motor, premotor, and prefrontal cortices and cerebellum. Conclusion SID VTAs were primarily in the dorsal GPi/GPe. The connectivity difference between the motor‐related cortices and subcortical regions may explain the presence and absence of SID. © 2020 International Parkinson and Movement Disorder Society

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confidence: 99%

Pallidal Connectivity Profiling of Stimulation‐Induced Dyskinesia in Parkinson's Disease

et al. 2020

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“…Treatments for epilepsy, disordered consciousness, psychiatric illness and neurodegenerative diseases could potentially all be augmented using such a technique. Already, dual targeting has been explored outside the realms of chronic pain by way of simultaneous stimulation of globus pallidus internus (GPi) and externus stimulation in Parkinson’s disease [ 44 ], GPi and subthalamic nucleus in Huntington’s disease [ 45 ] and ventral intermediate nucleus and the subthalamic area in Holme’s tremor [ 46 ]. Indeed, many promising applications of DBS such as Tourette’s syndrome [ 47 ], epilepsy [ 48 ] and minimally conscious states [ 49 ] boast a selection of possible deep brain targets.…”

Section: Discussionmentioning

confidence: 99%

Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature

et al. 2017

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Deep Brain Stimulation (DBS) has been used to target many deep brain structures for the treatment of chronic pain. The periaqueductal grey and periventricular grey (PAG/PVG) is an effective target but results are variable, sometimes short-lived or subject to tolerance. The centromedian intra-laminar parafascicular complex (CMPf) modulates medial pain pathways and CMPf DBS may address the affective aspects of pain perception. Stimulation of multiple deep brain targets may offer a strategy to optimize management of patients with complex pain symptomatology. However, previous attempts to stimulate multiple targets requires multiple trajectories and considerable expense. Using a single electrode to stimulate multiple targets would help overcome these challenges. A pre-requisite of such a technique is the ability to use different stimulation parameters at different contacts simultaneously on the same electrode. We describe a novel technique in 3 patients with chronic pain syndromes for whom conventional medical and/or neuromodulation therapy had failed using a single electrode technique to stimulate PVG/PAG and CMPf at dual frequencies.

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“…Other possible explanations for the delayed occurrence of choreic movements that, however, make it more difficult to explain the effects of stimulation at different intensities are secondary worsening of an undiagnosed tardive movement disorder, development of anticholinergic-induced chorea, 9 , 10 undetected mild concomitant dopaminergic denervation and altered sensitivity to spread of current to GPe, 11 and development of another neurodegenerative movement disorder. Finally, it might also be that a combination of such causes and effects might underlie the phenomena that were observed.…”

Section: Discussionmentioning

confidence: 99%

Development of Hyperkinesias after Long-term Pallidal Stimulation for Idiopathic Segmental Dystonia

Wloch

Blahak

Abdallat

et al. 2017

Tremor and Other Hyperkinetic Movements

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Varying time-course of effects of high frequency stimulation of sub-regions of the globus pallidus in patients with parkinson's disease

Cited by 12 publications

References 31 publications

Pallidal Connectivity Profiling of Stimulation‐Induced Dyskinesia in Parkinson's Disease

Pallidal Connectivity Profiling of Stimulation‐Induced Dyskinesia in Parkinson's Disease

Single Electrode Deep Brain Stimulation with Dual Targeting at Dual Frequency for the Treatment of Chronic Pain: A Case Series and Review of the Literature

Development of Hyperkinesias after Long-term Pallidal Stimulation for Idiopathic Segmental Dystonia

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