Where Are We with Deep Brain Stimulation? A Review of Scientific Publications and Ongoing Research

Harmsen, Irene E.; Fernandes, Filipe Wolff; Krauss, Joachim K.; Lozano, Andrés M.

doi:10.1159/000521372

Cited by 24 publications

(18 citation statements)

References 65 publications

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“…Following the publication in September 2001 in the New England Journal of Medicine of a worldwide multicentre trial of DBS in STN or in GPi [33], FDA approved these procedures for surgical treatment of patients with advanced PD, and they eventually received endorsement as efficient and safe by the International Parkinson and Movement Disorders Society [18]. DBS of the STN and the GPi became, since then, and still are, the most popular and world-spread methods for surgical treatment of PD [34].…”

Section: Deep Brain Stimulationmentioning

confidence: 99%

Deep brain stimulation for Parkinson's disease

Hariz

Blomstedt

2022

J Intern Med

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Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia–thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long‐lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow‐up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.

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Section: Deep Brain Stimulationmentioning

confidence: 99%

Deep brain stimulation for Parkinson's disease

Hariz

Blomstedt

2022

J Intern Med

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“…Data from the SANTE study showed a gradual improvement in neuropsychological outcome and quality of life from baseline based on the Liverpool seizure severity scale and Qualie‐31 scores 21 . Neuropsychological test composite scores showed statistically significant gains from baseline to 5 years including attention, executive function, depression, tension anxiety, total mood disturbance, and subjective cognitive function.…”

Section: Discussionmentioning

confidence: 98%

ANT‐DBS in epilepsy shows no effect on selected neuropsychiatric tests

Herrman

Osnes

Egge

et al. 2022

Acta Neuro Scandinavica

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Objectives Deep brain stimulation of the anterior thalamic nucleus (ANT‐DBS) is an established option in treatment‐resistant epilepsy and obtained FDA approval in 2018. Increased psychiatric comorbidity is well known in epilepsy. The main objective of this study was to investigate possible neuropsychiatric treatment‐related changes in patients receiving ANT‐DBS. Materials and Methods Bilateral ANT electrodes were implanted in 18 adult patients with refractory epilepsy in a randomized, double‐blinded study. Immediately after implantation, patients were randomized to stimulation ON (n = 8) or OFF (n = 10) for the first 6 months (blinded phase). During the next six months (open phase), both groups received active stimulation. Neuropsychiatric assessment was conducted before implantation (T1), at the end of the blinded period (T2), and 1 year after implantation (T3). Results Comparing preoperative status (T1) and 12 months (T3), postoperative outcome in all patients did not show significant differences between the two groups for any of the applied tests. Groupwise comparisons across the two first time points (the blinded period, representing the randomized controlled trial) showed no significant differences between the two groups in any of the neuropsychiatric parameters studied. Comparing test results after 6 months of stimulation in both groups (sum of ON group T1 to T2 and OFF group T2 to T3) did not show significant changes for any of the psychiatric assessments. Conclusions Our results indicate that ANT‐DBS has limited effect concerning psychiatric issues. Subjective side effects were, however, reported in individual patients.

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“…There is no doubt that DBS is and will remain for the foreseeable future the procedure of choice for patients with PD and other movement disorders, especially considering all the innovations and development of new hardware, new modes of stimulation, new indications, etc. [53], let alone the limitless potentials of DBS for enabling scientific discoveries and for research [54]. However, on a more down-to-earth level, Leksell-Laitinen's posteroventral pallidotomy is surviving and will remain an efficacious and needed procedure, including when DBS is not available or not affordable, or when it fails.…”

Section: Discussionmentioning

confidence: 99%