Deep Brain Stimulation and Microelectrode Recording for the Treatment of Parkinson’s Disease (original) (raw)
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Deep Brain Stimulation in Parkinsonʼs Disease
AJN, American Journal of Nursing, 2009
Purpose of review Deep-brain high-frequency stimulation of the thalamus was introduced in 1987 to treat tremor, and was applied in 1993 to the subthalamic nucleus to treat advanced Parkinson's disease. High-frequency stimulation of the subthalamic nucleus has become the surgical therapy of choice. This review concentrates on recent data on long-term results and side-effects, after 12 years of practice using this technique. Recent findings A literature search produced 260 papers from February 2004 to March 2005. The stable efficacy of high-frequency stimulation of the subthalamic nucleus on Parkinson's disease motor symptoms is confirmed. Evidence for a neuroprotective effect is still lacking. There are transient neuropsychological disturbances, but no cognitive impairment over time. Complications are rare and mild, mortality is extremely low and hardware complications are highly variable. Summary The safety and inocuity of the method legitimizes earlier operations, before impairment of the quality of life. Depression and suicide are related to pre-existing co-morbidities and multifactorial causes that could become contraindications. Neuropsychological effects should be documented, to determine whether they are caused by an alteration of high-frequency stimulation of the subthalamic nucleus, or inappropriate electrode placement. There is an urgent need for the organization of research and reports, and no need to report small series replicating wellestablished conclusions. Clinical reports should concentrate on unobserved effects in relation to causative parameters, based on the precise location of electrodes, and on clinical reports comparable between teams and on methods to optimize and facilitate the tuning of parameters and postoperative evaluations in order to make this treatment easier to provide for the neurologist.
DEEP BRAIN STIMULATION II Deep Brain Stimulation for the Treatment of Parkinson's Disease
Deep brain stimulation (DBS) is increasingly accepted as an adjunct therapy for Parkinson's disease (PD). It is considered a surgical treatment alternative for patients with intractable tremor or for those patients who are affected by long-term complications of levodopa therapy such as motor fluctuations and severe dyskinesias. Thalamic stimulation in the ventral intermediate nucleus (Vim) leads to a marked reduction of contralateral tremor but has no beneficial effect on other symptoms of Parkinson's disease. The subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) are targeted for the treatment of advanced Parkinson's disease. Several studies have proven the efficacy of STN-DBS and GPi-DBS in alleviating off motor symptoms and dyskinesias. Subthalamic nucleus deep brain stimulation is currently considered superior to GPi-DBS because the antiakinetic effect seems to be more pronounced, allows a more marked reduction of antiparkinsonian medication, and requires less stimulation energy. More recently, however, a number of reports on possible psychiatric and behavioral side effects of STN-DBS have been a matter of concern. Given the chronic nature of PD and the noncurative approach of DBS, both targets will need to be reevaluated on the basis of their long-term efficacy and their impact on quality of life. Despite the rapidly increasing numbers of DBS procedures, surprisingly few controlled clinical trials are available that address important clinical issues such as: When should DBS be applied during the course of disease? Which patients should be selected? Which target should be considered? Which guidelines should be followed during postoperative care? Here is summarized the available evidence on DBS as a therapeutic tool for the treatment of Parkinson's disease and the current state of debate on open issues.
Multiple Microelectrode Recordings in STN-DBS Surgery for Parkinson's Disease: A Randomized Study
Movement disorders clinical practice
Subthalamic nucleus deep brain stimulation improves motor symptoms and fluctuations in advanced Parkinson's disease, but the degree of clinical improvement depends on accurate anatomical electrode placement. Methods used to localize the sensory-motor part of the nucleus vary substantially. Using microelectrode recordings, at least three inserted microelectrodes are needed to obtain a three-dimensional map. Therefore, multiple simultaneously inserted microelectrodes should provide better guidance than single sequential microelectrodes. We aimed to compare the use of multiple simultaneous versus single sequential microelectrode recordings on efficacy and safety of subthalamic nucleus stimulation. Sixty patients were included in this double-blind, randomized study, 30 in each group. Primary outcome measures were the difference from baseline to 12 months in the MDS-UPDRS motor score (part III) in the off-medication state and quality of life using the Parkinson's Disease Question...
Surgical Neurology, 2006
Background: The contribution of MER to improving bilateral STN-DBS is debatable. To resolve the controversy and elucidate the role of MER in DBS, we compared the outcome of bilateral STN-DBS surgery with and without MER in parkinsonian patients. Methods: From February 2002 to November 2002, the first 7 of 13 consecutive parkinsonian patients received STN-DBS without MER (group A), and the last 6 received STN-DBS with MER (group B). Pre-and postoperative assessments included scoring of UPDRS with video taping, and MR images. Results: The mean Hoehn and Yahr stage was 3.6 in group A and 4.0 in group B. The mean followup was 7.4 months for group A and 5.3 months for group B. The mean coordinates of the tip of the permanent electrode relative to the mid-commissural point were x = 8.1 mm, y = 4.3 mm, and z = 5.9 mm for group A and x = 10.6 mm, y = 4.1 mm, and z = 6.9 mm for group B. When levodopa was withdrawn from group A for 12 hours at follow-up, the postoperative UPDRS total score improved by 27.6% (P = .01) and the motor score by 25.4% (P = .02); their LEDD decreased by 17.5% (P = .03). In group B, the postoperative UPDRS total score improved by 49.3% (P = .00002) and the motor score by 45.2% (P = .0004); LEDD decreased by 48.5% (P = .01). Conclusions: Although STN-DBS is a promising surgical modality for advanced parkinsonian patients, there is an inevitable learning curve associated with adopting this new procedure. Intraoperative MER is an effective way to ensure correct electrode placement in the STN. With the assistance of intraoperative MER, the outcome of STN-DBS can be improved significantly.
Neurological Sciences, 2010
Despite the wide diffusion of subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease, systematic practical recommendations for intraoperative electrophysiological monitoring are still lacking. In this paper, a shared protocol for intraoperative electrophysiological monitoring arising from the meetings of a panel of neurophysiologists of the DBS Study Group of the Italian Neurological Society is proposed. Intraoperative monitoring is composed by microrecordings and functional stimulation. In microrecordings, it is recommended to use at least 2-3 electrodes, descending with steps of 0.5-1 mm and waiting at least 60 s before changing the position. Functional stimulation is used to assess the clinical efficacy and the side effects induced by STN-DBS at different positions. Based on the therapeutic window, an algorithm to find the optimal target is proposed. The procedures for intraoperative monitoring for STN-DBS proposed here are safe, relatively cheap, take approximately 30-40 min per side and could offer valuable additional information to the surgeon.
IP Indian Journal of Neurosciences
Induced micro lesion effect (µLE) on basic motor symptoms of Parkinson's showing good results with the intra operative micro electrode recordings (iMER) of subthalamic-nuclei (STN) signals (patterns or signatures of STN) all through deep brain stimulations (DBS). MER-induced µLE was computed based on the difference between tremor, rigidity, and Bradykinesia (akinesia) scores in the pre op off-state and intra op on state following MER prior to test stimulus. To study the induced micro lesion effect on cardinal motoric feature-manifestations (symptoms) of Parkinson's during the subthalamic nuclei deep brain stimulations by the intra operative microelectrode recordings. Clinical Relevance-stimulated intra operative microelectrode recordings micro lesion effect progressed the motor-manifestations of Parkinson's. However, uncorrelated by the electrodes employed for the period of the process. MER-induced µLE was computed based on the difference between tremor, akinesia/Bradykinesia, and rigidity scores in the pre operative OFF state and intra operative state prior to stimulus-test experiment subsequent with micro electrode recording The MLE scores were enhanced by circa~22% on Brains left hemisphere (BLH) and by~14% on Brains right hemisphere (BRH) from zero line, i.e., electrical base line (p<0.05). Tremor scores were progressed by~32% (BLH) and by 14% (BRH) and (p<0.05), rigidity scores improved by 17.3% (BLH) and by 14.2% (BRH) (p<0.05) and Bradykinesia scores improved by 20.6% (BLH) and by 11.5% (BRH) and (p<0.05) from baseline. There was no significant difference between µLE and the number of microelectrodes used (p>0.05). Stimulated intra operative microelectrode recordings and µLE progressed the motor-manifestations of Parkinson's, yet, uncorrelated by the electrodes employed for the period of process.
Neurosurgery, 1999
been reported to be effective in alleviating the symptoms of advanced Parkinson's disease (PD). Although recent studies suggest that STN stimulation may be superior to GPi stimulation, a randomized, blinded comparison has not been reported. The present study was designed to provide a preliminary comparison of the safety and efficacy of DBS at either site. METHODS: Ten patients with idiopathic PD, L-dopa-induced dyskinesia, and response fluctuations were randomized to implantation of bilateral GPi or STN stimulators. Neurological condition was assessed preoperatively with patients on and off L-dopa and on DBS at 10 days and 3, 6, and 12 months after implantation. Patients and evaluating clinicians were blinded to stimulation site throughout the study period. Complete follow-up data were analyzed for four GPi patients and five STN patients.